Wise Words – Caffeine And Your Meds

Submitted by Dr Becky Wise

Caffeine is a naturally occurring substance in over 60 plants but the most familiar is the Coffea plant or “bean”. It helps these plants by acting as a pesticide and herbicide against species with which it competes. It has been used by humans since the Stone Age as a way to enhance awareness and elevate mood. Legends vary but the most common stories of discovery are an Emperor of China and a goat-herder in Ethiopia. “Coffee Houses” were opened in Constantinople, Venice and London in the 1600’s and have remained vital businesses in cities across the world ever since.

Caffeine is probably the most acceptable “psychoactive drug” in the world, but it is not without risk. It is certainly the most common stimulant product in America – found in hundreds of products specifically marketed for this purpose. However, let’s not lose sight of the fact that it is a drug, just like any other substance we use to alter our bodies. It is commonly used to restore alertness, fight fatigue, or relieve headache and can also be used medically for weight loss or even breathing problems in premature babies.

It has fairly short-term, mild effects, but it also has side-effects, and can lead to risks if used long-term and/or in high doses. Normal recommendations for adults to fight fatigue include 100mg every 4 hours to 200mg every 3 hours. 400mg per day is considered safe, 500-600mg per day is considered heavy use, and 1000mg could cause death. It is habit-forming and causes withdrawal symptoms in a very short amount of time which can persist for a week or more. It stays in the body longer in people who smoke, are pregnant, or have cirrhosis, but it is generally metabolized in 6-10 hours. However, people can become tolerant from repeated administration, able consume larger and larger amounts of caffeine with less and less effect.

coffee-beans-WEB Following is further information you may need to know. As always, be sure to discuss use of caffeine with your physician or pharmacist if you are using any prescription medication, whether short-term or chronically.

Side effects of caffeine:

Chest pain/palpitations, flushing, agitation, dizziness, headache, insomnia, restlessness, rash or itching, gastritis, frequent urination, pinpoint pupils, increased intraocular pressure, muscle tremors, and changes in blood sugar.

Severe reactions (contact medical provider immediately): allergic reactions (swelling, hives, chest tightness, difficulty breathing), diarrhea, vomiting, chest pain, and rapidly increased blood pressure.

Symptoms of overdose (call Poison Control at 1-800-222-1222): agitation, confusion, muscle twitching, seizures, ringing in ears, stomach pain, frequent urination, and unrelenting anxiety.

Caffeine and disease state issues:

Avoid in patients with anxiety, panic disorder, agitation, tremor, cardiac arrhythmias, and children under 12 years old.
Use with caution in patients with hypertension or other cardiac disorders, GERD or ulcers, liver or kidney impairment, seizure disorder, diabetes, and pregnancy/breast feeding.
Worsens Symptoms in patients with ulcers, irritable bowel disease, depression, diabetes, and heart disease.
Improves Risk in some patients with specific Parkinsonian tremors, certain types of cancer, and some types of stroke.

Drug Interactions occur with the following medications:
Antibiotics like Cipro (ciprofloxacin) or Levaquin (levofloxacin)
Breathing Medications like Theo-Dur (theophylline)
Antidepressants like Cymbalta (duloxetine)
Muscle Relaxants like Zanaflex (tizanidine)
Parkinson’s drugs like Azilect (rasagiline)
Anti-seizure medications like Dilantin (phenytoin) or Lithium
Herbal products like Guarana or Ephedra
Doses of Caffeine in common products:

Traditional Caffeinated Beverages:

• Regular 8oz = 163mg
• Decaf 8oz = 6mg
• Espresso 8oz = 411mg
• Tea 8oz = 55mg
• Iced Tea (black) 16oz = 30mg
• Green Tea 8oz = 35-60mg (depends on blend)

Soda Pops:

• CocaCola 12oz = 34mg
• Pepsi Cola 12oz = 38mg
• Dr. Pepper 12oz = 41mg
• Diet Coke 12oz = 45mg
• Mountain Dew Soda 12oz = 54mg
• Sprite/7-Up/Ginger Ale/Orange/Grape/most RootBeer = 0mg

Energy Drinks:

• Monster 16oz = 160mg
• Rock Star 16oz = 160mg
• Red Bull 8.46oz = 80mg
• Arizona Caution 16oz = 200mg
• Full Throttle 16oz = 200mg
• Ocean Spray Cran-Energy 20oz = 5mg
• V8/V-Fusion + energy 8oz = 80mg

Energy Shots:

• 5 hour 2oz = 200mg
• Liquid Caffeine 1oz = 500mg
• Mio ½ tsp = 60mg
• Crystal Light Energy ½ packet = 50mg

Pills:
• Zantrex 3 = 300mg (2 caps)
• NoDoz/Vivarin = 200mg (1 cap)
• Excedrin Migraine = 130mg (2 tabs)
• Midol complete = 120mg (2 caps)
• Bayer Back and Body = 65mg (2 caps)
• Anacin = 64mg (2 tabs)

Candy:
• Hershey’s Special Dark 1.5oz bar = 20mg
• Hershey’s Milk Chocolate 1.6oz bar = 9mg
• 1 Hershey’s Kiss = 1mg
• Jolt Gum = 45mg/piece
• Chocolate Milk 12oz = 2mg
• Silk Chocolate Soymilk 8oz = 4mg
• Coffee Ice Cream 4oz = 1mg-52mg (depending on brand)

A final note: Caffeine does NOT cancel the effects of alcohol. You will NOT become sober after drinking coffee. In fact, as a diuretic, it will make a hangover worse. Additionally, according to the CDC, folks who consume alcohol and energy drinks together are 3 times more likely to suffer alcohol related harm (car accidents, sexual assault, etc.)

For further information:
http://www.cdc.gov/alcohol/fact-sheets/caffeine-and-alcohol.htmhttp://www.nlm.nih.gov/medlineplus/caffeine.html
http://www.fda.gov/downloads/UCM200805.pdf
http://healthfinder.gov/FindServices/SearchContext.aspx?topic=133

Be Well, Be Wise,
Dr.Becky

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Dr. Rebecca Wise

Wise Words…. is a general medical information column from Dr Rebecca Wise. Dr. Wise has a master’s degree in education as well as her doctorate in pharmacy. She is an assistant professor and ambulatory care specialist at a Medication Therapy Management (MTM) clinic in Erie, PA.

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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