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Kumar VHS, Lipshultz SE. Caffeine and Clinical Outcomes in Premature Neonates. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E118. [PMID: 31653108 PMCID: PMC6915633 DOI: 10.3390/children6110118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/29/2019] [Accepted: 10/06/2019] [Indexed: 12/22/2022]
Abstract
Caffeine is the most widely used drug by both adults and children worldwide due to its ability to promote alertness and elevate moods. It is effective in the management of apnea of prematurity in premature infants. Caffeine for apnea of prematurity reduces the incidence of bronchopulmonary dysplasia in very-low-birth-weight infants and improves survival without neurodevelopmental disability at 18-21 months. Follow-up studies of the infants in the Caffeine for Apnea of Prematurity trial highlight the long-term safety of caffeine in these infants, especially relating to motor, behavioral, and intelligence skills. However, in animal models, exposure to caffeine during pregnancy and lactation adversely affects neuronal development and adult behavior of their offspring. Prenatal caffeine predisposes to intrauterine growth restriction and small growth for gestational age at birth. However, in-utero exposure to caffeine is also associated with excess growth, obesity, and cardio-metabolic changes in children. Caffeine therapy is a significant advance in newborn care, conferring immediate benefits in preterm neonates. Studies should help define the appropriate therapeutic window for caffeine treatment along with with the mechanisms relating to its beneficial effects on the brain and the lung. The long-term consequences of caffeine in adults born preterm are being studied and may depend on the ability of caffeine to modulate both the expression and the maturation of adenosine receptors in infants treated with caffeine.
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Affiliation(s)
- Vasantha H S Kumar
- Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA.
| | - Steven E Lipshultz
- Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA.
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Effects of Coffee Components on Muscle Glycogen Recovery: A Systematic Review. Int J Sport Nutr Exerc Metab 2018; 28:284-293. [PMID: 29345166 DOI: 10.1123/ijsnem.2017-0342] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coffee is one of the most consumed beverages in the world, and it can improve insulin sensitivity, stimulating glucose uptake in skeletal muscle when adequate carbohydrate intake is observed. The aim of this review is to analyze the effects of coffee and coffee components on muscle glycogen metabolism. A literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and seven studies were included, that explored the effects of coffee components on various substances and signaling proteins. In one of the studies with humans, caffeine was shown to increase glucose levels, Ca2+/calmodulin-dependent protein kinase phosphorylation, glycogen resynthesis rates, and glycogen accumulation after exercise. After intravenous injection of caffeine in rats, caffeine increased adenosine monophosphate-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC) phosphorylation, and glucose transport. In in vitro studies, caffeine raised AMPK and ACC phosphorylation, increasing glucose transport activity and reducing energy status in rat muscle cells. Cafestol and caffeic acid increased insulin secretion in rat beta cells and glucose uptake into human muscle cells. Caffeic acid also increased AMPK and ACC phosphorylation, reducing the energy status and increasing glucose uptake in rat muscle cells. Chlorogenic acid did not show any positive or negative effect. The findings from this review must be taken with caution due to the limited number of studies on the subject. In conclusion, various coffee components had a neutral or positive role in the metabolism of glucose and muscle glycogen, whereas no detrimental effect was described. Coffee beverages should be tested as an option for athletes' glycogen recovery.
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Khondker A, Dhaliwal A, Alsop RJ, Tang J, Backholm M, Shi AC, Rheinstädter MC. Partitioning of caffeine in lipid bilayers reduces membrane fluidity and increases membrane thickness. Phys Chem Chem Phys 2017; 19:7101-7111. [DOI: 10.1039/c6cp08104e] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Caffeine partitions in lipid membranes in the head to tail interface and leads to a thickening and defluidification.
