May 2003

Dear Readers: Here's the Article for this Month:

Name of article:

Symptomatic uses of caffeine in patients with cancer

Author(s): Paolo Manfredi and Gilbert R. Gonzales

Reference: Journal of Palliative Care 2003; 19/1: 63-65 (Front Line Dispatch)

Abstract: 

The Authors report a short revision of the literature regarding the symptomatic uses of caffeine in cancer patients.

Caffeine is a methylxanthine with a chemical structure similar to theophylline. Caffeine acts through the blockage of the methylxanthine-sensitive adenosine receptors.

In adults, caffeine has an half-life of 3-4 hours, it is metabolized in the liver to about 25 metabolites and it is excreted by the kidneys. Caffeine crosses the blood-brain barrier quickly thus stimulating the CNS. It induces other effects such as heart stimulation, smooth muscle relaxation and increased gastric acid secretion.

In non cancer patients, the use of caffeine is effective: 1. as a potent central stimulant on respirations in apnea of prematurity; 2. as adjuvant potentiating analgesic drugs in children, headache, in pain caused by sore throat and in pain following third molar extraction; 3. as antiasthenic drug; 4. to maintain the cognitive and psychomotor performance throughtout the day and evening. As far as cancer patients are concerned, the efficacy of caffeine has been studied particularly on the neuropsychological effects (sedation, impaired concentration, cognitive failure) in patients treated with opioid analgesics.

According to reported data in literature, neuropsychological symptoms are more frequent at the onset of treatment and after opioid dose increases (i.e.after the administration of rescue doses of short-release opioids for breakthrough pain). In a randomized controlled study carried out on patients with advanced cancer and treated with morphine, the administration of 200 mg of caffeine showed an amelioration of the cognitive performance with respect to the placebo (Mercadante S. et al. J Pain Symptom Manage 2001; 21: 269-372).

Moreover caffeine is able to reduce the sedative effect of benzodiazepines and potentiate the effects of other analgesics. In general caffeine is well-tolerated with few side effects such as mild agitation, palpitations and dyspepsia.

While awaiting further studies able to define the effective dose of caffeine, the Authors propose to titrate the dose up to 200 mg four times a day on an as-needed basis to manage the sedation in patients on opioids for treating cancer-related pain.

Why I chose this article.

Caffeine is a well-tolerated, low cost psychostimulant available in some countries as pharmacological preparation and anywhere as a beverage. The use of caffeine as a psychostimulant may be considered as first choice to manage the opioid-induced neuropsychological effects before prescription of drugs such as methylphenidate and dextroamphetamine.

Regards,

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC