Energy drinks for children and adolescents

Energy drinks can be consumed alone, producing in some cases
side effects related to excessive caffeine intake (1), but
frequently, energy drinks are ingested in combination with
alcohol (2). Some recent epidemiological surveys showed
that students' intake of energy drinks in combination with
alcohol has risen dramatically since their introduction in
the market (3). In one of these surveys, 24% of respondents
that consumed alcohol (n=697), had used energy drinks with
alcohol at least once in the last 30 days (4). In other
survey (n=450), most users associate energy drinks and
alcohol (48.4%), and a 35.8% of energy drinks and alcohol
users have consumed the combination more than 3 times in the
last month (5).

One reason for the alcohol-energy drink combination is the
consumer expectation that caffeine (a stimulant) could
counteract some of the cognitive and motor symptoms of
alcoholic intoxication (a depressant). Due to this
expectation risk behaviors can be taken more easily, as
driving a car despite alcohol consumption (6). Increased
heavy episodic drinking has also been observed associated
with the use of these drinks in combination with alcohol
(4).

Several studies have evaluated the effects of intake of
energy drinks on the alcohol intoxication. In one study (7)
the effects of the combination were evaluated in the context
of strenuous exercise. It was reported that there were no
differences in physical exercise measured by an ergometer
among individuals who had consumed alcohol and those who had
used the combination, suggesting that the energy drink
consumption does not reduce the deficits associated with
alcohol intake. Ferreira et al. (8) studied the effects of
the combination in 26 healthy volunteers (Red Bull at a dose
of 3.57 mL/kg, equivalent to 1 can for a 70-kg person and
two doses of alcohol at doses of 0.6 or 1.0 g/kg). A
reduction of some subjective effects on the central nervous
system due to alcohol (headache, weakness, dry mouth, and
motor coordination) was observed when it was taken with the
energy drink. Objective measures of intoxication such as
motor coordination, reaction time and breath alcohol
concentrations did not change significantly with the
combination. In the study of Curry and Stasio (9), the
addition of the energy drink to alcohol reduced
significantly overall performance score of
neuropsychological status, mainly visuospatial,
constructional and language performance scores were altered.
These results are consistent with other studies
investigating caffeine–alcohol interactions (10), and the
combination of ethanol with other psychostimulants (11, 12).
Thus, when mixing energy drinks and alcohol, users may not
feel the symptoms of alcohol intoxication and to conclude
mistakenly that they are capable of potentially dangerous
activities such as driving, and may increase the potential
for alcohol-related injury (2, 3).

Given the boom in consumption of both beverages at the same
time, manufacturers of some countries have created a new
class of energy drinks with an alcoholic content ranging
between 6 and 10% by volume. The sell of some of these
brands stopped because they directed marketing to underage
consumers (2) and they are actually under scrutiny by Food
and Drug Administration (14).

It is necessary to educate adolescents and youth to reduce
the consumption of tenergy drinks with high caffeine content
(1), but also to provide information and explain the risks
of taking these drinks in combination with alcohol.

1. Oddy WH, O'Sullivan TA. Energy drinks for children and
adolescents. BMJ 2009;339:b5268.

2. Simon M, Mosher J. Alcohol, energy drinks and youth a
dangerous mix. San Rafael, CA: Marin Institute, 2007.

3. Reissig CJ, Strain EC, Griffiths RR. Caffeinated energy
drinks- a growing problem. Drug Alcohol Depend 2009;99:1-10.

4. O'Brien MC, McCoy TP, Rhodes SD, Wagoner A, Wolfson M.
Caffeinated cocktails: energy drink consumption, high-risk
drinking, and alcohol-related consequences among college
students. Acad Emerg Med 2008;15:453-60.

5. Oteri A, Salvo F, Caputi AP, Calapai G. Intake of energy
drinks in association with alcoholic beverages in a cohort
of students of the School of Medicine of the University of
Messina. Alcohol Clin Exp Res 2007;31:1677-80.

6. Thombs DL, O'Mara RJ, Tsukamoto M, Rossheim ME, Weiler
RM, Merves ML, et al. Event-level analyses of energy drink
consumption and alcohol intoxication in bar patrons. Addict
Behav 2009 Nov 24. [Epud ahead of print].

7. Ferreira SE, de Mello MT, Rossi MV, Souza-Formigoni
ML.Does an energy drink modify the effects of alcohol in a
maximal effort test?. Alcohol Clin Exp 2004;28:1408-12.

8. Ferreira SE, de Mello MT, Pompéia S, de Souza-Formigoni
ML. Effects of energy drink ingestion on alcohol
intoxication. Alcohol Clin Exp Res 2006;30:598-605.

9. Curry K, Stasio MJ. The effects of energy drinks alone
and with alcohol on neuropsychological functioning. Hum
Psychopharmacol Clin Exp 2009;24:473-81.

10. Marczinski CA, Fillmore MT. Clubgoers and their trendy
cocktails: implications of mixing caffeine into alcohol on
information processing and subjective reports of
intoxication. Exp Clin Psychopharmacol 2006;14:450-8.

11. Farré M, de la Torre R, Llorente M, Lamas X, Ugena B,
Segura J, Camí J. Alcohol and cocaine interactions in
humans. J Pharmacol Exp Ther. 1993;266:1364-73.

12. Hernández-López C, Farré M, Roset PN, Menoyo E, Pizarro
N, Ortuño J, Torrens M, Camí J, de la Torre R. 3,4-
Methylenedioxymethamphetamine (MDMA, ecstasy) and alcohol
interactions in humans: Psychomotor performance, subjective
effects, and pharmacokinetics. J Pharmacology Exp Ther.
2002;300:236-44.

13. Food and Drug Administration [Homepage on the Internet].
FDA To Look Into Safety of Caffeinated Alcoholic Beverages.
November 13, 2009 [cited 2009, Dec 21]. Avalaible from:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/uc
m190427.htm.

Competing interests:
None declared