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Affiliation(s)
- Adree Khondker
- Department of Physics and Astronomy
- McMaster University
- Hamilton
- Canada
| | | | - Richard J. Alsop
- Department of Physics and Astronomy
- McMaster University
- Hamilton
- Canada
| | - Jennifer Tang
- Department of Physics and Astronomy
- McMaster University
- Hamilton
- Canada
| | - Matilda Backholm
- Department of Physics and Astronomy
- McMaster University
- Hamilton
- Canada
- Department of Applied Physics
| | - An-Chang Shi
- Department of Physics and Astronomy
- McMaster University
- Hamilton
- Canada
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Oritani S, Michiue T, Chen JH, Tani N, Ishikawa T. Biodistribution of diphenhydramine in reproductive organs in an overdose case. Hum Cell 2016; 30:106-116. [PMID: 27838883 DOI: 10.1007/s13577-016-0151-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
Motion sickness medications such as Travelmin® prescribed in Japan include diphenhydramine (DPH), dyphylline, diphenidol, and/or caffeine. Herein, we report a patient who died due to rhabdomyolysis after ingesting a DPH containing motion sickness medication. A Japanese male in his 30 s reported missing after going out for a drive early in the morning was found dead in his car in the evening of the same day. An autopsy showed moderate edema, congestion, and several petechiae in both lungs. The brain was congested and edematous with no atherosclerosis of cerebral arteries. The prostate and both testes were slightly edematous. Gastric contents included approximately 15 mL of dark-brown fluid without tablets or food residue. Toxicological examination showed that blood DPH levels in all tissues were between 4.90 and 7.27 μg/mL, which represented toxic to lethal levels. DPH (μg/mL) levels were approximately 3-9 times higher in the prostate (73.42) and testes (left, 28.23; right, 30.09) than those in all regions of the brain (range 7.75-12.33). Blood dyphylline, diphenidol and caffeine levels in reproductive organs reached high, but not toxic levels. In conclusion, DPH, dyphylline, diphenidol, and caffeine levels were higher in reproductive organs such as the prostate and testes than in the central nervous system and heart. As we determined in this case, motion sickness medications might accumulate in reproductive organs. Thus, further examination of tissue biodistribution of DPH, dyphylline, diphenidol, and caffeine is necessary to assess their potential long-term effects in these sites.
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Affiliation(s)
- Shigeki Oritani
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan
| | - Tomomi Michiue
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan.,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan
| | - Jian-Hua Chen
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan.,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan
| | - Naoto Tani
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan.,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan. .,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan.
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Intralipid in acute caffeine intoxication: a case report. J Anesth 2016; 30:895-9. [PMID: 27272169 DOI: 10.1007/s00540-016-2198-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/30/2016] [Indexed: 12/14/2022]
Abstract
Caffeine is arguably the most widely used stimulant drug in the world. Here we describe a suicide attempt involving caffeine overdose whereby the patient's severe intoxication was successfully treated with the prompt infusion of Intralipid. A 19-year-old man was found in an agitated state at home by the volunteer emergency team about 1 h after the intentional ingestion of 40 g of caffeine (tablets). His consciousness decreased rapidly, followed quickly by seizures, and electrocardiographic monitoring showed ventricular fibrillation. Advanced life support maneuvers were started immediately, with the patient defibrillated 10 times and administered 5 mg epinephrine in total and 300 + 150 mg of amiodarone (as well as lidocaine and magnesium sulfate). The cardiac rhythm eventually evolved to asystole, necessitating the intravenous injection of epinephrine to achieve the return of spontaneous circulation. However, critical hemodynamic instability persisted, with the patient's cardiac rhythm alternating between refractory irregular narrow complex tachycardia and wide complex tachycardia associated with hypotension. In an attempt to restore stability we administered three successive doses of Intralipid (120 + 250 + 100 mg), which successfully prevented a severe cardiovascular collapse due to a supra-lethal plasma caffeine level (>120 mg/L after lipid emulsion). The patient survived without any neurologic complications and was transferred to a psychiatric ward a few days later. The case emphasizes the efficacy of intravenous lipid emulsion in the resuscitation of patients from non-local anesthetic systemic toxicity. Intralipid appears to act initially as a vehicle that carries the stimulant drug away from heart and brain to less well-perfused organs (scavenging mechanism) and then, with a sufficient drop in the caffeine concentration, possibly as a tonic to the depressed heart.
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Ishikawa T, Yuasa I, Endoh M. Non specific drug distribution in an autopsy case report of fatal caffeine intoxication. Leg Med (Tokyo) 2015; 17:535-8. [PMID: 26594005 DOI: 10.1016/j.legalmed.2015.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 12/11/2022]
Abstract
Caffeine has long been recognized as an addictive substance that causes autonomic nerve effect, and is known to increase catecholamine secretion from the adrenal glands. In recent years, the risk of ingesting toxic levels of caffeine has increased because of the easy availability of analgesics, CNS (Central Nervous System) stimulant medicine and dietary supplements at shops, health stores and through online purchases. We report the death of a young female resulting from the ingestion for suicide of an online purchased sleepiness-preventing medicine containing caffeine. The autopsy findings included pulmonary edema and congestion plus cutaneous emphysema. The stomach contents included a dark-brown viscous fluid without tablet or food residue. Toxicological examination revealed the presence of caffeine in the right heart blood (154.2 μg/mL) and stomach contents (197.5 μg/mL) (lethal blood level, >80 μg/mL). The highest caffeine content was in the bile (852.3 μg/mL). Biochemical findings showed that catecholamine concentration in the peripheral blood in the iliac vein was elevated. Immunostaining of catecholamine was weak in the adrenal medulla. We recommend highlighting the toxicity risk of ingesting substances with a high caffeine concentration, and we propose that caffeine concentrations should be included in the comprehensive routine forensic toxicological tests for all cases.
