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Found an awesome way to see how a cup of coffee interacts with Meds

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I was hunting around my Epocrates phone app (wonderful source of clear PI info because it's meant for providers -- it also has an online site if you don't have space on your phone)  and came across an OTC med called Vivarin.  I've never seen it... but it's basically straight 200mg of caffeine.  That's pretty much exactly what you get in one (real ~10oz) mug of drip coffee. (http://www.caffeineinformer.com/caffeine-content/coffee-brewed).  There are variations in bean strength and brand - but all us coffee lovers know that the "official" tbl amount on the bag is really just a suggestion that needs tweaking.

But, anyway - the take away is: this is a super-easy way to see how drinking a cup of coffee will affect your medications.  I think it's far better than just looking at caffeine in general, because the dosing is actually indicative of true intake.  And, because it includes a number of MI meds.. I feel it's pretty relevant.


Like, for example: When looking at Vivarin + Fluvoxamine on Epocrates you get:

decr. caffeine dose or limit caffeine consumption: combo may incr. caffeine levels, risk of cardiovascular and CNS stimulatory effects, toxicity (hepatic metab. inhibited)

The same interaction also shows up on the drugs.com checker.. but IMO it's either too simplistic or overly wordy:

Consumer: Using caffeine together with fluvoxaMINE may increase the effects of caffeine. Contact your doctor if you experience nausea, vomiting, headache, nervousness, irritability, agitation, restlessness, insomnia, ringing in the ears, tremors, and increased heart rate . If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Pro: MONITOR: Coadministration with fluvoxamine may increase the plasma concentrations of caffeine in a dose-dependent manner. The proposed mechanism is fluvoxamine inhibition of CYP450 1A2, the isoenzyme responsible for the metabolic clearance of caffeine. In 12 healthy volunteers, pretreatment with fluvoxamine for 7 days (10 mg once or twice a day) resulted in a 2-fold increase in the mean 24-hour area under the plasma concentration-time curve (AUC) of a single 100 mg oral dose of caffeine. When the dosage of fluvoxamine was increased (25 mg once or twice a day for 7 days), the mean 24-hour AUC of single-dose caffeine increased 5-fold. The peak plasma concentration (Cmax) of caffeine increased 40% and 141%, respectively, during these treatment phases. Another study found that fluvoxamine (50 mg daily for 4 days, then 100 mg daily for 8 days) decreased the median total clearance of a single 200 mg oral dose of caffeine by 80% and increased the half-life from 5 to 31 hours in eight healthy volunteers.

MANAGEMENT: Caution is advised if caffeine is administered concurrently with fluvoxamine. Dosage adjustment should be considered in patients who experience excessive adverse effects of caffeine such as nausea, vomiting, headache, nervousness, irritability, agitation, restlessness, insomnia, tinnitus, tremors, and tachycardia. Alternatively, use of a selective serotonin reuptake inhibitor that does not significantly affect CYP450 1A2 activity (e.g., citalopram, escitalopram, fluoxetine, paroxetine, sertraline) may be considered.

Hence, it basically says the same thing, but Epocrates is much more direct and clear.

(For those inclined: They do give you the Vivarin pharmacology in a latter section - save the whole dose-dependent interaction mess, which is likely directly pulled from the full PI sheet.)


So, beyond my obvious pimping of Epocrates :P ... I really do think it would be helpful to add Vivarin to our interaction checks if we drink coffee.  We all know about the extra stimulation, but in some interactions (like with Cymbalta) it actually increases the med instead.

Just my two cents...

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Um, drinking a cup of coffee over 30 minutes is different than taking a pill all at once.  Speaking as someone who has consumed a lot of coffee, vivarin, and pretty much every legal and illegal stimulant there is, they really aren't the same.

The amount of caffeine in cup of coffee varies greatly depending on the kind of bean, the kind of roast, preparation method, etc.  6 fl oz of espresso is nothing like 6 fl oz of "decaf" (and yes, a cup of decaf still has more caffeine than a can of Pepsi). 


Also, tolerance.  If you've been drinking a pot of coffee a day for 20 years, you're not going to have the same side effects from interaction as from if you'd been on a med for 20 years then drank your first cup of coffee.




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  • 2 weeks later...

Well, I'd argue that most pills dissolve in roughly 45 mins on average.. so that and taking 30 mins to drink a cup isn't so different.  But my main point is actually that it can be used as a way to input the fact that you simply drink coffee into the interaction checker.

The average drip coffee is still roughly 200mg.  It can definitely be less or more depending on brand, but it's not a bad estimate.  I did include a link to different brand rankings for that reason.  As for espresso - you can't use oz for that.  A shot of espresso is roughly a whole cup of drip coffee.  It's way more concentrated.  (Although, interestingly enough, for me, it mostly lacks the adrenal activation of drip.  I have no idea why that is.)

The reason I mention it is that you can't put "cup of coffee" in a checker.. but this med is basically the equivalent and it's recognized.  I think that's helpful.

I completely agree with you on tolerance.  It's more the metabolic factors that I'd consider useful -- but even that varies with individuals (rapid, slow, and if it even translates into a difference).

But when you get to the point where you're actually looking at med metabolism to get things to work, it can't hurt to have the info.

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