Norfolk and Suffolk NHS Foundation Trust
Pharmacy, Hellesdon Hospital, Norwich, NR6 5BE
http://www.nsft.nhs.uk/

Professor Stephen Bazire
01603-421452
steve.bazire@nsft.nhs.uk

Medication: Caffeine

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Caffeine is a stimulant which affects the central nervous system. Caffeine is present in coffee, tea and cola drinks, some energy drinks and cold treatments, some chocolate, and headache tablets.

Updated 12.11

  • What is caffeine?

     Caffeine is a central stimulant, i.e. it stimulates the brain. Caffeine is present in coffee, tea and cola drinks etc.

    Updated 9.11

  • Is caffeine safe?

    Drinking tea and coffee is a common social activity as well as being many people's main fluid intake during a day. Moderate amounts of caffeine, i.e. 250-500mg per day, are thought to be harmless, unlike alcohol and nicotine, which have definite serious adverse effects. Indeed, it has been considered that most of the country would not operate properly without caffeine! Higher amounts of caffeine can, however, have noticeable unwanted effects.

    Updated 9.11

  • What is caffeinism?

    "Caffeinism" is the term used for people who are dependent upon caffeine i.e. suffer side effects from having too much caffeine, take larger amounts and need to keep drinking caffeine to function properly (including a "craving" feeling for caffeine). "Caffeinism" is thought to occur if you have an intake of above 600mg to 750mg of caffeine per day. Drinking more than 1000mg per day is well into the toxic range. The US Olympic Committee considers caffeine a stimulant and has an upper limit for caffeine levels in the blood, above which an athlete "fails a drugs test".

    People may drink large quantities of tea, coffee and cola drinks to relieve thirst or dry mouth caused by side effects of drugs, such as some antidepressants and antipsychotics. Since headaches can occur when caffeine is stopped, drinking caffeine stops these headaches occurring.

    Updated 9.11

  • What are the symptoms of caffeinism?

    The symptoms of caffeinism can include feelings of anxiety and nervousness, sleep disruption (especially difficult getting off to sleep), restlessness, irritability, diuresis (passing lots of water/urine), stomach complaints, tremulousness, palpitations and arrythmias (changed heart rate, especially faster beating). 150mg of caffeine at bedtime has been shown to have a marked effect on how long it takes to get to sleep, reduce total sleep time, the quality of sleep and REM (dreaming) periods. Caffeinism can make some illnesses such as anxiety more resistant to drug treatment. People who suffer from panic attacks may be more sensitive to the stimulant effects of caffeine.

    Suddenly stopping taking caffeine can produce problems. Withdrawal from even moderate amounts of caffeine can produce headaches (52%), anxiety (10%), rebound drowsiness, fatigue and lethargy, with many other effects reported.

    "Caffeinism" is considered a drug addiction and caffeine withdrawal syndrome is a documented condition.

    Updated 9.11

  • How do I know how much caffeine I have in a day?

    You can work out your daily intake of caffeine using this table:

    Source

    Source Caffeine content

    per 100 ml

    per container

    Brewed coffee
    Instant coffee
    Decaf. coffee
    Cocoa
    Brewed tea
    Coca-cola
    Pepsi cola
    55-85 mg
    35-45 mg
    2 mg
    3 mg
    25-55 mg
    11 mg
    7 mg
    140-210 mg/cup
    85-110 mg/cup
    5 mg/cup
    7 mg/cup
    55-140 mg/cup
    36 mg/can
    22 mg/can
    Milk chocolate
    Alka-Seltzer XS
    Red Bull (varies by country)
    Relentless
    Lucozade alert
    Lucozade Energy
    22 mg/100 g
    40 mg/tablet
    80mg/250ml
    160mg/500ml
    120mg/60ml
    80mg/500ml

    A cup is taken as being 250 ml

    There can be a wide range of caffeine in tea, depending on the type and for how long it is brewed. Contents can range from 40mg/mug through to as high as 130mg/mug in extreme cases.

    Updated 9.11

  • What could I do if my daily caffeine intake is too high?

    If you are taking more than about 600-750mg a day of caffeine, you might feel better if you took less caffeine, especially if you are anxious, don't sleep well or suffer panic attacks. Many people seem to be able to function well on higher levels than this. However, since caffeinism can be considered a drug "addiction", stopping caffeine suddenly is not a good idea as withdrawal effects (see previous page) are likely. The best plan for someone who may be drinking too much caffeine is to gradually reduce this to a safer level, preferably over several weeks.

    You can reduce your intake in many ways e.g.:

        •    Use decaffeinated (or at least instant) coffee and/or tea sometimes

        •    Avoid brewed coffee or strong tea

        •    Mix decaffeinated coffee powder with ordinary coffee powder to make a lower-caffeine drink

        •    Either drink smaller volumes of coffee or tea or make the drinks weaker

        •    Drink caffeine drinks less often

        •    Do not drink too many cola drinks e.g. Coca-Cola, Pepsi etc

    One useful plan is to start with one or two decaffeinated drinks per day. Then increase this gradually e.g. alternating decaffeinated drinks with ordinary caffeine-containing drinks. Avoid taking caffeine drinks within a couple of hours of going to bed. .

    Updated 9.11

Main pharmacy contact points

Main Trust switchboard in Norwich, tel: 01603-421421
Dispensary and all enquiries, tel: 01603-421212, fax: 01603-421365
Pharmacy office tel: 01603-421319
Medicines Information tel: 01603-421212
Unthank Road pharmacy tel: 01603-750031
Deputy Director and Clinical Pharmacy Manager John Hunter, tel: 01603-421364

Opening hours:
Main pharmacy open Monday to Friday: 8.30-16.30 (open at 9.15 on Wednesdays for staff meeting)
Unthank Road pharmacy tel: 01603-671917 open 9.15-12.00 Monday to Friday, also Tuesday and Wednesday afternoons for dose assessments.

Service objectives:
The pharmacy service to Norfolk and Suffolk NHS Foundation Trust has five main aims:

  1. Efficient drug distribution and purchasing
  2. Provision of accurate and independent education and information about medicine therapy to service users and carers
  3. Information and education for Trust and other professionals, and voluntary helpers
  4. Clinical activities to help ensure the optimum use of drug therapies
  5. Medicine management to ensure the most cost-effective use is made of resources