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Affiliation(s)
- Takaki Ishikawa
- Division of Legal Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori 683-8503, Japan; Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
| | - Isao Yuasa
- Division of Legal Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori 683-8503, Japan
| | - Minoru Endoh
- Division of Legal Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori 683-8503, Japan
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Pimparade MB, Morott JT, Park JB, Kulkarni VI, Majumdar S, Murthy SN, Lian Z, Pinto E, Bi V, Durig T, Murthy R, Shivakumar HN, Vanaja K, Kumar PC, Repka MA. Development of taste masked caffeine citrate formulations utilizing hot melt extrusion technology and in vitro-in vivo evaluations. Int J Pharm 2015; 487:167-76. [PMID: 25888797 DOI: 10.1016/j.ijpharm.2015.04.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/08/2015] [Accepted: 04/12/2015] [Indexed: 11/18/2022]
Abstract
The objective of this study was to develop caffeine citrate orally disintegrating tablet (ODT) formulations utilizing hot-melt extrusion technology and evaluate the ability of the formulation composition to mask the unpleasant bitter taste of the drug using in vitro and in vivo methods. Ethylcellulose, along with a suitable plasticizer, was used as a polymeric carrier. Pore forming agents were incorporated into the extruded matrix to enhance drug release. A modified screw configuration was applied to improve the extrusion processability and to preserve the crystallinity of the API. The milled extrudates were subjected to dissolution testing in an artificial salivary fluid and investigations using e-tongue, to assess the extent of masking of bitter taste of the API. There was an insignificant amount of drug released from the formulation in the salivary medium while over 80% of drug released within 30 min in 0.1N HCl. ODTs were also developed with the extrudate mixed with mannitol and crospovidone. The quality properties such as friability and disintegration time of the ODTs met the USP specifications. The lead extrudate formulations and the ODTs prepared using this formulation were subjected to human gustatory evaluation. The formulations were found to mask the unpleasant taste of caffeine citrate significantly.
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Affiliation(s)
- Manjeet B Pimparade
- Department of Pharmaceutics & Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Joseph T Morott
- Department of Pharmaceutics & Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Jun-Bom Park
- College of Pharmacy, Sahm Yook University, Seoul 139-742, South Korea
| | - Vijay I Kulkarni
- Department of Pharmaceutics & Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Soumyajit Majumdar
- Department of Pharmaceutics & Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, USA; Pii Center for Pharmaceutical Technology, The University of Mississippi, University, MS, USA
| | - S N Murthy
- Department of Pharmaceutics & Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Zhuoyang Lian
- Ashland Specialty Ingredients, Global Pharma R&D, Wilmington, USA
| | - Elanor Pinto
- Ashland Specialty Ingredients, Global Pharma R&D, Wilmington, USA
| | - Vivian Bi
- Ashland Specialty Ingredients, Global Pharma R&D, Wilmington, USA
| | - Thomas Durig
- Ashland Specialty Ingredients, Global Pharma R&D, Wilmington, USA
| | - Reena Murthy
- Institute for Drug Delivery and Biomedical Research, Bangalore, India
| | - H N Shivakumar
- Institute for Drug Delivery and Biomedical Research, Bangalore, India
| | - K Vanaja
- Visveswarapuram Institute of Pharmaceutical Sciences, Bangalore, India
| | - P C Kumar
- Visveswarapuram Institute of Pharmaceutical Sciences, Bangalore, India
| | - Michael A Repka
- Department of Pharmaceutics & Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, USA; Pii Center for Pharmaceutical Technology, The University of Mississippi, University, MS, USA.
