Caffeine
1. Identity: Chemical Names, Botanical Sources, and Common Forms
1.1 Chemical and Systematic Nomenclature
Caffeine (1,3,7-trimethylxanthine) is a plant alkaloid with a chemical structure of C8H10N4O2 and a molecular weight of 194.19. It is a bitter, white crystalline purine, a methylxanthine alkaloid, and is chemically related to the adenine and guanine bases of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). Structurally, caffeine and the other methylxanthines resemble the purines. Among its numerous synonyms catalogued by the NIST Chemistry WebBook are guaranine, theine, mateina, methyltheobromine, and 3,7-dihydro-1,3,7-trimethyl-1H-purine-2,6-dione — names that historically distinguished the compound when first isolated from different botanical sources, before its chemical identity was unified.
1.2 Natural Botanical Sources
Caffeine is found in the seeds, fruits, nuts, or leaves of a number of plants native to Africa, East Asia, and South America, where it helps to protect them against herbivores and from competition by preventing the germination of nearby seeds, as well as encouraging consumption by select animals such as honey bees. The most common sources of caffeine for human consumption are the tea leaves of the Camellia sinensis plant and the coffee bean, the seed of the Coffea plant.
At present there are 63 different species of plants known to contain caffeine. Historically, the most common food sources of caffeine in the human diet have been coffee (from the coffee plant, Coffea sp.), tea (from the tea plant, Camellia sinensis), and chocolate (from the cacao plant, Theobroma cacao). Some less common sources include cassine (Ilex vomitoria), yoco (Paullinia yoco), maté (from yerba maté, Ilex paraguariensis), and guaraná (Paullinia cupana).
Genomic researchers, including the team led by Denoeud et al. in 2014, concluded that this seemingly unrelated group of plants evolved independently, but in the same direction, to produce caffeine in order to deter predators from consuming their leaves.
1.3 Common Forms and Preparations
In its pure form, caffeine is a bitter white powder. It is encountered by consumers in a wide variety of forms: as naturally occurring constituent of brewed beverages (coffee, tea, maté, guaraná drinks, cocoa), as an added ingredient in cola-type soft drinks and energy drinks, and as an isolated supplement in capsules, tablets, powder, chewing gum, and time-release formulations. Time-release caffeine supplements have been developed to prolong the effects of caffeine. Global consumption of caffeine has been estimated at 120,000 tonnes per year, making it the world's most popular psychoactive substance.
2. Traditional and Historical Use
2.1 Tea — China and East Asia
Tea has been consumed in China for thousands of years, where it has been purported to have been discovered by the Chinese emperor Shen Nung in 2737 BCE. Traditional stories tell that monks drank tea to stay awake during meditation practice.
2.2 Coffee — Ethiopia and the Arab World
There is a popular Ethiopian legend wherein coffee is discovered by a goat herder named Kaldi, who found his goats frolicking and full of energy after eating the red fruit of the coffee shrub. Kaldi tried the fruit for himself and had a similar reaction. After witnessing their strange behavior, a monk took some of the fruit back to his fellow monks; they too spent the night awake and alert. Although the Arabs cultivated the plants and prepared drinks from coffee beans, it was only by the fourteenth century that the process of roasting was discovered. And only when this happened did the use of coffee rapidly spread in the Arab world.
By the 15th century, coffee had made its way to Yemen, where Sufi monks used it during religious ceremonies to stay alert. In the Muslim world, the need for a social drink was filled by coffee and the beverage was consumed both at home and in coffee bars. The fact that these coffee houses developed into independent intellectual centers was perceived as a threat to the authorities, and sometimes they were forced to close. Already in the sixteenth century, health arguments were used, for example, when Kair Bey, the governor of Mecca, prohibited the use of coffee in 1511. The appreciation of coffee as a beverage in Europe, where it was first known as "Arabian wine," dates from the 17th century. During this time "coffee houses" were established, the first being opened in Constantinople and Venice.
