Xanthine-containing Beverages

(USAN, rINN)

💊 Chemical information

Xantina, bebidas con.

💊 Adverse Effects

The adverse effects of xanthine-containing beverages are largely due to their caffeine, theophylline, and theobromine content. Common adverse effects are sleeplessness, anxiety, tremor, palpitations, and withdrawal headache.

Breast feeding.

For references to the effects of caffeinated beverages in breast feeding, see under Caffeine.

Effects on the heart.

A meta-analysis of published studies found no evidence of an association between coffee consumption and the development of coronary heart disease,1 and a large cohort study in men followed up for 14 years and women for up to 20 years also found no evidence of a link.2 Expert opinion in the UK3 has been that the evidence that caffeine or coffee consumption contributes to coronary heart disease development is inconsistent. Coffee prepared by boiling, as is the practice in Scandinavia for example, does raise serum cholesterol concentrations due to the presence of the diterpenes cafestol and kahweol, and coffee made in a cafetière (French press) has a similar effect, but filtered coffee does not, as the hypercholesterolaemic fraction does not pass a paper filter.4 A case-control study has suggested a relationship between consumption of boiled, but not filtered, coffee and incidence of a first non-fatal myocardial infarction.5 Others have raised concern that the potential pressor effect of caffeine itself may be a cardiovascular risk factor,6 but as mentioned above there is little evidence for this. A large prospective cohort study7 found no association between dietary caffeine and risk of atrial fibrillation or flutter. Tea drinking has not been associated with increased cardiovascular risk3—indeed, its polyphenol content has been suggested to have beneficial antoxidant effects.8,9
1. Myers MG, Basinski A. Coffee and coronary heart disease. Arch Intern Med 1992; 152: 1767–72
2. Lopez-Garcia E, et al. Coffee consumption and coronary heart disease in men and women: a prospective cohort study. Circulation 2006; 113: 2045–53
3. Department of Health. Nutritional aspects of cardiovascular disease. Report of the cardiovascular review group committee on medical aspects of food policy. Report on health and social subjects no
46. London: HMSO, 1994
4. Urgert R, et al. Comparison of effect of cafetière and filtered coffee on serum concentrations of liver aminotransferases and lipids: six month randomised controlled trial. BMJ 1996; 313: 1362–6
5. Hammar N, et al. Association of boiled and filtered coffee with incidence of first nonfatal myocardial infarction: the SHEEP and the VHEEP study. J Intern Med 2003; 253: 653–9
6. James JE. Is habitual caffeine use a preventable cardiovascular risk factor? Lancet 1997; 349: 279–81.
7. Frost L, Vestergaard P. Caffeine and risk of atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Clin Nutr 2005; 81: 578–82
8. Luo M, et al. Inhibition of LDL oxidation by green tea extract. Lancet 1997; 349: 360–1
9. Geleijnse JM, et al. Tea flavonoids may protect against atherosclerosis: the Rotterdam study. Arch Intern Med 1999; 159: 2170–4.

Effects on the muscles.

Severe myositis in an elderly man who drank around 14 litres of tea daily was attributed to hypokalaemia produced by the xanthine content of the beverage.1 The patient improved after intravenous potassium replacement and subsequently remained well with a reduction in tea intake.
1. Trewby PN, et al. Teapot myositis. Lancet 1998; 351: 1248.

Malignant neoplasms.

A review of available data did not suggest a clinically significant association between the regular use of coffee and the development of cancer of the lower urinary tract in men or women.1
1. Viscoli CM, et al. Bladder cancer and coffee drinking: a summary of case-control research. Lancet 1993; 341: 1432–7.

💊 Interactions

The possibility of synergistic effects in patients receiving xanthines who consume large amounts of xanthine-containing beverages should be borne in mind.

Antipsychotics.

Xanthine-containing beverages have been reported to precipitate some antipsychotic drugs from solution in vitro, but do not appear to alter antipsychotic concentrations in vivo. For references.