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Belal F, Walash M, El-Enany N, Zayed S. Highly sensitive HPLC method for assay of aliskiren in human plasma through derivatization with 1-naphthyl isocyanate using UV detection. J Chromatogr B Analyt Technol Biomed Life Sci 2013; 933:24-9. [DOI: 10.1016/j.jchromb.2013.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/26/2013] [Accepted: 06/07/2013] [Indexed: 11/25/2022]
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Mets MAJ, Baas D, van Boven I, Olivier B, Verster JC. Effects of coffee on driving performance during prolonged simulated highway driving. Psychopharmacology (Berl) 2012; 222:337-42. [PMID: 22315048 PMCID: PMC3382640 DOI: 10.1007/s00213-012-2647-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 01/18/2012] [Indexed: 11/26/2022]
Abstract
RATIONALE Coffee is often consumed to counteract driver sleepiness. There is limited information on the effects of a single low dose of coffee on prolonged highway driving in non-sleep deprived individuals. OBJECTIVES The aim of this study was to examine the effects of a single cup of coffee (80 mg caffeine) on simulated highway driving performance. METHODS Non-sleep deprived healthy volunteers (n024) participated in a double-blind, placebo-controlled, crossover study. After 2 h of monotonous highway driving, subjects received caffeinated or decaffeinated coffee during a 15-min break before continuing driving for another 2 h. The primary outcome measure was the standard deviation of lateral position (SDLP), reflecting the weaving of the car. Secondary outcome measures were speed variability, subjective sleepiness, and subjective driving performance. RESULTS The results showed that caffeinated coffee significantly reduced SDLP as compared to decaffeinated coffee, both in the first (p00.024) and second hour (p00.019) after the break. Similarly, the standard deviation of speed (p0 0.024; p00.001), mental effort (p00.003; p00.023), and subjective sleepiness (p00.001; p00.002) were reduced in both the first and second hour after consuming caffeinated coffee. Subjective driving quality was significantly improved in the first hour after consuming caffeinated coffee (p00.004). CONCLUSIONS These findings demonstrate a positive effect of one cup of caffeinated coffee on driving performance and subjective sleepiness during monotonous simulated highway driving.
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Affiliation(s)
- M A J Mets
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands.
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Porta M, Zima AV, Nani A, Diaz-Sylvester PL, Copello JA, Ramos-Franco J, Blatter LA, Fill M. Single ryanodine receptor channel basis of caffeine's action on Ca2+ sparks. Biophys J 2011; 100:931-8. [PMID: 21320437 DOI: 10.1016/j.bpj.2011.01.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 01/03/2011] [Accepted: 01/10/2011] [Indexed: 10/18/2022] Open
Abstract
Caffeine (1, 3, 7-trimethylxanthine) is a widely used pharmacological agonist of the cardiac ryanodine receptor (RyR2) Ca(2+) release channel. It is also a well-known stimulant that can produce adverse side effects, including arrhythmias. Here, the action of caffeine on single RyR2 channels in bilayers and Ca(2+) sparks in permeabilized ventricular cardiomyocytes is defined. Single RyR2 caffeine activation depended on the free Ca(2+) level on both sides of the channel. Cytosolic Ca(2+) enhanced RyR2 caffeine affinity, whereas luminal Ca(2+) essentially scaled maximal caffeine activation. Caffeine activated single RyR2 channels in diastolic quasi-cell-like solutions (cytosolic MgATP, pCa 7) with an EC(50) of 9.0 ± 0.4 mM. Low-dose caffeine (0.15 mM) increased Ca(2+) spark frequency ∼75% and single RyR2 opening frequency ∼150%. This implies that not all spontaneous RyR2 openings during diastole are associated with Ca(2+) sparks. Assuming that only the longest openings evoke sparks, our data suggest that a spark may result only when a spontaneous single RyR2 opening lasts >6 ms.
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Affiliation(s)
- Maura Porta
- Department of Physiology, Midwestern University, Downers Grove, Illinois, USA
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Perera V, Gross AS, McLachlan AJ. Caffeine and paraxanthine HPLC assay for CYP1A2 phenotype assessment using saliva and plasma. Biomed Chromatogr 2011; 24:1136-44. [PMID: 20853468 DOI: 10.1002/bmc.1419] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Caffeine has been extensively used as a probe to measure CYP1A2 activity in humans with caffeine clearance or the paraxanthine (major metabolite of caffeine) to caffeine concentration ratio being regarded as the preferred metric. A simple reverse-phased C(18) HPLC assay using ethyl acetate liquid-liquid extraction was developed to quantitate caffeine and paraxanthine concentrations in saliva and plasma. The mobile phase consisted of acetonitrile-acetic acid-H(2)O (100:1:899) and analytes were quantitated with UV detection at 280 nm. The extraction recovery for paraxanthine and caffeine was approximately 70% in both saliva and plasma. The assay was linear over the concentration ranges 0.05-2.50 and 0.05-5.00 µg/mL, for paraxanthine and caffeine, respectively, in saliva. In plasma the assay was linear over the ranges 0.025-2.50 and 0.025-5.00 µg/mL for paraxanthine and caffeine, respectively. Intra- and inter-assay precision and accuracy were less than 15%. Detection limits were 0.015 µg/mL for paraxanthine and caffeine in saliva, while it was 0.005 µg/mL for paraxanthine and caffeine in plasma. Utility was established in samples collected from two healthy volunteers who abstained from caffeine for 24 h and received a single 100 mg oral dose of caffeine. The assay developed is a robust, simple and precise technique to measure caffeine and paraxanthine in saliva and plasma of healthy volunteers after a single oral dose of caffeine.