2.3 Cacao — Mesoamerica
Cacao, native to Mesoamerica, provided another source of caffeine. Aztecs and Mayans consumed cacao as a bitter, spiced beverage, believing it to have divine and energizing properties. Even the Americas had their version of a caffeinated drink made from cacao. The first civilization to utilize it were the Olmecs of Mexico. The drink was passed on to the Izapa, the Mayans, and finally to Europeans, who used the cacao beans to make confections.
2.4 Guaraná and Yerba Maté — South America
Maté is made from a South American evergreen tree (Ilex paraguariensis) whose leaves contain caffeine. Maté is customarily consumed as a tea-like beverage. Guaraná is a vine that climbs trees in South America, and grows as a shrub when cultivated in the open. Its botanical name is Paullinia cupana H.B.K., variety sorbilis.
2.5 Isolation as a Pure Compound
Caffeine was first extracted from cocoa beans into its purest form — a white powder — in the 1820s by a German scientist named Friedrich Ferdinand Runge. The isolation of the pure compound allowed systematic pharmacological study to begin, eventually revealing that the "theine" of tea, the "guaranine" of guaraná, and the "caffeine" of coffee were identical molecules.
3. Key Constituents and Active Compounds
3.1 Caffeine as the Principal Active Compound
Caffeine is itself the primary bioactive molecule of interest across all its botanical sources. Its principal pharmacological metabolite is paraxanthine. In humans, N-3 demethylation of caffeine (1,3,7-trimethylxanthine) to paraxanthine (1,7-dimethylxanthine) is the main reaction in the metabolism of caffeine, accounting for around 80–90% of caffeine demethylation. This reaction is exclusively mediated by the cytochrome P450 isoform CYP1A2. The remainder of caffeine is metabolized to approximately 11% and 4% to the 1-demethylated product theobromine and 7-demethylated product theophylline, respectively.
Additional methylxanthines present alongside caffeine in some source plants include 1,3-dimethylxanthine (theophylline, present in tea) and 3,7-dimethylxanthine (theobromine, present in cacao). These co-occurring methylxanthines have their own pharmacological profiles but are typically present at lower concentrations than caffeine in most consumed preparations.
4. Mechanisms of Action
4.1 Adenosine Receptor Antagonism
Caffeine action is thought to be mediated via several mechanisms: the antagonism of adenosine receptors, the inhibition of phosphodiesterase, the release of calcium from intracellular stores, and antagonism of benzodiazepine receptors. The ability of caffeine to inhibit adenosine receptors appears to be highly important in its effects on behavior and cognitive function. This ability results from the competitive binding of caffeine and paraxanthine to adenosine receptors and is of importance in contributing to CNS effects, especially those involving the neuromodulatory effects of adenosine.
The behavioral effects of caffeine appear likely to be due in large measure to antagonism of the action of endogenous adenosine at A1- and A2a-receptors in the central nervous system. Due to the blocking of adenosine inhibitory effects through its receptors, caffeine indirectly affects the release of norepinephrine, dopamine, acetylcholine, serotonin, glutamate, and gamma-aminobutyric acid. There are two main classes of adenosine receptor — A1 and A2; caffeine and paraxanthine are nonselective antagonists at both, although they are not especially potent antagonists. The caffeine concentrations attained in vivo that cause mild CNS stimulation (5–10 µM) and that are associated with antiasthmatic effects (50 µM) are in the range associated with adenosine receptor blockade as quantitated by in vitro receptor binding assays.
4.2 Phosphodiesterase Inhibition
Caffeine increases intracellular concentrations of cyclic adenosine monophosphate (cAMP) by inhibiting phosphodiesterase enzymes in skeletal muscle and adipose tissues. These actions promote lipolysis via the activation of hormone-sensitive lipases with the release of free fatty acids and glycerol. Other biochemical mechanisms of action of caffeine, such as release of intracellular calcium, inhibition of phosphodiesterases, and blockade of regulatory sites of GABAA receptors, would require much higher concentrations than the micromolar concentrations of caffeine associated with behavioral stimulation. Phosphodiesterase inhibition is therefore considered pharmacologically significant primarily at higher doses rather than at the concentrations typically reached with dietary intake.
