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Fortschr Neurol Psychiatr 2020; 88(05): 318-330
DOI: 10.1055/a-0985-4236
Übersicht

Koffein, das am häufigsten konsumierte Psychostimulans: eine narrative Übersichtsarbeit

Caffeine, the most frequently consumed psychostimulant: a narrative review article
Maximilian Gahr
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
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Zusammenfassung

Koffein ist das weltweit am häufigsten konsumierte Psychostimulans. Es ist nahezu unbeschränkt verfügbar und unterliegt in Europa keiner staatlichen Regulation. Neben seiner primären Rolle als Inhalts- oder Zusatzstoff in zahlreichen Getränken findet es auch medizinische Verwendung in der adjuvanten Schmerztherapie, bei primärem Atemstillstand bei Neugeborenen und es ist zugelassen für die kurzfristige Beseitigung von Ermüdungserscheinungen. Der Wirkmechanismus von Koffein als Psychostimulans in typischerweise aufgenommen Dosierungen basiert vermutlich in erster Linie auf einem zentralen Antagonismus von Adenosinrezeptoren (A1- und A2A-Rezeptoren), was zu einer zentralen Hemmung der Adenosin-vermittelten Reduktion der Aktivität des dopaminergen und aufsteigenden Aktivierungssystems führt. Die Metabolisierung von Koffein ist hautsächlich abhängig von Cytochrom P450 1A2, sodass Faktoren, die die Aktivität von CYP 1A2 beeinflussen (z. B. Medikamente, Schwangerschaft), erhebliche Veränderungen der pharmakokinetischen Parameter induzieren können. Koffein führt insbesondere bei Individuen mit Schlafentzug zu einer Verbesserung der Vigilanz, Aufmerksamkeit und Reaktionszeit. Zudem kann es sportliche Ausdauerleistungen und muskuläre Kraft verbessern. Intoxikationen mit Koffein sind selten, können jedoch letal verlaufen. In üblicherweise aufgenommenen Mengen gilt Koffeingebrauch als nicht gesundheitsschädlich. Koffein weist zahlreiche, jedoch nicht alle Merkmale einer Substanz mit „Abhängigkeitspotential“ auf; Entzugssyndrome nach Beendigung einer längeren Anwendung und Toleranz sind bekannt. Im DSM-5 wird die „Koffeingebrauchsstörung“ als mögliche künftige Störung, die gegenwärtig weiterer Forschung bedarf, rubriziert. Das Koffeingebrauchsmuster von Patienten sollte im Rahmen der ärztlichen Tätigkeit berücksichtigt werden.

Abstract

Caffeine is the worldwide most frequently consumed psychostimulant. Its availability is nearly unlimited and in Europe it is not subject to state regulation. Apart from its primary role as an ingredient or additive in numerous beverages it also has medical use in apnea of prematurity, as an adjuvant in pain therapy and has regulatory approval for the short-term treatment of symptoms of fatigue. In doses typically administered caffeine’s mechanism of action as a psychostimulant is presumably primarily based on central antagonism at adenosine receptors (A1- und A2A-receptors), which facilitates central inhibition of adenosine-mediated reduction of the activity of the dopaminergic and ascending arousal system. Metabolisation of caffeine mainly depends on cytochrome P450 1A2. Thus, factors that influence the activity of CYP 1A2 (e. g. medication, pregnancy), may induce remarkable changes of pharmacokinetic parameters. Caffeine improves vigilance, attention and reaction time, particularly in sleep-deprived individuals. Moreover, it may improve endurance performances in sports and muscle strength. Intoxications with caffeine are rare, however can be fatal. In general, caffeine use seems not harmful within typical doses of intake. Caffeine features several, however not all characteristics of potentially addictive drugs; withdrawal after termination of a longer period of use and tolerance are known. In the DSM-5 “caffeine use disorder” is categorized as a possible future disorder that currently needs further study. The pattern of caffeine use of patients should be considered in the medical practice.

Schlüsselwörter

Adenosin - Coffeinum - Kaffee - Methylxanthine - Paraxanthin

Key words

adenosine - coffeinum - coffee - methylxanthines - paraxanthine


Publication History

Received: 27 May 2019

Accepted: 28 July 2019

Article published online:
14 October 2019

© Georg Thieme Verlag KG
Stuttgart · New York

 

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