💊 Uses and Administration

Xanthine-containing beverages including chocolate, coffee, cocoa, cola, maté, and tea are widely consumed and have a mild stimulant effect on the CNS. The primary xanthine constituent is caffeine but other xanthine derivatives such as theobromine and theophylline may also be present; cocoa and chocolate contain significant amounts of theobromine. Coffee is the kernel of the dried ripe seeds of Coffea arabica, C. liberica, C. canephora (robusta coffee), and other species of Coffea (Rubiaceae), roasted until it acquires a deep brown colour and a pleasant characteristic aroma. It contains about 1 to 2% of caffeine. Coffee has been used in the form of an infusion or decoction as a stimulant and as a flavour in some pharmaceutical preparations. A decoction is used as a beverage containing up to about 100 mg of caffeine per 100 mL. Preparations of instant coffee may contain up to 40% less caffeine while decaffeinated preparations may contain only up to about 3 mg per 100 mL. Kola (cola, cola seeds, kola nuts) is the dried cotyledons of Cola nitida and C. acuminata (Sterculiaceae), containing up to about 2.5% of caffeine and traces of theobromine. Kola is used in the preparation of cola drinks which may contain up to 20 mg of caffeine per 100 mL. Maté (Paraguay Tea) is the dried leaves of Ilex paraguensis (Aquifoliaceae), containing 0.2 to 2% of caffeine and traces of theobromine. Maté is less astringent than tea and is extensively used as a beverage in South America. Tea (thea, chá, thé, tee) is the prepared young leaves and leafbuds of Camellia sinensis (=C. thea) (Theaceae). It contains 1 to 5% of caffeine, up to 24% of tannin, and small amounts of theobromine and theophylline. Tea is used in an infusion as a beverage containing up to about 60 mg of caffeine per 100 mL. Guarana consists of the crushed seeds of Paullinia cupana var sorbilis (Sapindaceae). Caffeine appears to be its major active ingredient which was once termed guaranine. Herbal preparations include a beverage or liquid extract and may contain 5% caffeine.

Homoeopathy.

Coffee has been used in homoeopathic medicines under the following names: Coffea arabica; Coffea; Coffea cruda; Coff. cr. Kola has been used in homoeopathic medicines under the following names: Cola. Maté has been used in homoeopathic medicines under the following names: Ilex paraguayensis; Ile. para. Guarana has been used in homoeopathic medicines.

Diabetes mellitus.

Regular coffee consumption has been reported1-6 to reduce the risk of developing type 2 diabetes mellitus, although it is not clear whether this effect is due to caffeine or some other constituent in coffee.
1. Salazar-Martinez E, et al. Coffee consumption and risk for type 2 diabetes mellitus. Ann Intern Med 2004; 140: 1–8
2. van Dam RM, Hu FB. Coffee consumption and risk of type 2 diabetes: a systematic review. JAMA 2005; 294: 97–104
3. van Dam RM, et al. Coffee, caffeine, and risk of type 2 diabetes: a prospective cohort study in younger and middle-aged U.S. women. Diabetes Care 2006; 29: 398–403
4. Iso H, et al. The relationship between green tea and total caffeine intake and risk for self-reported type 2 diabetes among Japanese adults. Ann Intern Med 2006; 144: 554–62
5. Pereira MA, et al. Coffee consumption and risk of type 2 diabetes mellitus: an 11-year prospective study of 28 812 postmenopausal women. Arch Intern Med 2006; 166: 1311–16
6. Smith B, et al. Does coffee consumption reduce the risk of type 2 diabetes in individuals with impaired glucose? Diabetes Care 2006; 29: 2385–90.

💊 Preparations

Proprietary Preparations

Arg.: Radite; Braz.: Guarafort; Fr.: Camiline; Ger.: Carbo Konigsfeld; Ital.: Categ; UK: Yariba; USA: Tegreen. Multi-ingredient: Arg.: Centella Incaico; Energy Plus; Ginkgo Biloba Memo Diates; Guarana Diates; Ikx Gel Reductor; Yerba Diet; Austral.: Avena Complex; Bioglan 3B Beer Belly Buster; Infant Tonic†; Irontona; Vig; Vig Recovery†; Vig†; Vitanox; Vitatona; Braz.: Astenol†; Derm’attive 10†; Gastrogenol†; Kola Fosfatada Soel†; Canad.: Biotrim†; Energy Plus†; Cz.: Abfuhr-Heilkrautertee†; Fr.: Biotone†; Drainuryl; Filigel; Maxidraine†; Mincifit; Promincil†; Quintonine; Tealine†; Tonactil†; Uromil; YSE; Ger.: Cardibisana†; Myrrhinil-Intest; Nieroxin N†; Ramend Krauter†; Hong Kong: LEAN Formula w/ Advantra†; Wari-Procomil; Indon.: F-Slim; Lycoq; Irl.: Biofreeze; Ital.: Altadrine; Biomineral 5-Alfa Shampoo; Calmason; Chinoidina†; Dam; Four-Ton; Ginkoba Active; Memorandum; Snell Cell; Mex.: Noxivid; Philipp.: Fitrum; Jamieson Total Energy; Memory DD; Nutrafit; Pol.: Cardiol C; Penigra; Tobacoff; Port.: Lipoforte†; Rus.: Insti (Инсти); Spain: Exodren; Fitosvelt†; Rimagrip; Vigortonic; Thai.: Wari-Procomil†; UK: Biofreeze; Chlorophyll; Cleansing Herbs; Daily Fatigue Relief; Damiana and Kola Tablets; Glykola; Labiton†; Lion Cleansing Herbs; S.P.H.P.; Strength; Zotrim; Venez.: Demerung; Eufytose†.
Published May 08, 2019.