4.3 Intracellular Calcium Mobilization
Caffeine is a psychostimulant with, among its mechanisms of action, mobilization of intracellular calcium. Caffeine stimulates the release and reuptake of calcium in neurons and muscle-tissue cells — an essential process in the central and peripheral nervous systems for neuronal communication and muscle contraction in the musculoskeletal system.
4.4 Downstream Neurotransmitter Effects
Caffeine and other methylxanthines antagonize adenosine, which acts as an inhibitory neurotransmitter. Long-term caffeine intake leads to an increased affinity for adenosine at its receptor, which attempts to restore the balance. By blocking adenosine's inhibitory tone, caffeine effectively disinhibits multiple excitatory and modulatory neurotransmitter systems, producing its characteristic stimulant, mood-modifying, and alertness-enhancing effects.
5. Pharmacokinetics
5.1 Absorption and Distribution
Caffeine has high oral bioavailability, with 99% of caffeine being absorbed from the gastrointestinal (GI) tract into the bloodstream 45 minutes after ingestion. Caffeine is rapidly and completely absorbed in humans, typically within 45 minutes of ingestion. Peak plasma concentrations occur between 15 and 120 minutes after oral intake. It is distributed throughout the total body water, has low plasma binding, a short half-life, negligible first-pass metabolism, minimal renal elimination, excellent tolerability, and its biotransformation is virtually confined to the liver.
5.2 Metabolism
Caffeine is primarily metabolized in the liver by the cytochrome P450 oxidase enzyme system; in particular, by the CYP1A2 enzyme. However, this oxidase enzyme system is also present in other tissues, including the brain. Caffeine is almost exclusively metabolized in the liver by the cytochrome P450 enzyme system, with 3% or less being excreted unchanged in urine. Large variation exists in the consumption of caffeine-containing beverages and food between individuals, which can induce CYP1A2 activity. CYP1A2 activity and protein amount are affected by environmental, genetic, and epigenetic factors, resulting in large variation of between 5- to 6-fold in humans.
5.3 Half-Life and Elimination
The mean half-life of caffeine in the plasma of healthy individuals is about 5 hours. However, caffeine's elimination half-life may range between 1.5 and 9.5 hours, while the total plasma clearance rate for caffeine is estimated to be 0.078 L/h/kg. This wide range in the plasma mean half-life of caffeine is due to both innate individual variation and a variety of physiological and environmental characteristics that influence caffeine metabolism, including pregnancy, obesity, oral contraceptive use, and smoking status.
6. Scientific Evidence by Area of Use
6.1 Alertness, Wakefulness, and Cognitive Performance
Caffeine has numerous pharmacological and physiological effects, including cardiovascular, respiratory, renal, and smooth muscle effects, as well as effects on mood, memory, alertness, and physical and cognitive performance.
Numerous studies have shown that the qualitative subjective effects of caffeine are dose dependent, with lower doses (20–200 mg) producing predominantly positive subjective effects, such as well-being, energy, and alertness. Higher doses (300–500 mg) produce predominantly dysphoric subjective effects.
A 2021 systematic review and meta-analysis (PRISMA guidelines, 13 randomized crossover studies, published in Nutrients / PMC) examined caffeine's effects on cognitive performance in athletes. The results of the 13 studies suggest that the intake of a low/moderate dose of caffeine before and/or during exercise can improve self-reported energy, mood, and cognitive functions, such as attention; it may also improve simple reaction time, choice reaction time, memory, or fatigue, however, this may depend on the research protocols. Overall, the results indicated that caffeine improves attention performance (relative to a placebo) in athletes taking caffeine supplements before the start of their routine training or sports exercise. The strength of this evidence is moderate to good for attention and reaction time; evidence for higher-order cognitive domains such as inhibitory control is less consistent.
6.2 Physical and Athletic Performance
Improvements in physical performance were widely documented with caffeine, including greater distance coverage, high-speed distance coverage, and impact frequencies. From three studies that assessed technical skills, it appears caffeine may benefit gross-skill performance, but have no effect, or negatively confound finer technical-skill outcomes. There is compelling evidence that ingesting moderate caffeine doses (~3 to 6 mg·kg−1) approximately 60 minutes before exercise may improve physical performance in team sports, whereas evidence is presently too scarce to draw confident conclusions regarding sport-specific skill performance.
