Medication Summary
The objectives of pharmacotherapeutic intervention of caffeine toxicity include (1) stabilization of heart rate and blood pressure; (2) seizure control with benzodiazepines; (3) decontamination with activated charcoal, sorbitol, or both; and (4) correction of electrolyte disturbances.
Tachydysrhythmias may be treated with calcium channel blockers or beta-blockers (preferred) for rate control or with antidysrhythmics, depending on the rhythm disturbance.
Benzodiazepines
Class Summary
These drugs are used for seizure control.
Lorazepam (Ativan)
Sedative hypnotic with short onset of action and relatively long half-life. Increases action of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter in brain.
Vasopressors
Class Summary
These agents are used to increase blood pressure.
Phenylephrine (Neo-Synephrine)
Strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity. Vasoconstricts arterioles and increases venous return.
Dopamine (Intropin)
Naturally occurring endogenous catecholamine that stimulates dopaminergic, beta1-adrenergic, and alpha1-adrenergic receptors in dose-dependent fashion. At 2-5 mcg/kg/min, acts on dopaminergic receptors in renal and splanchnic vascular beds, causing their vasodilation. At 5-15 mcg/kg/min, acts on beta-adrenergic receptors to increase heart rate and contractility. At 15-20 mcg/kg/min, acts on alpha-adrenergic receptors to increase systemic vascular resistance and raise BP.
Beta-blockers
Class Summary
These drugs are used for rate control in cases of atrial fibrillation or another SVT. They should not be used to treat hypertension in the setting of caffeine or sympathomimetic overdose.
Esmolol (Brevibloc)
Ultrashort action. Selectively blocks beta1-receptors with little or no effect on beta2-receptors. Useful in patients at risk for complications from beta-blockade, particularly those with reactive airway disease, mild-to-moderate left ventricular (LV) dysfunction, and/or peripheral vascular disease. Short half-life of 8 min allows for titration to desired effect and quick discontinuation if needed.
Calcium channel blockers
Class Summary
These drugs are used for rate control in atrial fibrillation or another SVT. They should not be used to treat hypertension in the setting of caffeine or sympathomimetic overdose.
Diltiazem (Cardizem CD, Cardizem LA, Tiazac)
Decreases conduction velocity in AV node and increases refractory period by blocking calcium influx, converting SVT or slowing rate in atrial fibrillation. Also has vasodilator activity but may be less potent than other agents.
Antidysrhythmics
Class Summary
These drugs are used for the treatment of ventricular dysrhythmias. Amiodarone may also be useful in the treatment of atrial fibrillation.
Amiodarone (Cordarone)
Class III antiarrhythmic. May inhibit AV conduction and sinus node function. Prolongs action potential and refractory period in myocardium and inhibits adrenergic stimulation. Effective in converting atrial fibrillation and flutter to sinus rhythm and in suppressing recurrence. Before administration, control ventricular rate with another agent (eg, calcium channel blocker). Drug of choice for life-threatening ventricular arrhythmias, except for disorders of prolonged repolarization (eg, long-QT syndrome [LQTS]).
Lidocaine (Dilocaine, Xylocaine)
Second-line drug for VT or VF. Class IB antiarrhythmic that increases electrical stimulation threshold of ventricle, suppressing automaticity of conduction through the tissue.
GI decontaminants
Class Summary
These substances adsorb caffeine after acute injections and limit the absorption of caffeine into the systemic circulation. They are most effective when administered within 1 hour of ingestion.
Activated charcoal (Actidose-Aqua, Insta-Char)
Network of pores absorbs 100-1000 mg of drug per gram of charcoal, preventing absorption of drug in intestine.
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Caffeine content of various foods, beverages, medications, and supplements. Caffeine content is approximate for brewed beverages and chocolate).
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Chemical structure of caffeine.
Tables
Item |
Amount |
Caffeine Content, mg |
| Milk chocolate | 8 oz | 5 |
| Dark semi-sweet chocolate | 1 oz | 20 |
| Brewed green tea | 8 oz | 20 |
| Anacin | 1 tablet | 32 |
| Coca-Cola Classic | 12 oz | 35 |
| Pepsi cola | 12 oz | 38 |
| Espresso | 1 oz | 40 |
Fiorinal/Fioricet |
1 tablet |
40 |
| Mountain Dew | 12 oz | 54 |
| Brewed Coffee, generic | 8 oz | 57 |
| Midol | 1 felcap | 60 |
| Excedrin pain reliever | 1 tablet | 65 |
Brewed black tea, generic |
8 oz |
45-74 |
| Dexatrin Natural | 1 tablet | 80 |
| Jolt cola | 12 oz | 80 |
Red Bull Regular |
8.4 oz |
80 |
| Monster energy drink | 16 oz | 80 |
Jolt caffeine energy gum |
2 pieces | 100 |
Penguin caffeinated mints |
6 pieces |
100 |
| No Doz | 1 tablet | 100 |
Rockstar |
16 oz |
160 |
Monster Energy |
16 oz |
160 |
Espresso, generic |
1 oz |
170 |
| Vivarin | 1 tablet | 200 |
| Alani Nu | 12 oz | 200 |
| 5 Hour Energy | 1.9 oz | 200 |
| Ripped Fuel Extreme Ephedra Free | 2 capsules | 220 |
| Taiwanese Milk Tea | 24 oz | 226 |
NOS |
16 oz |
280 |
| Bang Energy | 16 oz | 300 |
Starbucks Tall Americano |
16 oz |
330 |
