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1. All you need to know about the
Caffeine
Information through Evidence-Based
Medicine
Prepared By:
Akash Agnihotri

2. All you need to know about the
Caffeine
Part-5
• Nutritional facts for some
brands that contains
caffeine
Part-4
• Pregnancy Considerations
• Mechanism of action
• Pharmacokinetics
• Facts
Part-3
• Health Effects continue
• Labeled uses
• Off-label uses
• Adverse Reactions
• Contraindications
Part-2
• Pharmacological Effects
• Health Effects
Part-1
• General Info
• Effects
• Consumption and Content
• Metabolism
• Physiology

3. Caffeine: General Info
• Caffeinated coffee and tea are the most
consumed, socially accepted stimulants in the
world.
• Approximately 90 percent of all adults in the
world consume caffeine daily.
• In their natural forms, coffee and tea contain
several chemical components that may confer
both beneficial and adverse health effects,
including caffeine and antioxidants (eg,
polyphenols, catechins, and flavonoids).

4. Caffeine: Effects
Caffeine has multiple systemic effects on the
neuropsychiatric, cardiovascular, endocrine, and
gastrointestinal systems.
The impact on health may be modified by genetic
factors, age, sex, medications, and other
environmental exposures.

5. Caffeine: Consumption & Content
For most adults, consumption of up to 400 mg of
caffeine a day appears to be safe (as per FDA)
Table: Caffeine Content of Commercially Available
Energy Drinks in the Indian Market
Table: Nidhi Bedi et al., Indian Pediatr 2014;51: 529-533
https://www.indianpediatrics.net/july2014/july-529-533.htm

6. Caffeine: Content in soft drinks
Source: https://www.uptodate.com/contents/benefits-and-risks-of-caffeine-and-caffeinated-
beverages?search=caffeine%20in%20bevarages&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

7. Caffeine: Content in Chocolates
Source: https://www.uptodate.com/contents/benefits-and-risks-of-caffeine-and-caffeinated-
beverages?search=caffeine%20in%20bevarages&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

8. Caffeine: In children and
adolescents
Wikoff D, Welsh BT, Henderson R, et al. Systematic review of the potential adverse effects of caffeine consumption in healthy
adults, pregnant women, adolescents, and children. Food Chem Toxicol. 2017;109(Pt 1):585-648. doi:10.1016/j.fct.2017.04.002
• Limited data are available about safe levels of
caffeine consumption in children and
adolescents.
• A systematic review found that intake of 2.5
mg caffeine/kg of body weight per day is not
associated with adverse effects

9. Caffeine: Metabolism
• Caffeine is rapidly absorbed in the
gastrointestinal tract and undergoes
demethylation in the liver via the enzyme
cytochrome P450 1A2 (CYP1A2)
• Defects in the CYP1A2 enzyme are associated
with impaired caffeine metabolism and
prolonged caffeine half-life

10. Caffeine: Physiology
• Caffeine is a potent antagonist of central and
peripheral nervous system adenosine receptors,
thereby stimulating the release of excitatory
neurotransmitters
• The behavioral effects of caffeine are
attributed to its effects on adenosine
receptors

11. All you need to know about the
Caffeine
Information through Evidence-
Part-2
• Pharmacological Effects
• Health Effects

12. Caffeine: Pharmacological effects
• Chlorogenic acid, found in both coffee and
black tea, raises homocysteine concentrations
in plasma
• In addition, polyphenols in coffee such as
caffeic acid and chlorogenic acid inhibit DNA
methylation in a dose-dependent manner, which
prevents downregulation of tumor suppressor
proteins and DNA repair enzymes involved in
carcinogenesis

13. Caffeine: Pharmacological effects
• Diterpenoids in unfiltered coffee may raise
plasma low-density lipoprotein (LDL)
cholesterol and lower high-density lipoprotein
(HDL) cholesterol
• Induction of detoxifying enzymes (eg,
glutathione S-transferase) that protect
against oxidative insults has been identified in
vitro studies with rat liver cells exposed to
coffee

14. Caffeine: Pharmacological effects
• Unidentified compounds in coffee, other than
caffeine, activate the sympathetic system and
may increase blood pressure. This effect is
brief and occurs primarily in non-habitual
coffee drinkers.
• Several other antioxidants in coffee, cocoa,
and teas may contribute to beneficial effects.
• Antioxidants do pass through coffee filters.

15. Caffeine: Health effects
1. Cognitive/neuropsychiatric
• In rested individuals, caffeine in low and moderate
doses, approximately 30 to 300 mg, improves vigilance
and reaction time
• In sleep-deprived individuals, caffeine's positive
effects generalize to a wide variety of functions,
including learning and decision-making and real-world
activities such as automobile and aircraft operation
• Individuals who are habitual consumers of coffee and
tea perform better on various tests of cognitive
performance, such as reaction time and visuospatial
reasoning

16. Caffeine: Health effects
2. Alertness
• Caffeine consumption leads to increased
alertness, mental energy, and ability to
concentrate, particularly when subjects are
fatigued or working at night
• This is probably the fundamental reason why so
many humans regularly consume caffeine.