Results of systematic review show that caffeine improves anaerobic capacity and endurance, while placebo perceived as caffeine can also increase performance by reducing pain and improving concentration. This placebo component deserves acknowledgment in interpreting magnitude-of-effect estimates. The overall quality of athletic-performance evidence is strong for endurance performance and moderate for team-sport physical output, based on multiple double-blind randomized crossover trials.
6.3 Neuroprotection: Parkinson's Disease
The first evidence for the potential neuroprotective effect of caffeine came from the Honolulu Heart Program, a large prospective study of 8,004 Japanese-American men over a 30-year follow-up. The study revealed that daily consumption of coffee during mid-life reduced the risk for developing Parkinson's disease (PD) at age 65 by 5-fold compared to non-coffee drinkers, after age- and smoking-adjustment.
Epidemiological studies and clinical reports suggest that caffeine consumption is closely associated with a reduced risk of neurodegenerative diseases including Alzheimer's disease, Parkinson's disease, and dementia. Animal studies provide a neurobiological basis for the inverse relationship between caffeine consumption and the reduced risk of developing PD, and support the clinical potential for caffeine and A2AR antagonists as a disease-modifying drug target for PD. However, these are largely observational and mechanistic findings; randomized controlled trials confirming that caffeine supplementation reduces incident PD in humans are not yet established.
6.4 Neuroprotection: Alzheimer's Disease and Dementia
There is suggestive evidence from clinical studies that caffeine is neuroprotective against dementia and possibly Alzheimer's disease (AD) (20 out of 30 studies support this), but further studies are required to prove this link. Clinical studies also indicate that caffeine is a cognitive normalizer and not a cognitive enhancer. Furthermore, clinical studies suggest the neuroprotective effect of caffeine might be confounded by gender.
According to collected overall findings, caffeine may reduce elevated oxidative stress; inhibit the activation of adenosine A2A, thereby regulating the accumulation of amyloid-β; reduce the hyperphosphorylation of tau; and reduce the accumulation of misfolded proteins, such as α-synuclein, in Alzheimer's and Parkinson's diseases. Although caffeine has shown potent anti-inflammatory and antioxidant effects both in vitro and in vivo in animal studies, the evidence is inconclusive of its clinical outcomes in humans. Currently, evidence supporting the use of caffeine as a drug in subjects with neurodegenerative diseases is insufficient. The overall evidence strength is therefore: observational (epidemiological) data are encouraging; preclinical mechanistic data are substantial; human RCT evidence is insufficient.
6.5 Cardiovascular System
Caffeine is a frequently consumed stimulant in coffee, tea, chocolate, sodas, and energy drinks. While its effects on the cardiovascular system have been extensively studied, there remains controversy surrounding its potential risks, particularly in patients with heart disease. A comprehensive overview of caffeine's pharmacological properties, sources, and cardiovascular effects emphasizes its arrhythmogenic potential. Mechanisms of cardiovascular action include adenosine receptor antagonism, phosphodiesterase inhibition, calcium mobilization, and catecholamine release.
No consistent evidence of increased cardiovascular risk exists at normal consumption levels. Sleep disturbance has been noted above 3 mg/kg taken near bedtime. High single doses (>500 mg) can cause transient anxiety, tachycardia, or jitteriness. The EFSA 2015 scientific opinion assessed cardiovascular safety based on a large body of evidence; the absence of consistent risk at moderate intakes is noted, but individual susceptibility remains a variable.
6.6 Respiratory System
It has been well known for a long time that caffeine (and some of its metabolites) can influence respiration and can be used to treat asthma, and that there are increases in cardiac activity and blood pressure, and that methylxanthines have marked renal effects. Theophylline, a structurally related methylxanthine and minor caffeine metabolite, has been used as an established bronchodilator. Caffeine itself, at higher pharmacological concentrations, produces similar respiratory stimulant effects via adenosine antagonism in brainstem respiratory centers; this underlies its clinical use (as injectable caffeine citrate) in treating apnea of prematurity in neonates.
