caffeine (NoDoz, Vivarin)
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Introduction
Tradenames: NoDoz, Vivarin.
Indications
- drowsiness, fatigue
- treatment of apnea in infants
- obesity, weight loss ?[7][9]
- neuroprotection in women ?[6]
- may diminish risk of non melanoma skin cancer[9]
- may reduce risk of diabetes mellitus type 2[15][16]
- may reduce risk of stroke in women[17]
- may reduce risk of depression in women[14]
- nasal congestion, sinusitis[20]
- urinary incontinence[20]
- higher caffeine intake associated with reduced cardiovascular risk[25]
- 200-300 mg of caffeine/day may confer 40% reduced cardiometabolic risk[32]
- diminished risk of Parkinson's disease (PD)[26][29]
Dosage
- 100-200 mg PO every 3-4 hours PRN
- maximum: 400 mg/day[12]
- < 500 mg/day considered to be safe[18]
- lethal dose: >= 3 grams within a few hours[18]
Tabs: 100 & 200 mg.
Pharmacokinetics
- metabolized in liver to paraxanthine
- caffeine is a minor metabolite of theophylline
- metabolized by cyt P450 1A2[3]
- maternal metabolism reduced during early pregnancy, clearance is prolonged[8]
- fetal metabolism is low[8]
- high-dose 800 mg in 6 hours increases renal calcium clearance 77%[30]
elimination via liver
1/2life = 3.5 hours
protein binding = 35 %
Adverse effects
- hypertension in adults, adolescents[5]
- moderate use does not increase risk of miscarriage[10]
- high caffeine intake in combination with high stress may be associated with auditory hallucinations[13]
- no association between caffeine intake & cardiovascular events[23]
- no association with arrhythmia (500 mg over 5 hours) in patients with heart failure, even during exercise[24]
- caffeine (>=200 mg/day) during pregnancy associated with overweight offspring up to 5 years of age[27]
- genetic variant in CYP1A2 resulting in slow metabolism of caffeine increases risk of albuminuria, hyperfiltration, & hypertension in heavy coffee consumers (> 3 cups/day)[31]
- toxic effects of caffeine occur with intake > 1.2 grams/day
Drug interactions
- any drug which inhibits cyt P450 1A2 can increase caffeine levels
- any drug which induces cyt P450 1A2 can diminish caffeine levels
- drug interaction(s) of lithium carbonate with xanthine
- drug interaction(s) of MAO inhibitor with caffeine
- drug interaction(s) of methotrexate with caffeine
Laboratory
Mechanism of action
- blocks adenosine A-2A receptors
- relaxes smooth muscle of bronchial airways & pulmonary blood vessels
- in mice, inhibits PP-2A dephosphorylation of threonine 75 on DARPP-32
- may have neuroprotective properties in women[6]
- may have anti-tumor properties[7]
- enhances alertness[19]
- activates arousal[19]
- suppresses the urge to sleep[19]
- may enhance memory consolidation[21]
Notes
- energy drinks may contain significant amounts of caffeine[12]
- FDA recommends avoiding powdered pure caffeine being marketed directly to consumers[23]
More general terms
Additional terms
Component of
- caffeine/choline salicylate
- acetaminophen/caffeine/chlorpheniramine/guaifenesin/n methylephedrine
- caffeine/codeine/pheniramine/phenylephrine/salicylate
- caffeine/cobalamin/ibuprofen/pyridoxine/riboflavin/thiamine
- belladonna alkaloid/caffeine/ergotamine/phenobarbital
- belladonna alkaloid/caffeine/ergotamine/pentobarbital
- acetaminophen/caffeine/phenyltoloxamine
- acetaminophen/caffeine/magnesium salicylate/phenyltoloxamine
- acetaminophen/caffeine/isometheptene
- acetaminophen/caffeine/citrate/phenyltoloxamine/salicylamide
- acetaminophen/caffeine/chlorpheniramine/phenylephrine
- acetaminophen/caffeine/chlorpheniramine/hydrocodone/phenylephrine
- acetaminophen/caffeine/chlorpheniramine/guaifenesin
- acetaminophen/caffeine/chlorpheniramine
- acetaminophen/aspirin/caffeine/codeine/salicylamide
- benzoate/caffeine
- caffeine/magnesium salicylate
- aspirin/caffeine/dihydrocodeine
- acetaminophen/caffeine/phenyltoloxamine/salicylamide
- acetaminophen/caffeine/magnesium salicylate
- acetaminophen/caffeine/dihydrocodeine
- caffeine/salicylate
- caffeine/pheniramine/phenylephrine/salicylate
- sodium benzoate/caffeine
- aspirin/caffeine/citrate/orphenadrine
- aspirin/caffeine
- aspirin/butalbital/caffeine/codeine (Fiorinal with Codeine)
- aspirin/caffeine/salicylamide
- acetaminophen/caffeine/pyrilamine
- acetaminophen/caffeine/citrate
- acetaminophen/caffeine/citrate/salicylamide
- acetaminophen/caffeine
- acetaminophen/caffeine/guaifenesin/phenylephrine
- acetaminophen/caffeine/salicylate
