Caffeine and medications

CA031 Carillo, J. A. and J. Benitez. Clinically significant pharmacokinetic interactions between dietary caffeine and medications. Clin Pharmacokinetics 2000 39(2) 127-153. 

There are no available medications that can fully reverse the effects of alcohol intoxication. Caffeine and other stimulants can induce arousal and alertness, but they are less effective at... 

Obtain a thorough medication use history, including present and past drugs prescription and nonprescription drugs the patient s self-assessment of response and side-effect problems use of alcohol, tobacco, caffeine, and illicit substances and use of herbal products and dietary supplements, as well as any allergies and adherence difficulties. 

This chapter will cover the production of coffee, tea, and cocoa, which comprise the primary crops that account for the majority of worldwide caffeine consumption. Caffeine-containing crops and products comprise a large share of the international market and are primary commodities for many national economies.3 4 Trade of such products is also important in the understanding of availability, market demand, and overall exposure to caffeine from various sources. Information is presented to a lesser degree for soft drinks, many of which do contain caffeine and are consumed primarily in the industrialized nations. Another source of caffeine exposure which contributes less than any beverages and foods under consideration are prescription and non-prescription medications, which are described in lesser detail. 

Caffeine consumption is primarily due to coffee, tea and soft drinks. In the U.S., it is estimated that coffee contributes to 75% of the total caffeine intake, tea is 15%, and soda with caffeine accounts for 10% 5 chocolate and other caffeine-containing foods and medications contribute relatively little to overall caffeine exposure. Caffeine also varies by sources tea leaves contain 1.5 to 3.5% caffeine kola nuts contain 2% caffeine and roasted coffee beans contain 0.75 to 1.5% caffeine.6 Coffee varies in caffeine content some analyses have estimated that caffeine may range from 0.8 to 1.8%, depending on the type of coffee.7 Crops of coffee, tea, and cocoa are very similar in their production periods and their useful life in production. Typically coffee, tea, and cocoa trees can be productive with crops every 5 years for a total period of 40 years,8 or an estimated 8 yields per tree. 

Once chronic insomnia has developed, it hardly ever spontaneously resolves without treatment or intervention. The toll of chronic insomnia can be very high and the frustration it produces may precipitate a clinical depression or an anxiety disorder. Insomnia is also associated with decreased productivity in the workplace and more frequent use of medical services. Einally, substance abuse problems may result from the inappropriate use of alcohol or sedatives to induce sleep or caffeine and other stimulants to maintain alertness during the day. 

Complete inventory of all medications, alcohol, caffeine, and other substances... 

Substance-Induced Insomnia. A variety of substances can cause or worsen sleep problems (see Table 9.2). Patients often miss the connection between the ingestion of a medication or caffeine and the onset of their insomnia, and they rarely spontaneously volunteer this information. 

In previous chapters, we examined drugs specifically intended to keep you awake (such as caffeine) and drugs that are specifically intended to help you sleep (such as benzodiazepines). There are, however, many medications that are taken for the purpose of treating other medical conditions—allergies, high blood pressure, epilepsy, obesity, chronic pain, and psychiatric disorders such as schizophrenia and depression—that also can affect your sleep. In addition, addictive drugs such as alcohol, nicotine, and cocaine have strong effects on sleep. 

Legally, caffeine is not regulated as a dangerously addictive substance. Yet, withdrawal from caffeine is documented as a recognized set of symptoms in the medical literature. Many people who regularly consume caffeine and then suddenly stop will experience... 

Caffeine has been associated with changes in the metabolism of clozapine (SEDA-20, 50 SEDA-22, 61). Seven schizophrenic patients taking clozapine monotherapy participated in a study of the effects of caffeine withdrawal from the diet (247). After a caffeine-free diet for 5 days, clozapine plasma concentrations fell by 50%. The authors suggested that schizophrenic patients treated with clozapine should have their caffeine intake medically supervised, and that monitoring of concentrations of clozapine and its metabolite may be warranted. 

Concern about the possible harmful effects of caffeine on the outcome of pregnancy has evolved mainly from studies of animals which have shown a reduction in intrauterine fetal growth. However, the implications of these data for men are unclear, because of the differences in mode of exposure to caffeine, the amounts consumed, and caffeine metabolism. The possible effects of caffeine intake on the human fetus have been reviewed (SEDA-7, 8) the conclusion was that the scientific data currently available could not answer the question. In an analysis of interview and medical record data in 12 205 non-asthmatic women to evaluate the relation between coffee consumption and adverse outcomes in pregnancy, the findings were negative. 

Caffeine is an extremely important drug because of its widespread use. Overall it also seems to be a relatively safe drug. Despite the many years of research that have been devoted to caffeine, however, we still have a lot to learn about it. Probably the most essential research concerns tfcveloping better ways to obtain accurate measures of caffeine consumption. Such advances would help us answer important research questions. F or example, we need to know more about the long-term effects of caffeine use in children, the development of tolerance to caffeine, and the prevalence of more minor symptoms of higher, but not extreme, levels of caffeine use. Another question is how caffeine affects people in special populations, such as those who arc medically or psychiatrically ill. 

F Caffeine and the other methyixanthine drugs are in medications used to treat a variety of medical problems. 

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