Pharmacokinetic-pharmacodynamic modeling of caffeine: tolerance to pressor effects

The effects of caffeine on ambulatory blood pressure, heart rate, and mood in coffee drinkers

The present study examined the effects of caffeine, as typically ingested through coffee, on ambulatory systolic and diastolic blood pressure (BP), heart rate, and mood. Normotensive coffee drinkers wore a BP monitor for two 24-hr periods, consuming decaffeinated coffee. Each cup was supplemented with 125 mg caffeine or cornstarch. Systolic and diastolic BPs were elevated on the day caffeine was consumed (maximum, 3.6 and 5.6 mm Hg, respectively), most notably shortly after ingestion. Heart rate was higher overnight following caffeine consumption. Negative Affectivity was also increased by caffeine, but Positive Affectivity and tiredness were unaffected.

A pharmacokinetic-pharmacodynamic model of tolerance to morphine analgesia during infusion in rats

A pharmacokinetic-pharmacodynamic (PK-PD) model was constructed to describe the kinetics of tolerance development to morphine-induced antinociception. Tail-flick latencies in response to hot water (50 degrees C) were assessed in male Sprague-Dawley rats exposed to a 12-hr iv infusion of either morphine (1.4 to 3.0 mg/kg per hr) or saline. Morphine-induced antinociception, expressed as the percentage of maximum possible response (% MPR), peaked after 120 min of infusion and decreased thereafter despite sustained systemic morphine concentrations. Both the rate and extent of tolerance development increased with increasing concentrations; an overall residual effect of approximately 24% MPR was observed at the end of the infusion regardless of the steady-state morphine concentration. The kinetics of tolerance offset were examined in a separate experiment by assessing tail-flick latency 15 min after morphine iv bolus (2 mg/kg) in tolerant and control rats. Recovery of response neared completion 18.5 days after a 12-hr exposure to morphine (2.0 mg/kg per hr). A PK-PD model was constructed to account for the delay in onset of antinociceptive effect and tolerance development relative to the blood concentration-time profile. According to this model, both the extent and the rate of tolerance development were modulated by the kinetics of the drug in the central compartment. Accumulation of a hypothetical "inhibitor" acting either as a reverse agonist, a competitive or noncompetitive antagonist, or a partial agonist could potentially account for the loss of pharmacologic effect in the presence of an agonist. The rate of tolerance development predicted from the PK-PD model varied widely (28-fold) depending on the type of pharmacologic interaction selected to account for the loss of effect. Using the rate of tolerance offset to discriminate between the different models (t1/2 offset 5.4 days), onset and offset of tolerance was described accurately by postulating that the inhibitor behaves as a partial agonist with low intrinsic activity (5.5% MPR) and high binding affinity for the receptor (IC50 15.0 ng/ml).

Sympathomimetic effects of paraxanthine and caffeine in humans

Caffeine is metabolized extensively (on average 80%) to paraxanthine. With regular caffeine consumption, average serum levels of paraxanthine are two thirds those of caffeine. Both caffeine and paraxanthine competitively and nonselectively inhibit adenosine receptors in vitro. To examine the contribution of paraxanthine to the pharmacologic activity of caffeine, we administered to 12 subjects in a crossover design oral caffeine (2 or 4 mg/kg) versus placebo or oral paraxanthine (same dose as caffeine) versus placebo, each after 3 days of methylxanthine abstinence. Both caffeine and paraxanthine significantly increased diastolic blood pressure, plasma epinephrine levels, and free fatty acids. Caffeine and paraxanthine produced a similar magnitude of response at 4 mg/kg; however, caffeine appeared to produce greater responses than paraxanthine at 2 mg/kg. Caffeine and paraxanthine have similar sympathomimetic actions. The activity of paraxanthine needs to be considered in understanding the clinical pharmacology of caffeine, particularly with chronic, repetitive caffeine consumption.

Effect of caffeine on circadian excretion of urinary calcium and magnesium

OBJECTIVE

To determine if later renal conservation occurs in calcium (Ca) and magnesium (Mg) excretion after morning caffeine-induced increases in urinary Ca and Mg excretion.

DESIGN

Before-after trial of caffeine abstinance and consumption was conducted on two consecutive days in a metabolic ward while subjects ate a controlled diet containing 11.3 mmol Ca and 12.7 mmol Mg. 17 healthy males and females, ages 17-41 yr volunteered. Two caffeine doses of 3 mg/kg lean body mass caffeine were consumed at 7 and 10 a.m. on second day. Salivary caffeine concentrations and urinary Ca, Mg, sodium and creatinine excretion were measured.

RESULTS

Salivary caffeine peaked at 4.7 umol/mL at 11:30 a.m. and declined with a half-life of 7.3 hours. Urinary Ca and Mg were elevated significantly (p = 0.01 and p = 0.04) for six h after the second caffeine dose. Caffeine had no significant effect on urinary calcium or magnesium excretion between 4 p.m. and 1 a.m. Between 1 and 4 a.m., urinary Ca and Mg excretion was decreased after caffeine (p = 0.04 and p = 0.01). Creatinine excretion was not different at any time.

CONCLUSIONS

Nighttime compensatory renal conservation was insufficient to offset morning caffeine-induced mineral losses, resulting in net 24-hour urinary increases of 0.32 mmol Ca and 0.16 mmol Mg.

Tolerance to oral and IP caffeine: locomotor activity and pharmacokinetics

Locomotor activity increase was a bitonic function of acute caffeine IP doses (2.5-40 mg/kg) in rats. When the schedule-induced polydipsic, orally self-administered dose of caffeine was increased over blocks of daily 3 h sessions from 9.3 to 36.5 mg/kg, postsession activity increased monotonically as a function of dose. The rate of tolerance development to the increase in locomotor activity produced by caffeine depended on the route of administration. Tolerance onset occurred on the fourth day of chronic IP doses, but remained incomplete after 21 doses. With the highest dose level of oral caffeine self-administration, tolerance developed on day 13, but remained incomplete even after 17 doses. Acute tolerance occurred for each of the IP doses, whereas a linear relation between locomotor activity and serum caffeine concentration was obtained after oral self-administration. There were two- to threefold higher locomotor activity AUCs(4 h) with oral caffeine at three dose levels compared to the activity AUCs(4 h) for IP doses.

Caffeine effects on learning, performance, and anxiety in normal school-age children

OBJECTIVE

The purpose of this investigation was to study the acute effects of caffeine on learning, performance, and anxiety in normal prepubertal children.

METHOD

Twenty-one children were evaluated in a double-blind, placebo-controlled crossover design. Subjects were studied during four sessions, 1 week apart, under the following conditions: baseline, placebo, 2.5 mg/kg caffeine, and 5.0 mg/kg caffeine. Subjects were randomized to order of placebo and the two dosages of caffeine. Dependent measures included tests of attention, manual dexterity, short-term memory, and processing speed. Anxiety rating scales were also administered. Saliva samples were analyzed for caffeine levels.

RESULTS

Caffeine improved performance on two of four measures of the Test of Variables of Attention and on a test of manual dexterity in the dominant hand. There was a trend toward increased current level of self-reported anxiety after caffeine on a visual analogue measure of anxiety. Children reported feeling significantly less "sluggish" after caffeine ingestion than after placebo ingestion.

CONCLUSIONS

In a small sample size, there was indication that caffeine enhanced performance on a test of attention and on a motor task. Children also reported feeling less "sluggish" but somewhat more anxious. Because caffeine is so widely available and frequently consumed by children, these results are important and need replication.