Sleep Aids And Stimulants (cont.)
What stimulant products are available OTC?
Persons with insomnia often suffer from fatigue as a
result of sleep deprivation. Stimulant products are
frequently used in an attempt to offset fatigue and other
unpleasant side effects that can accompany a lack of sleep.
(These products are also used by persons who need to stay
awake for longer periods of time than is normal for them,
such as school examinations or long distance driving.)
However, the use of stimulant products can also cause
insomnia, leading to a counterproductive effort to deal
with sleep deprivation.
Caffeine
Caffeine (for example,
NoDoz, Caffedrine) is the sole active
ingredient in most non-prescription stimulants. It is the
only drug approved by the FDA for this purpose. Caffeine is
used for improving alertness and for staying awake.
Caffeine is a powerful stimulant, but tolerance (the need
to use increasing amounts) can be developed. Caffeine also
is present in medications for menstrual cramps, headaches,
and colds. Additionally, caffeine is found in coffee, tea,
and chocolate.
Caffeine increases alertness by stimulating the nerves
in the brain and spinal cord. It decreases muscle fatigue
by stimulating muscle contraction. Caffeine also increases
the heart rate and the force of contraction of the heart.
The effect of caffeine varies among individuals and some
people are only affected minimally.
Pregnancy and Lactation: Studies have shown that
moderate caffeine intake does not cause low birth weights,
miscarriages, or premature births. However, there are
reports of birth problems in women who consume more than
300 milligrams per day of caffeine. Therefore, daily
caffeine intake should probably be limited to less than 300
milligrams during pregnancy.
Caffeine is secreted into breast milk. The concentration
of caffeine in breast milk is approximately one-percent of the
amount in the mother's blood. A lack of sleep and
irritation may occur in breastfed infants whose mothers
consume more than 600 milligrams of caffeine per day. No
adverse effects have been noted in breastfed infants whose
mothers consume between 200-336 milligrams per day of
caffeine. A mother can limit the amount of caffeine her
infant receives by limiting the amount of her caffeine
intake and ingesting the caffeine after nursing.
Children: Caffeine is not recommended for children less
than 12 years of age.
Drug Interactions: Cimetidine (Tagamet),
norfloxacin
(Noroxin),
ciprofloxacin (Cipro), and the
estrogens in
oral
contraceptives block the break-down and elimination of
caffeine from the body. Use of caffeine with these drugs
could lead to increased levels of caffeine in the body and,
therefore, a higher likelihood of side effects.
Caffeine decreases the absorption of iron tablets. Iron
should be administered one hour before or two hours after the
consumption of caffeine.
Caffeine decreases the effects of sedatives, and
sedatives decrease the restlessness, alertness, and arousal
that is caused by caffeine.
Adverse Effects: The most common adverse effects of
caffeine are insomnia, nervousness, excitement, headaches,
vomiting, diarrhea, and stomach pain. Caffeine also causes
abnormal heartbeats and increases heart rate.
Dependence can occur from the regular use of caffeine.
If caffeine intake is stopped suddenly, a withdrawal
reaction that consists of fatigue, headaches, anxiety,
vomiting, and restlessness may occur. Symptoms of
withdrawal start 12-24 hours after the last consumption of
caffeine and may last for a week.
References: American Insomnia Association; "Medications for Insomnia." HELPGUIDE.org;
"Sleeping Pills and Sleep Medications for Insomnia." FDA News; "FDA Requests Label Change for All Sleep Disorder Drug Products." Medical Guide.org.
Last Editorial Review: 1/14/2009
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