17. Caffeine: Health effects
3. Headache
• Caffeine has significant pharmacologic
properties that can alleviate or generate
headache symptoms.
• Caffeine has long been used for its analgesic
properties in the treatment of headache and is
frequently used alone or in combination with
other medications.
• Randomized trials have found that combination medications that
include caffeine (aspirin, acetaminophen, and caffeine) are more
effective for tension and migraine headaches than acetaminophen
or low-dose ibuprofen alone.
• Goldstein J, Silberstein SD, Saper JR, Ryan RE Jr, Lipton RB. Acetaminophen, aspirin, and caffeine in combination versus ibuprofen for acute
migraine: results from a multicenter, double-blind, randomized, parallel-group, single-dose, placebo-controlled study. Headache. 2006;46(3):444-453.
doi:10.1111/j.1526-4610.2006.00376.x
• Diener HC, Gold M, Hagen M. Use of a fixed combination of acetylsalicylic acid, acetaminophen and caffeine compared with acetaminophen alone in
episodic tension-type headache: meta-analysis of four randomized, double-blind, placebo-controlled, crossover studies. J Headache Pain.
2014;15(1):76. Published 2014 Nov 19. doi:10.1186/1129-2377-15-76

18. Caffeine: Health effects
3. Headache
• Habitual caffeine consumption is associated
with chronic migraine and analgesic rebound
headache.
• In a case-control study, patients with daily
caffeine consumption were more likely to have
chronic migraines (odds ratio [OR] 2.9, 95% CI
1.5-5.3) and analgesic rebound headaches (OR
2.2, 95% CI 1.2-3.9) than patients who did not
regularly consume caffeine.
• Headaches are the most common symptom of
caffeine withdrawal.

19. All you need to know about the
Caffeine
Information through Evidence-
Part-3
• Health Effects continue
• Labeled uses
• Off-label uses
• Adverse Reactions
• Contraindications

20. Caffeine: Health effects
4. Parkinson disease
• A meta-analysis found evidence of a dose-
response relationship between coffee or tea
intake and decreased risk for Parkinson
disease.
• The mechanism of how caffeine might protect
against Parkinson disease is not known.
Hernán MA, Takkouche B, Caamaño-Isorna F, Gestal-Otero JJ. A meta-analysis of coffee drinking,
cigarette smoking, and the risk of Parkinson's disease. Ann Neurol. 2002;52(3):276-284.
doi:10.1002/ana.10277

21. Caffeine: Health effects
5. Alzheimer disease
• There are very few studies examining the
relationship between coffee and Alzheimer
disease.
• In a pooled analysis of two cohort and two case
control studies on coffee and Alzheimer
disease, coffee consumption was associated
with a small protective effect against
Alzheimer disease (relative risk [RR] 0.70, 95%
CI 0.55-0.90)
Barranco Quintana JL, Allam MF, Serrano Del Castillo A, Fernández-Crehuet Navajas R. Alzheimer's
disease and coffee: a quantitative review. Neurol Res. 2007;29(1):91-95.
doi:10.1179/174313206X152546

22. Caffeine: Health effects
6. Cardiovascular
• Low to moderate coffee consumption (up to
three cups per day) may protect against
myocardial infarction.
• Heavy coffee intake may trigger coronary and
arrhythmic events in susceptible individuals,
although coffee intake is not considered a long-
term risk factor for myocardial disease.

23. Caffeine: Label Uses
• Caffeine citrate: Treatment of apnea of
prematurity.
• Caffeine [OTC labeling]: Helps restore mental
alertness or wakefulness when experiencing
drowsiness or fatigue.

24. Caffeine: Off-Label Uses
• Augmentation of seizure induction during
electroconvulsive therapy (caffeine and sodium
benzoate)
• Postdural puncture headache (caffeine and
sodium benzoate)
• Reversal of dipyridamole- or regadenoson-
induced adverse reactions (eg, angina,
hypotension) during nuclear cardiac stress
testing (alternative agent)

25. Caffeine: Adverse Reactions
• The following adverse drug reactions and
incidences are derived from product labeling
unless otherwise specified (1% to 10%):
• Dermatologic:
• Skin rash (9%)
• Epidermal thinning (2%)
• Xeroderma (2%)
• Endocrine & metabolic: Acidosis (2%)
• Gastrointestinal:
• Gastritis (2%), gastrointestinal hemorrhage
(2%)

26. Caffeine: Contraindications
• Hypersensitivity to caffeine or any component
of the formulation; sodium benzoate is not for
use in neonates.
• OTC labeling: When used for self-medication,
do not use in children <12 years of age or as a
substitute for sleep.