- acetaminophen/aspirin/caffeine/salicylamide
- aspirin/caffeine/propoxyphene (Darvon Compound)
- aspirin/butalbital/caffeine (Fiorinal)
- acetaminophen/butalbital/caffeine/codeine (Fioricet with Codeine)
- acetaminophen/butalbital/caffeine (Fioricet, Esgic)
- aspirin/caffeine/orphenadrine (Norgesic)
- caffeine/ergotamine (Cafergot, Ercaf, Wigraine)
- caffeine/ergotamine/pentobarbital (Cafergot PB)
- coffee
- Camellia sinensis (green & black tea)
- guarana
- acetaminophen/aspirin/caffeine (Excedrin Extra, Excedrin migraine)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
- ↑ 3.0 3.1 Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220233&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Lindskog et al. Nature 418:774-8, 2002
- ↑ 5.0 5.1 Journal Watch 24(11):88, 2004 Savoca MR, Evans CD, Wilson ME, Harshfield GA, Ludwig DA. The association of caffeinated beverages with blood pressure in adolescents. Arch Pediatr Adolesc Med. 2004 May;158(5):473-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15123481
- ↑ 6.0 6.1 6.2 Ritchie K, Carriere I, de Mendonca A, Portet F, Dartigues JF, Rouaud O, Barberger-Gateau P, Ancelin ML. The neuroprotective effects of caffeine: a prospective population study (the Three City Study). Neurology. 2007 Aug 7;69(6):536-45. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17679672
- ↑ 7.0 7.1 7.2 Lu YP, Nolan B, Lou YR, Peng QY, Wagner GC, Conney AH. Voluntary exercise together with oral caffeine markedly stimulates UVB light-induced apoptosis and decreases tissue fat in SKH-1 mice. Proc Natl Acad Sci U S A. 2007 Jul 31;104(31):12936-41. Epub 2007 Jul 30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17664435
- ↑ 8.0 8.1 8.2 Prescriber's Letter 15(3): 2008 Caffeine and the Risk of Miscarriage Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240309&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 9.0 9.1 9.2 Heffernan TP et al. ATR-Chk1 pathway inhibition promotes apoptosis after UV treatment in primary human keratinocytes: Potential basis for the UV protective effects of caffeine. J Invest Dermatol 2009 Feb 26 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19242509 <Internet> http://dx.doi.org/10.1038/jid.2008.435
- ↑ 10.0 10.1 Committee Opinion No. 462: Moderate Caffeine Consumption During Pregnancy Obstetrics & Gynecology, 2010 116:467-468 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20664420 <Internet> http://journals.lww.com/greenjournal/Citation/2010/08000/Committee_Opinion_No__462__Moderate_Caffeine.42.aspx
- ↑ Mayo Clinic Staff Caffeine content for coffee, tea, soda and more Mayo clinic Health Information http://www.mayoclinic.com/health/caffeine/AN01211
- ↑ 12.0 12.1 12.2 Prescriber's Letter 18(1): 2011 Energy Drinks Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270107&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 13.0 13.1 Crowe SF et al The effect of caffeine and stress on auditory hallucinations in a non-clinical sample. Pers Individ Dif 2011 Apr; 50:626 Not indexed in PubMed http://www.sciencedirect.com/science/article/pii/S019188691000591X
Journal Watch Psychiatry July 11, 2011 Massachusetts Medical Society (Subscription required) http://psychiatry.jwatch.org/cgi/content/full/2011/711/1?q=pfw-featured - ↑ 14.0 14.1 Lucas M et al Coffee, Caffeine, and Risk of Depression Among Women Arch Intern Med. 2011;171(17):1571-1578. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21949167 <Internet> http://archinte.ama-assn.org/cgi/content/abstract/171/17/1571
Berkowitz SA Coffee Consumption and Depression Risk Arch Intern Med. 2011;171(17):1578 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21949168 <Internet> http://archinte.ama-assn.org/cgi/content/extract/171/17/1578 - ↑ 15.0 15.1 Salazar-Martinez E et al Ann Intern Med 140:1, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14706966
- ↑ 16.0 16.1 van Dam RM, Hu FB. Coffee consumption and risk of type 2 diabetes: a systematic review. JAMA. 2005 Jul 6;294(1):97-104. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15998896
- ↑ 17.0 17.1 Larsson SC et al. Coffee consumption and risk of stroke in women. Stroke 2011 Mar 10 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21393590 <Internet> http://stroke.ahajournals.org/cgi/content/abstract/STROKEAHA.110.603787v
- ↑ 18.0 18.1 18.2 Journal Watch: Massachusetts Medical Society http://www.jwatch.org Sepkowitz KA Energy Drinks and Caffeine-Related Adverse Effects JAMA. 2012, Dec 19 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23330171 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1487123
