Many of our patients have high temperatures, especially during COVID outbreaks. Some of them are taking over the counter pain relief as required. This is of course recommended, however many of our patients are also tachycardic due at least in part to their high temperatures. When they complain of palpitations, do they need to be aware of the effects of caffeine-paracetamol combinations? Should they be taking this combination at all, or should they simply ease off dietary sources of caffeine while taking analgesics? Here are a few quotes on the subject for discussion. Full references are below. For a fast fact summary, have a look at the featured image below:

A dose of caffeine equivalent to a mug of coffee added to a standard dose of common analgesics such as paracetamol or ibuprofen provided better pain relief. Analgesic plus caffeine increased the number of people who had a good level of pain relief by 5% to 10% compared with analgesic alone

Derry et al, 2014.

But…

When the recommended paracetamol-caffeine dosing regimen is combined with dietary caffeine intake, the resulting higher dose of caffeine may increase the potential for caffeine-related adverse effects such as insomnia, restlessness, anxiety, irritability, headaches, gastrointestinal disturbances and palpitations.

EMC, 2017

Even a small dose of 50 mg caffeine can cause tachycardia, anxiety and ectopic beats. Toxicity is normally seen at doses > 500 mg, but this depends on tolerance.

Take into account dietary and other medicinal sources of caffeine: people may not be aware from the brand name that a particular preparation contains caffeine. Consider whether paracetamol with caffeine is necessary: it cannot be assumed that it will be tolerated in the same way as paracetamol alone.

NPS MedicineWise, 2010

References

Derry, C.J. et al, 2014. Caffeine as an analgesic adjuvant for acute pain in adults. [online] Available at: https://www.cochrane.org/CD009281/SYMPT_caffeine-analgesic-adjuvant-acute-pain-adults (Accessed 21/01/21)

EMC, 2017. Paracetamol & Caffeine 500/65 mg Effervescent Tablets. [online] Available at: https://www.medicines.org.uk/emc/product/7416/smpc#gref (Accessed 21/01/21)

NPS MedicineWise, 2010. Paracetamol with caffeine (Panadol Extra) available over the counter from pharmacies. [online] Available at: https://www.nps.org.au/radar/articles/paracetamol-with-caffeine-panadol-extra-available-over-the-counter-from-pharmacies (Accessed 21/01/21)