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Definition

Caffeine is a drug that stimulates the central nervous system.

Purpose

Caffeine makes people more alert, less drowsy, and improves coordination. Combined with certain pain relievers or medicines for treating migraine headache, caffeine makes those drugs work more quickly and effectively. Caffeine alone can also help relieve headaches. Antihistamines are sometimes combined with caffeine to counteract the drowsiness that those drugs cause. Caffeine is also sometimes used to treat other conditions, including breathing problems in newborns and in young babies after surgery.

Description

Caffeine is found naturally in coffee, tea, and chocolate. Colas and some other soft drinks contain it. Caffeine also comes in tablet and capsule forms and can be bought without a prescription. Over-the-counter caffeine brands include No Doz, Overtime, Pep-Back, Quick-Pep, Caffedrine, and Vivarin. Some pain relievers, medicines for migraine headaches, and antihistamines also contain caffeine.

Recommended dosage

Adults and children age 12 years and over

100-200 mg no more than every 3-4 hours. In timed-release form, the dose is 200-250 mg once a day. Timed-release forms should not be taken less than six hours before bedtime.

Children under 12 years

Not recommended.

Other considerations

People should avoid taking much caffeine when it is being used as an over-the-counter drug and should consider how much caffeine is being taken in from coffee, tea, chocolate, soft drinks, and other foods that contain caffeine. A pharmacist or physician should be consulted to find out how much caffeine is safe to use.

Precautions

Caffeine cannot replace sleep and should not be used regularly to stay awake as the drug can lead to more serious sleep disorders, such as insomnia.

People who use large amounts of caffeine over long periods build up a tolerance to it. When this happens, they have to use more and more caffeine to get the same effects. Heavy caffeine use can also lead to dependence. If the person then stops using caffeine abruptly, withdrawal symptoms may occur. These can include throbbing headaches, fatigue, drowsiness, yawning, irritability, restlessness, vomiting, or runny nose. These symptoms can go on for as long as a week if caffeine is avoided. Then the symptoms usually disappear. As of 2004, caffeine withdrawal has been officially recognized as a disorder classification manual.

If taken too close to bedtime, caffeine can interfere with sleep. Even if it does not prevent a person from falling asleep, it may disturb sleep during the night.

The notion that caffeine helps people sober up after drinking too much alcohol is a myth. In fact, using caffeine and alcohol together is not a good idea. The combination can lead to an upset stomach, nausea, and vomiting.

Older people may be more sensitive to caffeine and thus more likely to have certain side effects, such as irritability, nervousness, anxiety, and sleep problems.

Special conditions

Caffeine may cause problems for people with certain medical conditions or who are taking certain medicines.

ALLERGIES

Anyone with allergies to foods, dyes, preservatives, or to the compounds aminophylline, dyphylline, oxtriphylline, theobromine, or theophylline should check with a physician before using caffeine. Anyone who has ever had an unusual reaction to caffeine should also check with a physician before using it again.

PREGNANCY

Caffeine can pass from a pregnant woman's body into the developing fetus. Although there is no evidence that caffeine causes birth defects in people, it does cause such effects in laboratory animals given very large doses (equal to human doses of 12-24 cups of coffee a day). In humans, evidence exists that doses of more than 300 mg of caffeine a day (about the amount of caffeine in 2-3 cups of coffee) may cause miscarriage or problems with the baby's heart rhythm. Women who take more than 300 mg of caffeine a day during pregnancy are also more likely to have babies with low birth weights. Any woman who is pregnant or planning to become pregnant should check with her physician before using caffeine.

BREASTFEEDING

Caffeine passes into breast milk and can affect the nursing baby. Nursing babies whose mothers use 600 mg or more of caffeine a day may be irritable and have trouble sleeping. Women who are breastfeeding should check with their physicians before using caffeine.

OTHER MEDICAL CONDITIONS

Caffeine may cause problems for people with these medical conditions:

• peptic ulcer
• heart arrhythmias or palpitations
• heart disease or recent heart attack (within a few weeks)
• high blood pressure
• liver disease
• insomnia (trouble sleeping)
• anxiety or panic attacks
• agoraphobia (fear of being in open places)
• premenstrual syndrome (PMS)

USE OF CERTAIN MEDICINES

Using caffeine with certain other drugs may interfere with the effects of the drugs or cause unwanted-and possibly serious-side effects.

Side effects

At recommended doses, caffeine can cause restlessness, irritability, nervousness, shakiness, headache, lightheadedness, sleeplessness, nausea, vomiting, and upset stomach. At higher than recommended doses, caffeine can cause excitement, agitation, anxiety, confusion, a sensation of light flashing before the eyes, unusual sensitivity to touch, unusual sensitivity of other senses, ringing in the ears, frequent urination, muscle twitches or tremors, heart arrhythmias, rapid heartbeat, flushing, and convulsions. High caffeine consumption can lead to benign breast disease, which also can increase risk of breast cancer.

Interactions

Certain drugs interfere with the breakdown of caffeine in the body. These include oral contraceptives that contain estrogen, the antiarrhythmia drug mexiletine (Mexitil), the ulcer drug cimetidine (Tagamet), and the drug disulfiram (Antabuse), used to treat alcoholism.

Caffeine interferes with drugs that regulate heart rhythm, such as quinidine and propranolol (Inderal). Caffeine may also interfere with the body's absorption of iron. Anyone who takes iron supplements should take them at least an hour before or two hours after using caffeine.

Serious side effects are possible when caffeine is combined with certain drugs. For example, taking caffeine with the decongestant phenylpropanolamine can raise blood pressure. And serious heart problems may occur if caffeine and monoamine oxidase inhibitors (MAO) are taken together. These drugs are used to treat Parkinson's disease, depression, and other psychiatric conditions. A pharmacist or physician should be consulted about which drugs can interact with caffeine.

Because caffeine stimulates the nervous system, anyone taking other central nervous system (CNS) stimulants should be careful about using caffeine. Those trying to withdraw from caffeine are advised to do reduce their consumption slowly over time by substituting decaffeinated or non-caffeinated products for some of the caffeinated products.

Key Terms

Arrhythmia

Abnormal heart rhythm.

Central nervous system

The brain and spinal cord.

Fetus

A developing baby inside the womb.

Palpitation

Rapid, forceful, throbbing, or fluttering heartbeat.

Withdrawal symptoms

A group of physical or mental symptoms that may occur when a person suddenly stops using a drug to which he or she has become dependent.

For Your Information

Resources

Periodicals

• "Caffeine Withdrawal Recognized as Disorder." Ascribe Health News Service September 29, 2004.
• "High Caffeine Intake May Increase Risk of Benign Breast Disease." Women's Health Weekly September 16, 2004: 32.

This article was updated on 08-14-2006