Interaction of Energy Drinks with Prescription Medication and Drugs of Abuse

Episodic Migraine in the Pediatric Population: Behavioral Therapies and other Non-Pharmacological Treatment Options

PURPOSE OF REVIEW

The purpose of this review is to present current evidence on the multifaceted approach required for managing pediatric migraine. This includes identifying migraine triggers, managing acute pain episodes, and implementing preventive strategies. The review focuses on non-pharmacological interventions, such as behavioral and lifestyle modifications. By exploring these aspects, the review seeks to provide a comprehensive understanding of effective migraine management in children and adolescents.

RECENT FINDINGS

Non-pharmacological treatments like cognitive-behavioral therapy (CBT), relaxation techniques, and biofeedback are effective alternatives to medication. Nutraceuticals and dietary considerations, including ketogenic diet, alongside education and regular follow-ups, optimize outcomes. Integrating tools for tracking migraine patterns and training for clinicians, parents, and patients enhances treatment effectiveness. Engaging adolescents and their families through education and active participation is essential for improving their quality of life. This review presents available evidence of non-pharmacological strategies for managing episodic migraine in pediatrics. CBT and lifestyle modification are documented for their effect. Future research is required to create evidence-based, comprehensive treatment plans including these and other non-pharmacological strategies tailored to individual needs.

Green Tea: Current Knowledge and Issues

Green tea possesses antioxidant, anti-inflammatory, anticancer, and antimicrobial activities, reduces body weight, and slows down aging. These effects are primarily attributed to catechins contained in green tea leaves, particularly epigallocatechin-3-gallate. However, in humans, the realization of green tea's beneficial effects is limited. In order to summarize and critically analyze the available scientific information about green tea's health benefits and issues related to its use, we conducted an in-depth literature review in scientific databases. A number of in vitro studies reported that green tea catechins modulate various signaling pathways in cells, which is thought to underlie their beneficial effects. However, data on the effects of catechins in humans are scarce, which is partly due to their low stability and oral bioavailability. Furthermore, catechins may also participate in pharmacokinetic interactions when co-administered with certain drugs such as anticancer agents, drugs for cardiovascular diseases, immunosuppressors, etc. As a result, adverse drug reactions or therapy failure may occur. In conclusion, over the years, various approaches have been investigated to optimize catechin intake and to achieve beneficial effects in humans, but to date, the use of catechins for prophylaxis or disease treatment remains limited. Therefore, future studies regarding the possibilities of catechins administration are needed.

Nutritional Risks of Heavy Metals in the Human Diet-Multi-Elemental Analysis of Energy Drinks

Background: In recent years, the consumption of energy drinks (EDs) by adolescents and young adults has increased significantly, so concerns have been raised about the potential health risks associated with excessive ED consumption. Most analyses on EDs focus on the caffeine content. Research on the content of minerals (essential and toxic) in energy drinks can be considered scarce. Therefore, there is a need for research stating the actual status of heavy metal content in commercially available energy drinks. Methods: This research presents the determination of the total concentrations of macro-elements and trace elements (TEs), such as Na, K, Mg, Ca, Al, Cr, Co, Cu, Fe, Mn, Ni, B, Zn, V, Sr, Ba, Pb, Cd, and As in nine samples of energy drinks using inductively coupled plasma optical emission spectrometry (ICP-OES) and inductively coupled plasma mass spectrometry (ICP-MS) techniques. Results: The order in the content of macro-minerals in the EDs was as follows: Na > K > Mg > Ca. The results showed that ED 1, ED 3, and ED 7 samples had the highest micro-mineral concentrations. All the samples had a hazard quotient and hazard index < 1, indicating no non-carcinogenic risk from exposure to single or multiple heavy metals in both the adolescent and adult age groups. Some samples exceeded the threshold limit of acceptable cancer risk for As, Ni, and Cr in both adolescents and adults. Conclusions: This assessment showed that in addition to health implications based on the caffeine content of EDs, there might be a carcinogenic risk associated with the toxic element content of these beverages. This research also highlights notable differences in the TE levels among various ED brands, which may have important implications for consumer well-being and health.

Characteristics of the drinking habits of people who overdose over-the-counter drugs: Insights from a nationwide Japanese survey

Aim

To analyze the drinking habits of individuals who overdosed on over-the-counter (OTC) drugs, such as cough suppressants, antitussives, antipyretic analgesics, and combination cold medications, in Japan.

Methods

This cross-sectional study analyzed data collected from 2881 participants through a national survey conducted in Japan in 2023. Through a self-administered questionnaire, the participants were categorized into OTC (overdosed OTC drugs in the past year) and control (did not overdose OTC drugs) groups. Variables related to drinking habits, social background, smoking habits, use of other medications, such as analgesics, tranquilizers, controlled drugs, and products containing high concentrations of caffeine, and perception of OTC drugs were compared between the two groups. Additionally, we matched the participants in the OTC (n = 25) and control (n = 100) groups by sex and age in a 1:4 ratio to assess these variables. Multivariate analyses were performed to examine how these factors are associated with drinking habits in individuals with OTC drug overdose.

Results

OTC drug overdose was prevalent among teenagers and those in their 50s, and was associated with habitual binge drinking and consumption of energy drinks. Those overdosing on OTC drugs obtained them mostly from drugstores and pharmacies.

Conclusion

This is the first study to show a relationship between drinking habits and OTC drug overdose. An understanding of the characteristics of drinking habits in those who overdose on OTC drugs can help reduce fatal health risks in this population.

Beyond the buzz: the fatal consequences of caffeine overconsumption

Caffeine is a naturally occurring stimulant present in dozens of plant species including Coffea arabica and Camellia sinensis, from which we obtain coffee and tea, respectively. It is one of the world's most widely consumed psychoactive substances frequently used to increase alertness, elevate mood, and ward off fatigue. In traditional preparations, caffeine is generally well-tolerated by the consumer. However, complications can arise with the addition of caffeine to products like energy drinks, medications, and supplements. Furthermore, with pure caffeine accessible online, a consumer may unknowingly or inadvertently consume caffeine in dangerous amounts. Symptoms of caffeine toxicity include classic central nervous system stimulation side effects, such as agitation, insomnia, gastrointestinal distress, tachycardia, seizures, and death in extreme cases. To evaluate concentrations of toxicological significance, caffeine cases were assessed at a large reference laboratory (NMS Labs). From 2019 to 2023, 406 blood cases underwent confirmation testing via LC-MS-MS; the mean and median caffeine concentrations were 35 and 4.8 µg/mL, respectively. While most caffeine-containing cases indicate traditional use in the general population with concentrations <25 µg/mL (62%, N = 254), 10% (N = 42) of the cases were >100 µg/mL, indicating levels which may contribute to a fatal outcome. To gain insight into the significance of caffeine in determining the cause and manner of death, cases with various manners of death are presented. Despite being one of the most common toxicological findings in medicolegal death investigations, caffeine is often overlooked. Screening results should undergo scrutiny, and confirmation testing should be considered in cases where caffeine intoxication is prominently featured in the case history or scene investigation.

How Does the Powder Mixture of Ibuprofen and Caffeine Attenuate the Solubility of Ibuprofen? Comparative Study for the Xanthine Derivatives to Recognize Their Intermolecular Interactions Using Fourier-Transform Infrared (FTIR) Spectra, Differential Scanning Calorimetry (DSC), and X-ray Powder Diffractometry (XRPD)

Molecular interactions between active pharmaceutical ingredients (APIs) and xanthine (XAT) derivatives were analyzed using singular value decomposition (SVD). XAT derivatives were mixed with equimolar amounts of ibuprofen (IBP) and diclofenac (DCF), and their dissolution behaviors were measured using high-performance liquid chromatography. The solubility of IBP decreased in mixtures with caffeine (CFN) and theophylline (TPH), whereas that of DCF increased in mixtures with CFN and TPH. No significant differences were observed between the mixtures of theobromine (TBR) or XAT with IBP and DCF. Mixtures with various molar ratios were analyzed using differential scanning calorimetry, X-ray powder diffraction, and Fourier-transform infrared spectroscopy to further explore these interactions. The results were subjected to SVD. This analysis provides valuable insights into the differences in interaction strength and predicted interaction sites between XAT derivatives and APIs based on the combinations that form mixtures. The results also showed the impact of the XAT derivatives on the dissolution behavior of IBP and DCF. Although IBP and DCF were found to form intermolecular interactions with CFN and TPH, these effects resulted in a reduction of the solubility of IBP and an increase in the solubility of DCF. The current approach has the potential to predict various interactions that may occur in different combinations, thereby contributing to a better understanding of the impact of health supplements on pharmaceuticals.

Functional Role of Taurine in Aging and Cardiovascular Health: An Updated Overview

Taurine, a naturally occurring sulfur-containing amino acid, has attracted significant attention in recent years due to its potential health benefits. Found in various foods and often used in energy drinks and supplements, taurine has been studied extensively to understand its impact on human physiology. Determining its exact functional roles represents a complex and multifaceted topic. We provide an overview of the scientific literature and present an analysis of the effects of taurine on various aspects of human health, focusing on aging and cardiovascular pathophysiology, but also including athletic performance, metabolic regulation, and neurological function. Additionally, our report summarizes the current recommendations for taurine intake and addresses potential safety concerns. Evidence from both human and animal studies indicates that taurine may have beneficial cardiovascular effects, including blood pressure regulation, improved cardiac fitness, and enhanced vascular health. Its mechanisms of action and antioxidant properties make it also an intriguing candidate for potential anti-aging strategies.