6.7 Metabolic Effects: Lipolysis and Body Composition
Caffeine increases intracellular concentrations of cyclic adenosine monophosphate (cAMP) by inhibiting phosphodiesterase enzymes in skeletal muscle and adipose tissues. These actions promote lipolysis via the activation of hormone-sensitive lipases with the release of free fatty acids and glycerol. The repeated administration of caffeine does not change its pharmacokinetics, but in many cases development of tolerance does occur. Tolerance is not observed for all effects of the drug, such as fat cell lipolysis, but is seen for certain behavioral actions, such as some of its stimulant properties. Accordingly, lipolytic effects observed acutely may diminish with habituation.
7. Body Systems and Health Areas Associated with Caffeine
- Central Nervous System: Stimulation of alertness, reduction of perceived fatigue, mood modulation, and potential neuroprotection via adenosine receptor blockade and modulation of dopaminergic, cholinergic, and glutamatergic pathways.
- Cardiovascular System: Transient increases in heart rate and blood pressure, particularly at higher doses or in non-habituated individuals; adenosine antagonism affects vascular tone; arrhythmogenic potential at high doses is an area of ongoing investigation.
- Respiratory System: Bronchodilation via adenosine antagonism and smooth muscle relaxation; clinically used to treat neonatal apnea of prematurity.
- Musculoskeletal System: Enhancement of muscle contractility via calcium mobilization and cAMP-mediated signaling; contributes to ergogenic effects on physical performance.
- Metabolic/Adipose System: Acute promotion of lipolysis and free fatty acid release via phosphodiesterase inhibition and cAMP elevation.
- Renal System: Methylxanthines have marked renal effects, including mild diuresis, though tolerance to this effect develops in habitual consumers.
- Reproductive System/Fetal Development: Caffeine crosses the placenta and the fetal liver is deficient in the enzymes needed to metabolize it, prolonging fetal exposure; epidemiological data link high intake to reduced birth weight.
8. Dosage Forms and Dosages Reported in Studies
8.1 Regulatory Reference Values
Single doses of caffeine up to 200 mg (about 3 mg/kg body weight for a 70-kg adult) do not give rise to safety concerns. The same amount does not give rise to safety concerns when consumed less than 2 hours prior to intense physical exercise under normal environmental conditions.
For regular consumption, EFSA concluded that caffeine consumption up to 400 mg over the course of 24 hours is not likely to cause any harm to the adult consumer.
Daily caffeine intakes from all sources up to 200 mg per day by pregnant women do not raise safety concerns for the fetus.
8.2 Dosages Used in Clinical Studies
- Cognitive and sports performance: Compelling evidence exists that ingesting moderate caffeine doses (~3 to 6 mg·kg−1) approximately 60 minutes before exercise may improve physical performance in team sports.
- Subjective effects: Lower doses (20–200 mg) produce predominantly positive subjective effects such as well-being, energy, and alertness. Higher doses (300–500 mg) produce predominantly dysphoric subjective effects.
- Tolerance induction (experimental): A 300-mg challenge to caffeine-free individuals caused tension, anxiety, and jitteriness, compared to a total absence of effect among individuals receiving a chronic dose of 900 mg per day.
- Withdrawal studies: Withdrawal symptoms have been documented after relatively short-term exposure to high doses of caffeine (6–15 days of greater than or equal to 600 mg/day).
- Drug interaction study (fluvoxamine): A crossover study administered 200 mg caffeine orally, and subjects separately took fluvoxamine 50 mg per day for 4 days and 100 mg per day for 8 days, after which they again ingested 200 mg caffeine.
- Time-release formulation: A time-release supplement containing 194 mg of caffeine reached peak plasma caffeine concentration of 1.88 ± 0.46 mg/L at 6 hours following ingestion, while the equivalent regular caffeine capsule rapidly reached peak plasma caffeine concentration of 2.40 ± 0.40 mg/L at 3 hours.