27. All you need to know about the
Caffeine
Information through Evidence-
Part-4
• Pregnancy Considerations
• Mechanism of action
• Pharmacokinetics
• Facts

28. Caffeine: Pregnancy Considerations
• Caffeine crosses the placenta
• Serum concentrations in the fetus are similar
to those in the mother
Breastfeeding considerations
• Caffeine and its metabolites are present in
breast milk

29. Caffeine: Mechanism of action
• Increases levels of 3'5' cyclic AMP by
inhibiting phosphodiesterase
• CNS stimulant which increases medullary
respiratory center sensitivity to carbon
dioxide, stimulates central inspiratory drive,
and improves skeletal muscle contraction
(diaphragmatic contractility)
• Prevention of apnea may occur by competitive
inhibition of adenosine

30. Caffeine: Pharmacokinetics
• Distribution: Vd:
Neonates: 0.8 to 0.9 L/kg.
Adults: 0.6 L/kg.
• Protein binding: 36%.
• Metabolism: Hepatic, via demethylation by
CYP1A2
• Half-life elimination:
• Neonates: 72 to 96 hours.
• Infants ≥9 months, Children, Adolescents
• Adults: 5 hours.

31. Caffeine: Pharmacokinetics
• Time to peak, serum: Preterm neonates: Oral:
30 minutes to 2 hours.
• Caffeine is absorbed into the blood and
tissues within about 45 minutes of being
consumed
• Excretion:
• Neonates: Urine (86% unchanged).
• Infants ≥9 months, Children, Adolescents,
and Adults: Urine (1% unchanged).

32. Caffeine: Facts
• Death from too much caffeine is rare, but
possible
• In rare instances, when caffeine is consumed
at high enough doses (typically in excess of
5 grams in adults — the amount in about 30
to 50 cups of coffee), it can kill.

33. Caffeine: Facts
• Caffeine withdrawal is a real condition
• In the latest version of the psychology
handbook "Diagnostic and Statistical Manual of
Mental Disorders" (DSM-5), caffeine
withdrawal is listed as a mental health
condition.
• The text describes the effects seen in some
people who abruptly stop or dramatically cut
back on their daily use of caffeine

34. Caffeine: Facts
• Caffeine resembles a brain chemical
• Caffeine has a similar molecular structure to
adenosine, a neurotransmitter (a substance
that transmits nerve impulses in the brain).
Because of its chemical resemblance to
adenosine, caffeine can bind to adenosine
receptors in brain cells.
• It blocks the sleep-inducing actions of
adenosine and speeds up nerve cell activity.
This causes a person to feel temporarily more
awake and energetic.

35. Caffeine: Facts
• Caffeine can be found in unusual places
• These days, consumers might notice caffeine in
some unexpected places. People can purchase
caffeine-infused bottled water, jelly beans, breath
mints, peanut butter and chewing gum.
• Even caffeinated bath soaps that supposedly help wake
people up in the morning, also added to shampoos
• In addition, caffeine is in some weight-loss products
and dietary supplements.
• It may be listed on the label as guarana, kola nut, yerba
mate, green tea extract or green coffee bean extract,
according to the National Institutes of Health.

36. Caffeine: Facts
• Coffee beans come from a red fruit
• Coffee comes from shrubs, known as coffee
cherries, that produce a red berry when ripe.
• The actual coffee beans, which are green, are
found inside the coffee cherries.

37. All you need to know about the
Caffeine
Information through Evidence-
Part-5
• Nutritional facts for some
brands that contains
caffeine

38. Caffeine: Nutrition Facts: Some
Brands
Caffeine- 50mg/sachet

39. Caffeine: Nutrition Facts: Some
Brands
Caffeine- 72mg/bottle (250ml)

40. Caffeine: Nutrition Facts: Some
Brands
Caffeine- 75mg/Can (250ml)

41. Caffeine: Nutrition Facts: Some
Brands
Caffeine- 61.5mg/Bottle (250ml)
Pepsi (354ml can)- 38mg caffeine
Coca-Cola (354ml can)- 34mg caffeine

42. Thanks for Reading
Part-5
• Nutritional facts for some
brands that contains
caffeine
Part-4
• Pregnancy Considerations
• Mechanism of action
• Pharmacokinetics
• Facts
Part-3
• Health Effects continue
• Labeled uses
• Off-label uses
• Adverse Reactions
• Contraindications
Part-2
• Pharmacological Effects
• Health Effects
Part-1
• General Info
• Effects
• Consumption and Content
• Metabolism
• Physiology
Information through Evidence-Based
Medicine
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43. Follow @drugs_info_ on Instagram
@drugsinfo01 on Facebook
youtube/DrugsInfo
Prepared By: Akash Agnihotri