Energy drinks may cause caffeine overdose, drug interactions

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Clinicians should be aware of the possible adverse events that adolescents who drink energy drinks can experience and should screen families to warn them about potential risks, pediatricians warn.

“Energy drinks have no therapeutic benefit, and many ingredients are understudied and not regulated,” Sara M. Seifert, BS, and colleagues from the University of Miami and the Leonard M. Miller School of Medicine, also in Miami, wrote in the March issue of Pediatrics.

The researchers reviewed 121 documents containing information about energy drinks — two-thirds of which were scientific literature — to assess adolescent consumption rates, identify potential health risks and evaluate current regulations. Other documents included reports from government agencies and interest groups, and manufacturer websites.

Children (<12 years old), adolescents (ages 12 to 18) and young adults (ages 19 to 25) are the most frequent consumers, reports indicated, accounting for 50% of the energy-drink market — the fastest growing segment of the U.S. beverage market as a whole.

Furthermore, energy drink caffeine content can be as high as three times that of regular colas — containing as much as 70 to 80 mg of caffeine per 8 oz. serving.

Risk for overdose is particularly high among young people, the researchers found, with almost half of the 5,448 caffeine overdoses reported in 2007 occurring among people aged younger than 19 years.

"Both the known and unknown pharmacology of various ingredients, combined with reports of toxicity, suggest that these drinks may put some children at risk for serious adverse health effects,” the researchers wrote.

They warned that children and adolescents with the following health problems are especially vulnerable to high doses of caffeine: children with cardiovascular, renal or liver disease; seizures; diabetes; mood and behavioral disorders; or hyperthyroidism.

However, because energy drinks are classified as dietary supplements the FDA has yet to set caffeine limits for the beverages as it does for soda.

Furthermore, adverse event reporting for energy drinks has not been accurate in the U.S. — the American Association of Poison Control did not create a unique code for energy drinks until 2010. But reports from Germany, which has maintained records since 2002, indicate that possible side effects can include liver damage, kidney failure, respiratory disorders, agitation, seizures, psychotic conditions, rhabdomyolysis, tachycardia, cardiac arrhythmias, hypertension, HF and death.

Other countries that have documented adverse events include Ireland, which recorded two deaths between 1999 and 2005, and New Zealand, which reported 20 incidents that included symptoms such as nausea, vomiting abdominal pain, “jitteriness,” racing heart and agitation.

“Until research establishes energy-drink safety in children and adolescents, regulation, as with tobacco, alcohol and prescription medication, is prudent,” the researchers wrote.

Although caffeine is the major ingredient in energy drinks, other additives can enhance caffeine concentration and may pose risks for drug interaction, the researchers warned.

Other common energy drink ingredients include kola nut, yerba mate, cocoa, taurine, L-carnitine, 5-hydroxy tryptophan, vinpocetine, yohimbine and ginseng.

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