Optimizing human performance in extreme environments through precision medicine: From spaceflight to high-performance operations on Earth

Humans operating in extreme environments often conduct their operations at the edges of the limits of human performance. Sometimes, they are required to push these limits to previously unattained levels. As a result, their margins for error in execution are much smaller than that found in the general public. These same small margins for error that impact execution may also impact risk, safety, health, and even survival. Thus, humans operating in extreme environments have a need for greater refinement in their preparation, training, fitness, and medical care. Precision medicine (PM) is uniquely suited to address the needs of those engaged in these extreme operations because of its depth of molecular analysis, derived precision countermeasures, and ability to match each individual (and his or her specific molecular phenotype) with any given operating context (environment). Herein, we present an overview of a systems approach to PM in extreme environments, which affords clinicians one method to contextualize the inputs, processes, and outputs that can form the basis of a formal practice. For the sake of brevity, this overview is focused on molecular dynamics, while providing only a brief introduction to the also important physiologic and behavioral phenotypes in PM. Moreover, rather than a full review, it highlights important concepts, while using only selected citations to illustrate those concepts. It further explores, by demonstration, the basic principles of using functionally characterized molecular networks to guide the practical application of PM in extreme environments. At its core, PM in extreme environments is about attention to incremental gains and losses in molecular network efficiency that can scale to produce notable changes in health and performance. The aim of this overview is to provide a conceptual overview of one approach to PM in extreme environments, coupled with a selected suite of practical considerations for molecular profiling and countermeasures.

Polymorphisms in the gene encoding CYP1A2 influence prostate cancer risk and progression

The role of the cytochrome P450 1A2 (CYP1A2) rs2472299, rs2470890 and rs11072508 polymorphisms in prostate cancer risk, disease progression and tumour development remains unclear. The potential associations of these three CYP1A2 polymorphisms and haplotypes with prostate cancer susceptibility and its clinicopathological characteristics were therefore investigated. The present case-control study consisted of 522 patients with prostate cancer and 554 healthy controls. High-resolution melting analysis was used to determine the CYP1A2 polymorphisms. No significant association in prostate cancer risk was seen for CYP1A2 rs2472299 and rs11072508. However, a significantly decreased risk of prostate cancer was found for CYP1A2 rs2470890 [odds ratio (OR), 0.67; P=0.02] in the recessive model. After analysis of the associations of clinical status and these three CYP1A2 polymorphisms, the CYP1A2 rs2470890 and rs11072508 polymorphisms showed a positive association with a higher Gleason score (rs2470890 OR, 1.36, P=0.04 in the allelic model; rs11072508 OR, 1.37, P=0.04 in the allelic model and OR, 1.60, P=0.03 in the dominant model). All three polymorphisms showed a significant positive association with pathological T stage in the additive, allelic and dominant genetic models (P<0.05). Haplotype analysis revealed that the most common haplotypes 'GTT' and 'ACC' were significantly associated with pathological T stages 3 and 4 (OR, 0.62; P=0.02 and OR, 1.54; P=0.03, respectively). A significant association was found between the 'GTT' haplotype and the Gleason score (OR, 0.71; P=0.03). In conclusion, these CYP1A2 polymorphisms and haplotypes have the potential to predict prostate cancer disease progression.

Energy drinks at adolescence: Awareness or unawareness?

Energy drinks (EDs) are beverages similar to soft drinks, characterized by high caffeine concentrations with additional ingredients like taurine and vitamins, marketed for boosting energy, reducing tiredness, increasing concentration, and for their ergogenic effect. The majority of consumers are children, adolescents, and young athletes. Although EDs companies claim about the ergogenic and remineralizing properties of their products, there is a serious lack of evidence at preclinical as well as clinical level to validate their benefits. The regular intake and long-term consequences of these caffeinated drinks are not well documented, especially the possible negative effects in adolescents whose brain is still developing. EDs combined with alcohol are also gaining popularity among adolescents and different publications indicate that this combined consumption might increase the risk to develop an alcohol use disorder, as well as produce serious adverse cardiovascular effects. There is an increasing need to disseminate knowledge on EDs damage on health, so that adolescents can be aware about the potential harmful outcomes of consuming these drinks.

Utilization of 4-fluoro-7-nitro-2,1,3-benzoxadiazole (NBD-F) as a fluorogenic reagent for the development of a spectrofluorometric assay method for taurine in energy drinks

The development of a simple, inexpensive, sensitive, and selective spectrofluorometric assay method for taurine in energy drinks utilizing 4-fluoro-7-nitro-2,1,3-benzoxadiazole as a fluorogenic agent is described. Conditions affecting the derivatization reaction are investigated and optimized. The optimal conditions are found to be as follows: buffer, pH 10; 4-fluoro-7-nitro-2,1,3-benzoxadiazoleconcentration, 0.05%; reaction time, 30 min; temperature, 50 °C. Fluorescence measurements are carried out at a wavelength of 542 nm, with excitation at a wavelength of 485 nm. The method is validated under the optimum conditions. The method is found to be linear in the range of 2.0–12.5 µg/mL, with a correlation coefficient of 0.9993. The limits of detection and quantification (µg/mL) are 0.6 and 2.02, respectively, which are appropriate for taurine assays in commercial energy drinks. In addition, the proposed method recorded excellent accuracy since the recovery values caused by presence of excipients are found to be in the range of 99.3%–102.87%. The values of relative standard deviation for intra- and inter-day precision were found to be in the ranges of 0.236%–0.659% and 2.12%–2.63%, respectively.