Paging Dr. Frischer: Coffee and Medications
Did you know that two of every three American adults drink coffee, and that they average two to three cups every day? Now consider that some 70% of adults take at least one medication per day. This means that every day, most adults drink coffee and take medication. Are there medications that should not be taken with a cup of coffee?
Some of us have issues with caffeine, including nausea, heartburn, sleep problems, and anxiety. It can increase the risk of heart disease for those who are already at risk. It can cause palpitations, and worsen tremors. Pregnant women who consume large amounts of caffeine may raise the chance of preterm birth and even miscarriage.
One more problem with caffeine is that it can interfere with how our body absorbs or reacts to a number of common medications. Caffeine could reduce the effectiveness of a drug, or increase the risk of side effects. Here are some medications which should not be taken with coffee:
Anticoagulants (blood thinners): These are often prescribed for those at high risk of blood clots. Caffeine increases the concentration of this medication in the bloodstream, enhancing its effects, and could increase the risk of bleeding.
Antidepressants: Drinking large amounts of coffee and other highly caffeinated drinks can reduce the medication’s absorption, slow its metabolism (especially with the older antidepressants, like tricyclics), and worsen side effects like anxiety, insomnia, and heart palpitations. These effects depend on the particular antidepressant.
Antipsychotic medications: Caffeine interacts with antipsychotics by interfering with liver metabolism and receptor pathways. When the breakdown of the medication is blocked, levels of the drug in the blood go up, which increases the risk of side effects.
Asthma medication: Bronchodilators can cause restlessness, racing heart, headache and irritability, and caffeine can worsen these side effects. In addition, caffeine can reduce the amount of medication absorbed by the airways.
Blood pressure medication: Untreated hypertension can lead to heart disease, kidney failure, and stroke. Some blood pressure medications (including Inderal and Lopressor) reduce the strain on the heart by lowering the heart rate. Drinking coffee at the same time may result in less of the drug being absorbed, as well as increasing the heart rate.
Dementia medication: Caffeine decreases how much of a cholinesterase inhibitor reaches the brain.
Cold and allergy medication: Many of these medications (including, but not limited to, Sudafed) contain pseudoephedrine, which can act as a central nervous system stimulant. Its effects are similar to that of caffeine and may increase the risk of side effects like restlessness, heart palpitations, and trouble sleeping. The letter D will often appear in the name of antihistamines which contain pseudoephedrine (Claritin-D, Zyrtec-D, Allegra-D).
Diabetes medication: Caffeine can make it more difficult to manage diabetes because it raises blood glucose levels and insulin. This could worsen diabetes symptoms and interfere with glucose control.
Osteoporosis medication: Medications like Fosamax, Actonel and Boniva strengthen bones and reduce fracture risk. Drinking coffee and other highly caffeinated drinks affects the absorption of these drugs, and can make them less effective.
Antibiotics: Quinolone antibiotics like Ciprofloxacin and Levofloxacin treat bacterial infections. These antibiotics can enhance the effects of caffeine and increase the risk of side effects like heart palpitations and restlessness.
Thyroid medications: Those with hypothyroidism have low levels of thyroid hormone. Proper absorption and effectiveness require that these medications be taken separately from other foods or medicines.
Melatonin: Caffeine acts as a stimulant, and melatonin is a natural hormone made by the body that helps us to feel sleepy. Taking them together is counterproductive.
If you are taking any of these medications and you love your coffee, I urge you to ask your healthcare provider or your pharmacist for advice. Depending on the medication, the amount of caffeine, and each individual’s metabolism, 30 minutes to two hours may need to pass in between. Note that while decaffeinated coffee does contain some caffeine (between three and 15 milligrams) it could be a better alternative.