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Affiliation(s)
- Vidya Perera
- Faculty of Pharmacy, The University of Sydney, NSW 2006, Australia
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Mulder EJH, Tegaldo L, Bruschettini P, Visser GHA. Foetal response to maternal coffee intake: role of habitual versus non-habitual caffeine consumption. J Psychopharmacol 2010; 24:1641-8. [PMID: 19506007 DOI: 10.1177/0269881109106310] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little is known about the effect on the human foetus of long-term and acute exposure to caffeine. We studied the organisation of foetal sleep-wake states in 13 healthy near-term foetuses over a wide range of maternal plasma caffeine concentrations (0-13 μg/mL) reflecting normal lifestyle conditions (day 0) and again following intake of two cups of regular coffee (~300 mg of caffeine) intermitted by 50 h of abstinence (day 2; acute effects). On either day, 2 h simultaneous recordings were made of foetal heart rate, general-, eye-, and breathing-movements. The recordings were analysed for the presence of each of four foetal behavioural states: quiet- and active-sleep, quiet- and active-wakefulness. There was a linear relationship between maternal caffeine content and the incidence of foetal general movements during active sleep on day 0 (R = 0.74; P < 0.02). After coffee loading on day 2, foetuses of non- or low-caffeine consumers showed increases in active wakefulness (P < 0.001), general movements (P < 0.05) and heart rate variation (P < 0.01) but lower basal heart rate (P < 0.01) compared with their day 0 values. The changes in foetal heart rate (variation) and behaviour occurred between 90 and 180 min post-consumption. In contrast, foetuses of habitual caffeine consumers remained unaffected suggestive of foetal tolerance to caffeine. The results indicate differential performance between foetuses regularly exposed to caffeine and those caffeine-naive, both under normal maternal lifestyle conditions and in response to maternal coffee ingestion.
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Affiliation(s)
- E J H Mulder
- Department of Perinatology and Gynecology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands.
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Shiran MR, Lennard MS, Iqbal MZ, Lagundoye O, Seivewright N, Tucker GT, Rostami-Hodjegan A. Contribution of the activities of CYP3A, CYP2D6, CYP1A2 and other potential covariates to the disposition of methadone in patients undergoing methadone maintenance treatment. Br J Clin Pharmacol 2009; 67:29-37. [PMID: 19133059 DOI: 10.1111/j.1365-2125.2008.03312.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS To investigate the influence of different cytochrome P450 (CYP) activities and other potential covariates on the disposition of methadone in patients on methadone maintenance therapy (MMT). METHODS Eighty-eight patients (58 male; 21-55 years; 84 White) on MMT were studied. CYP2D6 activity [3 h plasma metabolic ratio of dextromethorphan (DEX) to dextrorphan (DOR)] was determined in 44 patients (29 male; 24-55 years), CYP1A2 activity (salivary caffeine elimination half-life) in 44 patients (21 male; 24-55 years) and CYP3A activity (oral clearance of midazolam) in 49 patients (33 male; 23-55 years). Data on all three CYPs were obtained from 32 subjects. Total plasma concentrations of (RS)-methadone and total and unbound plasma concentrations of both enantiomers were measured by LC/MS. Population pharmacokinetics and subsequent multiple regression analysis were used to calculate methadone oral clearance and to identify its covariates. RESULTS Between 61 and 68% of the overall variation in total plasma trough concentrations of (RS)-, (R)- and (S)-methadone was explained by methadone dose, duration of addiction before starting MMT, CYP3A activity and illicit morphine use. CYP3A activity explained 22, 16, 15 and 23% of the variation in unbound (R)-, unbound (S)-, total (RS)- and total (S)-methadone clearances, respectively. Neither CYP2D6 nor CYP1A2 activity was related to methadone disposition. CONCLUSIONS CYP3A activity has a modest influence on methadone disposition. Inhibitors and inducers of this enzyme should be monitored in patients taking methadone.
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Affiliation(s)
- Mohammad-Reza Shiran
- Academic Unit of Clinical Pharmacology, University of Sheffield and Sheffield Care Trust, Substance Misuse Services, Sheffield, UK
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Wongl SHY, Marzoukl N, McHugh SL, Cazesl E. Simultaneous Determination of Theophylline and Caffeine by Reversed Phase Liquid Chromatography Using Phenyl Column. ACTA ACUST UNITED AC 2006. [DOI: 10.1080/01483918508074096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Caffeine is a mild central nervous stimulant that occurs naturally in coffee beans, cocoa beans and tea leaves. In large doses, it can be profoundly toxic, resulting in arrhythmia, tachycardia, vomiting, convulsions, coma and death. The average cup of coffee or tea in the United States is reported to contain between 40 and 150 mg caffeine although specialty coffees may contain much higher doses. Over-the-counter supplements that are used to combat fatigue typically contain 100-200 mg caffeine per tablet and doses of 32-200mg are included in a variety of prescription drug mixtures. Fatal caffeine overdoses in adults are relatively rare and require the ingestion of a large quantity of the drug, typically in excess of 5 g. Over a period of approximately 12 months our office reported two cases of fatal caffeine intoxication. In the first case, the femoral blood of a 39-year-old female with a history of intravenous drug use contained 192 mg/L caffeine. In the second case, femoral blood from a 29-year-old male with a history of obesity and diabetes contained 567 mg/L caffeine. In both cases, the cause of death was ruled as caffeine intoxication and the manner of death was accidental.
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Affiliation(s)
- Sarah Kerrigan
- New Mexico Department of Health, Scientific Laboratory Division, Toxicology Bureau, P.O. Box 4700, Albuquerque, NM 87196-4700, USA.
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Bulaj ZJ, Franklin MR, Phillips JD, Miller KL, Bergonia HA, Ajioka RS, Griffen LM, Guinee DJ, Edwards CQ, Kushner JP. Transdermal estrogen replacement therapy in postmenopausal women previously treated for porphyria cutanea tarda. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2000; 136:482-8. [PMID: 11128750 DOI: 10.1067/mlc.2000.111024] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral contraceptives and postmenopausal estrogen replacement therapy are recognized as risk factors for the development of porphyria cutanea tarda (PCT) in women. The recommended clinical practice is to withhold estrogen therapy in women who have had phlebotomy therapy for PCT and are clinically and biochemically normal. We tested the safety and efficacy of transdermal estrogen replacement therapy in 7 women previously treated for PCT and compared them with 19 non-porphyric control subjects treated with transdermal or oral estrogens. Gonadotrophic hormone levels, estrogen levels, liver function studies, body iron stores, urine porphyrin excretion, and cytochrome P4501A2 (CYP1A2) activity were monitored for 1 year. Four of the women previously treated for PCT completed the study. None had evidence of a porphyric relapse. CYP1A2 activity, measured by three different methods, did not differ between study subjects receiving estrogens, patients with active PCT, and non-porphyric control subjects, nor did CYP1A2 activity change during the study period. Gonadotrophic hormone levels fell and estrogen levels rose in all women receiving estrogens. The administration of estrogens by the transdermal route appeared to be safe in the small number of subjects we studied and should be considered for women previously treated for PCT.
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Affiliation(s)
- Z J Bulaj
- Department of Medicine and the General Clinical Research Center, University of Utah School of Medicine, Salt Lake City 84132, USA
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17
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Forsyth JT, Grünewald RA, Rostami-Hodjegan A, Lennard MS, Sagar HJ, Tucker GT. Parkinson's disease and CYP1A2 activity. Br J Clin Pharmacol 2000; 50:303-9. [PMID: 11012552 PMCID: PMC2014998 DOI: 10.1046/j.1365-2125.2000.00259.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/1999] [Accepted: 06/05/2000] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED AIMS MPTP, a neurotoxin which induces parkinsonism is partially metabolized by the enzyme CYP1A2. Smoking appears to protect against Parkinson's disease (PD) and cigarette smoke induces CYP1A2 activity. Thus, we investigated the hypothesis that idiopathic PD is associated with lower CYP1A2 activity using caffeine as a probe compound. METHODS CYP1A2 activity was assessed using saliva paraxanthine (PX) to caffeine (CA) ratios. Caffeine half-life was also estimated from salivary concentrations of caffeine at 2 and 5 h post dose. 117 treated and 40 untreated patients with PD and 105 healthy control subjects were studied. RESULTS PX/CA ratios were 0. 57, 0.93 and 0.77 in treated patients, untreated patients and healthy control subjects, respectively, with no significant differences between study groups (95% CI: treated patients vs controls -0.24, 0.57; untreated patients vs controls -0.75, 0.35). However, patients with PD (treated or untreated) had caffeine half-lives shorter than that in controls (treated patients: 262 min, untreated patients: 244 min, controls: 345 min; 95% CI: controls vs treated patients 23, 143 (P = 0.003); controls vs untreated patients 19, 184 (P = 0.011)). Amongst the patients with PD, caffeine half-life was also inversely related to the age of onset of disease (P = 0.012); gender and concomitant drugs did not influence this significantly. CONCLUSIONS Based on PX/CA ratio, there was no evidence of decreased CYP1A2 activity in patients compared with control subjects. The observed decrease in the elimination half-life of caffeine in PD may be caused by increased CYP2E1 activity, an enzyme that also contributes to the metabolism of caffeine. The latter warrants further investigation.