- EFSA acute safe dose: For the general population, excluding pregnant women, the safe daily dose is set at 400 mg caffeine per day and 200 mg caffeine per occasion.
9. Safety Considerations and Drug Interactions
9.1 Tolerance
The repeated administration of caffeine does not change its pharmacokinetics, but in many cases development of tolerance does occur. Tolerance is not observed for all effects of the drug, such as fat cell lipolysis, but is seen for certain behavioral actions, such as some of its stimulant properties.
9.2 Dependence and Withdrawal
Regular use can produce physical and psychological dependence. Abrupt cessation may precipitate a clinically significant withdrawal syndrome that is recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
Caffeine withdrawal most commonly manifests with headache, fatigue or drowsiness, decreased alertness, depressed or irritable mood, difficulty concentrating, and flu-like symptoms such as nausea, muscle pain, or stiffness.
In humans, a review of 37 clinical reports and experimental studies dating back to 1833 shows that headache and fatigue are the most frequent withdrawal symptoms, with a wide variety of other signs and symptoms occurring at lower frequency, such as anxiety, impaired psychomotor performance, nausea/vomiting, and craving. When caffeine withdrawal occurs, severity can vary from mild to extreme (incapacitating). The withdrawal syndrome has an onset at 12–24 hours, peak at 20–48 hours, and a duration of about 1 week.
9.3 Pregnancy
The caffeine dose of 200 mg per day is declared as safe for pregnant women with respect to the fetus by EFSA, based on results on reduced birth weight in epidemiological studies. Fetal metabolism of caffeine is slower, prolonging exposure. Of particular concern is the rate of caffeine intake among populations potentially vulnerable to the negative effects of caffeine consumption: pregnant and lactating women, children and adolescents, young adults, and people with underlying heart or other health conditions, such as mental illness.
9.4 CYP1A2-Mediated Drug Interactions
Smoking and diets rich in cruciferous vegetables induce CYP1A2 gene expression, resulting in enhanced caffeine clearance. Conversely, alcohol consumption, oral contraceptives, fluvoxamine, and quinolone antibiotics are known to inhibit CYP1A2 activity, lower caffeine clearance, and increase both the area under the plasma concentration time curve and the elimination half-life.
A number of drugs, including certain selective serotonin reuptake inhibitors (particularly fluvoxamine), antiarrhythmics (mexiletine), antipsychotics (clozapine), psoralens, idrocilamide, phenylpropanolamine, bronchodilators (furafylline and theophylline), and quinolones (enoxacin), have been reported to be potent inhibitors of this isoenzyme. Pharmacokinetic interactions at the CYP1A2 enzyme level may cause toxic effects during concomitant administration of caffeine and certain drugs used for cardiovascular, CNS, gastrointestinal, infectious, respiratory, and skin disorders.
Interaction between caffeine and fluvoxamine has been described in vivo, leading to a lowering of the total clearance of caffeine by 80% during fluvoxamine intake. Other SSRIs did not exhibit significant pharmacokinetic interactions with caffeine. However, caffeine enhanced the antidepressant effects of fluoxetine and escitalopram while increasing the drug concentration of plasma serum paroxetine.
9.5 Interaction with Adenosine-Based Medications
Because caffeine is a competitive adenosine receptor antagonist, its use may interfere with adenosine administered for diagnostic cardiac stress testing (pharmacological adenosine must achieve receptor occupation that caffeine competes for). Patients undergoing such testing are typically instructed to abstain from caffeine for a defined period. Caffeine action is mediated in part via antagonism of adenosine receptors, providing the mechanistic basis for this clinically recognized interaction.
9.6 High-Dose and Vulnerable Populations
For healthy adults, caffeine consumption is relatively safe, but for some vulnerable populations, caffeine consumption could be harmful, including impairments in cardiovascular function, sleep, and substance use. For children and adolescents, the information available is insufficient to base a safe level of caffeine intake.
Withdrawal symptoms from caffeine can closely resemble psychiatric disorders such as anxiety and mood disturbances, often accompanied by abnormal vital signs, necessitating careful evaluation by emergency and hospital physicians to avoid unnecessary diagnostics.
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