Do caffeine-containing analgesics promote dependence? A review and evaluation.
OBJECTIVE
Debates about the suspected association between kidney disease and use of analgesics have led to concern about whether caffeine could stimulate an undesirable overuse of phenacetin-free combined analgesics. A committee was asked to critically review the pertinent literature and to suggest guides for clinical practice and for consideration of international regulatory authorities.


METHODS
A group of international scientists, jointly selected by the regulatory authorities of Germany, Switzerland, and Austria and the pharmaceutical industry.


METHODS
All invited experts evaluated relevant literature and reports and added further information and comments.


CONCLUSIONS
Caffeine has a synergistic effectiveness with analgesics. Although caffeine has a dependence potential, the potential is low. Experimental data regarding dependence potential for caffeine alone may not correspond to the conditions in patients with pain. Withdrawal is not likely to cause stimulation or sustainment of analgesic intake. For drug-induced headache, no single or combined analgesic was consistently identified as causative, and no evidence exists for a special role of caffeine. Strong dependence behavior was observed only in patients using phenacetin-containing preparations, coformulated with antipyretics/analgesics and caffeine. This finding may have led to the impression that caffeine stimulates overuse of analgesics.


CONCLUSIONS
Although more experimental and long-term data would be desirable to show possible mechanisms of dependence and to offer unequivocal proof of safety, the committee concluded that the available evidence does not support the claim that analgesics coformulated with caffeine, in the absence of phenacetin, stimulate or sustain overuse.
Feinstein
A R
AR
Department of Medicine and Epidemiology, Yale University School of Medicine, New Haven, CT, USA.
Heinemann
L A
LA
Dalessio
D
D
Fox
J M
JM
Goldstein
J
J
Haag
G
G
Ladewig
D
D
O'Brien
C P
CP
D000700:Analgesics / Q000009:adverse effects*; D002110:Caffeine / Q000009:adverse effects*; D004357:Drug Synergism; D019317:Evidence-Based Medicine; D006261:Headache / Q000139:chemically induced*; D006801:Humans; D010615:Phenacetin / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome; D019966:Substance-Related Disorders / Q000503:physiopathology
D000700:Analgesics; D002110:Caffeine; D010615:Phenacetin