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Affiliation(s)
- J T Forsyth
- Sections of Clinical Neurology and Molecular Pharmacology and Pharmacogenetics, Division of Clinical Sciences, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
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18
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Couturier EG, Laman DM, van Duijn MA, van Duijn H. Influence of caffeine and caffeine withdrawal on headache and cerebral blood flow velocities. Cephalalgia 1997; 17:188-90. [PMID: 9170342 DOI: 10.1046/j.1468-2982.1997.1703188.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Caffeine consumption may cause headache, particularly migraine. Its withdrawal also produces headaches and may be related to weekend migraine attacks. Transcranial Doppler sonography (TCD) has shown changes in cerebral blood flow velocities (BFV) during and between attacks of migraine. In order to examine whether headache and changes in BFV could develop from controlled caffeine alterations, 20 healthy volunteers without a headache history, underwent clinical evaluation, TCD and serum caffeine measurements on four occasions, comparing conditions of regular caffeine intake, caffeine withdrawal and "re-caffeination". After 24 h of complete caffeine abstinence, 10 suffered from moderate to severe headaches with complete recovery within 1 h after caffeine intake. The BFVs in both middle cerebral, both posterior cerebral and basilar arteries were higher following the withdrawal period, reaching statistical significance in the left middle cerebral basilar and both posterior cerebral arteries. BFVs decreased significantly within half an hour after caffeine intake in all subjects, and were similar to baseline values after 2 h. Our results emphasize the relationship between caffeine withdrawal, the development of headache and alterations in cerebral blood flow velocities. Also, these findings indicate that accurate interpretation of TCD measurements should account for the influence of caffeine on BFVs.
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Affiliation(s)
- E G Couturier
- Department of Clinical Neurophysiology, Sint Lucas Hospital, Amsterdam, The Netherlands
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19
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High-performance liquid chromatography of alkaloids. Chem Nat Compd 1991. [DOI: 10.1007/bf00630347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Caffeine has been shown to affect both physiological functioning and certain aspects of performance. These effects are typically attributed to a simple increase in general arousal. The present study was based on the theory that the effects of caffeine are actually multidimensional. Specifically, we hypothesized that the drug raises arousal, acts to maintain elevated arousal under conditions otherwise conductive to habituation, and enhances the impact of situational and psychological sources of arousal. Subjects were given caffeine (300 mg) or placebo and white noise or no noise and exposed to a series of pure tones and two Backwards Recall Tasks, one novel, the other repetitive. Electrodermal activity (EDA) and task performance were recorded. Caffeine increased arousal as measured by EDA. It also acted to slow habituation during repetitive stimulation, thus maintaining heightened arousal. Finally, it enhanced the effects of novel stimulation, which also independently raised arousal. These results support a multidimensional theory of caffeine effects and provide some understanding of the popularity of caffeine as a psychotropic agent.
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Affiliation(s)
- R A Davidson
- National Institutes of Health, NINDS, Bethesda, MD 20892
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21
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Wahlländer A, Mohr S, Paumgartner G. Assessment of hepatic function. Comparison of caffeine clearance in serum and saliva during the day and at night. J Hepatol 1990; 10:129-37. [PMID: 2185297 DOI: 10.1016/0168-8278(90)90041-o] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hepatic microsomal function was assessed by a caffeine clearance test at night and during the day using saliva and serum samples obtained simultaneously. In 26 patients with cirrhosis, 21 patients with noncirrhotic liver disease and 15 control subjects caffeine elimination correlated well during the day and at night (r = 0.915 for serum and 0.917 for saliva). The correlation coefficients for caffeine clearance in saliva and serum were 0.940 during the day and 0.963 overnight. In the cirrhotic patients, clearance differed significantly from noncirrhotic liver disease and controls in saliva samples overnight: 0.51 +/- 0.45 ml/min per kg versus 0.91 +/- 0.44 and 1.41 +/- 0.56, respectively. Comparable results were obtained for serum clearance overnight and clearances during the day. Serum and saliva clearances at night correlated well with the aminopyrine breath test (rs = 0.884 and 0.907, respectively). Overnight caffeine clearance in saliva might be a simple useful method for assessing progression and prognosis of liver disease.