- ↑ 19.0 19.1 19.2 19.3 19.4 Journal Watch. April 10, 2013 Massachusetts Medical Society http://www.jwatch.org
Sharwood LN et al. Use of caffeinated substances and risk of crashes in long distance drivers of commercial vehicles: Case-control study. BMJ 2013 Mar 19; 346:f1140. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23511947 - ↑ 20.0 20.1 20.2 Deprecated Reference
- ↑ 21.0 21.1 Borota D et al Post-study caffeine administration enhances memory consolidation in humans. Nature Neuroscience. Jan 12, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24413697 <Internet> http://www.nature.com/neuro/journal/vaop/ncurrent/full/nn.3623.html
- ↑ FDA Safety Alert. July 20, 2014 FDA Consumer Advice on Powdered Pure Caffeine. http://www.fda.gov/Food/RecallsOutbreaksEmergencies/SafetyAlertsAdvisories/ucm405787.htm
- ↑ 23.0 23.1 23.2 Hand L Moderate Tea Drinking Tea May Slow CAC Progression, Cut CV Event Risk: MESA. Medscape. Sep 23, 2016 http://www.medscape.com/viewarticle/869038
- ↑ 24.0 24.1 Zuchinali P et al. Short-term effects of high-dose caffeine on cardiac arrhythmias in patients with heart failure: A randomized clinical trial. JAMA Intern Med 2016 Oct 17; [e-pub] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27749954 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2569283
- ↑ 25.0 25.1 Miller PE, Zhao D, Frazier-Wood AC et al. Associations of coffee, tea, and caffeine intake with coronary artery calcification and cardiovascular events. Am J Med 2017 Feb; 130:188 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27640739 <Internet> http://www.amjmed.com/article/S0002-9343(16)30925-1/abstract
- ↑ 26.0 26.1 26.2 Postuma RB, Anang J, Pelletier A et al. Caffeine as symptomatic treatment for Parkinson disease (Cafe-PD): A randomized trial. Neurology 2017 Sep 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28954882
- ↑ 27.0 27.1 Papadopoulou E, Botton J, Brantsaeter AL. Maternal caffeine intake during pregnancy and childhood growth and overweight: results from a large Norwegian prospective observational cohort study. BMJ Open, Volume 8, Issue 3. April 2018 http://bmjopen.bmj.com/content/8/3/e018895
- ↑ Rothaus C Coffee, Caffeine, and Health NEJM Resident 360. July 22, 2020 https://resident360.nejm.org/clinical-pearls/coffee-caffeine-and-health
- ↑ 29.0 29.1 George J Does Caffeine Protect Against Parkinson's? - Benefit seen even for people with Parkinson's genetic risk MedPage Today September 30, 2020 https://www.medpagetoday.com/neurology/parkinsonsdisease/88893
Crotty GF, Maciuca R, Macklin EA et al Association of caffeine and related analytes with resistance to Parkinson's disease among LRRK2 mutation carriers: A metabolomic study. Neurology 2020. Sept 30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32999056 https://n.neurology.org/content/early/2020/09/30/WNL.0000000000010863 - ↑ 30.0 30.1 Reuter SE, Schultz HB, Ward MB et al The effect of high-dose, short-term caffeine intake on the renal clearance of calcium, sodium and creatinine in healthy adults. Br J Clin Pharmacol 2021. April 14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33852164 https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.14856
- ↑ 31.0 31.1 Mahdavi S, Palatini P, El-Sohem A. CYP1A2 Genetic Variation, Coffee Intake, and Kidney Dysfunction JAMA Netw Open. 2023;6(1):e2247868 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36701157 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800839
- ↑ 32.0 32.1 Lu X, Zhu X, Li G, Wu L, Shao L, Fan Y, Pan CW, Wu Y, Borne Y, Ke C. Habitual Coffee, Tea, and Caffeine Consumption, Circulating Metabolites, and the Risk of Cardiometabolic Multimorbidity. J Clin Endocrinol Metab. 2024 Sep 17:dgae552. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39287934
- ↑ 33.0 33.1 Spriano P Ready for a Jolt? Caffeine Brings Benefits and Risks Medscape. Oct 11, 2024 https://www.medscape.com/viewarticle/ready-jolt-caffeine-brings-benefits-and-risks-2024a1000ilx
Database
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2519
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=64119
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=6241
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=21996
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=28309
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=22181