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Affiliation(s)
- A Wahlländer
- Department of Medicine II, Klinikum Grosshadern, University of Munich, Federal Republic of Germany
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22
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Salvador HS, Koos BJ. Effects of regular and decaffeinated coffee on fetal breathing and heart rate. Am J Obstet Gynecol 1989; 160:1043-7. [PMID: 2729379 DOI: 10.1016/0002-9378(89)90157-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effects of maternal consumption of regular or decaffeinated coffee on the fetus were determined in eight pregnant women at 32 to 36 weeks of gestation. This was a single-blind crossover study in which two cups of caffeinated or decaffeinated coffee were consumed after an overnight fast. The total maternal caffeine ingested was 454 +/- 4 mg for regular coffee and 12 +/- 0.4 mg for decaffeinated coffee. Maternal consumption of regular coffee was associated with a twofold increase in the incidence of fetal breathing activity and a significant fall in baseline fetal heart rate. Decaffeinated coffee also increased the incidence of fetal breathing activity and produced a slight reduction in fetal heart rate. These results indicate that maternal consumption of regular and decaffeinated coffee can stimulate fetal breathing. Moreover, these results suggest that caffeinated coffee can produce baseline shifts in fetal heart rate.
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Affiliation(s)
- H S Salvador
- Department of Gynecology and Obstetrics, School of Medicine, Loma Linda University, CA 92354
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23
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Pfeifer RW, Notari RE. Predicting caffeine plasma concentrations resulting from consumption of food or beverages: a simple method and its origin. DRUG INTELLIGENCE & CLINICAL PHARMACY 1988; 22:953-9. [PMID: 3243174 DOI: 10.1177/106002808802201204] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Multiple dosage regimens for therapeutic agents are commonly comprised of a constant dosing interval and a constant dose size. This is not true for the ingestion of a pharmacologically active agent that is a component in a dietary source. Caffeine is contained in foods and beverages that are regular components of the diet for many people. Because daily intake is unsystematic, a computer program was written to simulate caffeine plasma concentration-time courses following ingestion of variable amounts on irregular schedules. Literature values for caffeine pharmacokinetics, for the caffeine content in various foods and beverages, and for consumer habits were employed to simulate various caffeine plasma concentration-time courses. By searching for predictable traits in a wide variety of plasma concentration-time courses representing normal adults, a simple noncomputer method was developed to allow individuals to estimate caffeine plasma concentrations based on personal intake habits. Changes in the time courses due to smoking, oral contraceptive use, and liver disease, all of which alter caffeine pharmacokinetics, were also examined.
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Affiliation(s)
- R W Pfeifer
- Hospital Pharmacy, Ohio State University Hospitals, Columbus
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24
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Abdel-Moety EM. First-derivative spectrophotometric and gas-liquid chromatographic determination of caffeine in foods and pharmaceuticals. I. Rapid determination of caffeine in coffee, tea and soft drinks. ZEITSCHRIFT FUR LEBENSMITTEL-UNTERSUCHUNG UND -FORSCHUNG 1988; 186:412-6. [PMID: 3388978 DOI: 10.1007/bf01127301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A simple and rapid spectrophotometric method is described for the determination of caffeine in coffee, tea and soft drinks. To exclude the irrelevant absorptions, due to the presence of some accompanying naturally occurring ingredients in the analysed multicomponent drinks, the derivative method is found to be superior. Another gas-liquid chromatographic (GLC) procedure for the quantitation of the analeptic agent, in bulk form and in the same drinks, is also investigated. The recovery testing of the proposed methods gives good percentage mean recoveries with relatively low deviations. The results of the methods described are compared with those obtained by direct UV-spectrophotometry as well as by applying an official pharmacopoeial procedure for caffeine.
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Affiliation(s)
- E M Abdel-Moety
- Department of Analytical Chemistry, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Egypt
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Caffeine. ACTA ACUST UNITED AC 1986. [DOI: 10.1016/s0099-5428(08)60413-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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