Coca (Erythroxylum coca)

• Background
• Related terms
• Evidence
• Dosing
• Safety
• Methodology
• Selected references

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Coca (Erythroxylum coca)

Background

The coca plant ( Erythroxylum coca ), or "coca," is native to the Andean region in western South America. Coca leaves have been used widely by native South American tribes for thousands of years. It has been suggested that the use of the coca plant was originally reserved for priests and royalty in ancient South America and was used for religious purposes.

Traditionally, coca plant products (for example, coca leaves, coca leaf tea) have been used for reducing pain, decreasing hunger, and for their stimulant effects. Cocaine, an alkaloid that is processed from the coca plant, is a highly addictive stimulant. In 1999, an estimated 30% of drug-related visits to emergency departments were due to cocaine toxicity. Cocaine production and trade is illegal in most countries. Unprocessed coca leaf, however, may be legal in some South American countries because the use of coca leaves has traditionally been considered to be a part of local cultural identity, particularly for specific indigenous groups. To prevent cocaine production, coca plant cultivation is often restricted in these countries.

Coca leaves have been used for treating cocaine dependence. Coca leaves have also been used for studies of exercise tolerance and hypoglycemia. Use of illicit cocaine has had negative effects on antisocial behavior and general health. Further study is needed.

Related terms

Bazuco (Spanish), Bolivian coca, Bolivianischer Kokastrauch (German), coca (English, French, Portuguese, Spanish), coca leaves, coca paste, cocaine, cocaine hydrochloride, cocaine plant, cocaine salt, Erythroxylaceae (Family), Erythroxylon (former Genus), Erythroxylum (Genus), Erythroxylum coca , Erythroxylum coca var. coca , Erythroxylum coca var. ipadu , Erythroxylum novogranatense var. novogranatense , Erythroxylum novogranatense var. truxillense , espadu (Portuguese), honger-en-dorstboom (Dutch), Huanuco coca, koka (Polish, Slovakian), koka pravá (Czechoslovakian), koka sort (Dutch), koka(cserje) (Hungarian), kokainovník pravý (Czechoslovakian), kokaplante (Danish), Kokastrauch (German), mamas coca (Quechua), mumus (Quechua), pitillo (Spanish).

Note : There are four plants from the Erythroxylum family that are typically grown for cultivation in South America, including E. coca var. coca , E. novogranatense var. novogranatense , E. coca var. ipadu , and E. novogranatense var. truxillense .

This monograph includes information on the coca plant and coca plant products, such as coca leaves, coca leaf tea, as well as cocaine. Coca leaves and cocaine are two different substances. Cocaine is an alkaloid present in the leaves of the coca plant. Cocaine powder, an addictive stimulant, has the potential for being toxic, particularly in large quantities or with long-term use. Cocaine abuse has resulted in increased illness and death.

The growth, sale, and possession of cocaine are illegal in most countries. Unprocessed coca leaf, however, may be legal in some South American countries because the use of coca leaves has traditionally been considered to be a part of the local cultural identity, especially for specific indigenous groups. As a preventive measure against cocaine production, coca plant cultivation is often limited in South American countries.

This monograph does not include information on prescription cocaine hydrochloride.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Grading rationale

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Adaptogen, addiction (morphine), altitude sickness, anesthetic, antidepressant, appetite suppressant, asthma, bleeding, broken bones, bruises, cachexia (tissue wasting), colds, constipation, depression, diaphoresis (sweating), diarrhea, digestion, edema (feet), fatigue, food additive, gastrointestinal disorders, headaches, hemorrhoids, insecticide, joint pain, malaria, motion sickness, myalgia (muscle pain), nausea, nosebleeds, pain, rashes, rheumatism, sexual dysfunction, stimulant, thirst, tonic (nervous breakdown), ulcers, vomiting, wounds.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

General : Drinking coca tea is a common practice in several South American countries. Coca tea bags normally contain about a gram of leaves.

Cocaine dependence : Chewing 100 to 200 grams of coca leaf per week for about 27 months has been used.

Exercise tolerance : In one study, an average of 16 grams of coca leaves was chewed for one hour. In another study, subjects chewed 15 grams of coca leaves (yielding 0.4%-0.7% cocaine) for one hour. "Unlimited" or "usual" amounts of coca leaves have both been chewed for one hour. The amount of coca leaves chewed by the treatment group was obtained by subtracting the weight of the subjects' supply of coca leaves after chewing from the weight of their initial supply before chewing. In another study, habitual coca chewers were given the amount that they "normally" chewed, and "non-chewers" were given 4.5 grams; chewing lasted for one hour.

Hypoglycemia (low blood sugar) : An unknown amount of coca leaves was chewed for thirty minutes.

Children (under 18 years old)

Insufficient available data.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in people with known allergy to coca ( Erythroxylum coca ), its constituents (including cocaine), or members of the Erythroxylaceae family.

Side Effects and Warnings

Note : Avoid use of coca leaf tea and illicit cocaine-containing products; although it is used in specific pharmaceutical preparations, cocaine produced outside of the pharmaceutical industry is illegal in most countries including the United States.

Coca leaves : Chronic chewing of coca leaves may lead to a cycle of malnutrition, tiredness, and illness, as well as dental and skin problems. Increased heart rate and blood pressure have also been noted with use of coca leaf products. Patients that have diabetes or are using diabetic drugs should use coca leaf products cautiously, as they have been reported to increase blood sugar levels. Although coca plant products have been suggested as a source of nutrition, human study suggests that chronic chewing of coca leaves may cause malnutrition.

Cocaine : Heart problems are one of the most common reported side effects of long-term cocaine use or overdose. These may include irregular heartbeats, abnormally fast heart rate, heart attack, stroke, and death. Other common reported side effects of using large amounts of cocaine include restlessness, mood swings, migraines, seizures, hallucinations, and psychosis (mental deterioration). Other problems from long-term cocaine use may include kidney, nose, and skin problems. Patients that also use alcohol or tobacco should avoid using cocaine, because using these together has resulted in increased liver toxicity, irregular heartbeats, heart attack, heart failure, and death.

Coca leaves or cocaine : Patients that have cardiovascular (heart) or blood pressure issues, or those that use drugs that affect blood pressure should avoid using coca leaves or cocaine, as both have increased heart rate and blood pressure. Patients that use stimulants should avoid use of coca leaves or cocaine. Patients that have a known allergy/hypersensitivity to coca ( Erythroxylum coca ), its constituents (including cocaine), or members of the Erythroxylaceae family should avoid use of coca. Patients who are pregnant should avoid using cocaine or coca leaf products, as cocaine use during pregnancy has increased the risk of birth defects, separation of the placenta from the uterus, premature labor, and death of the fetus. Avoid cocaine or coca leaf products in lactating women, as cocaine has been found in breast milk.

Pregnancy and Bre astfeeding

Avoid cocaine or coca leaf products in pregnant women, as cocaine use during pregnancy has increased the risk of birth defects, separation of the placenta from the uterus, premature labor, and death of the fetus. Avoid cocaine in lactating women, as cocaine has been found in breast milk.

Methodology

This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Selected references

1. Buck, A. A., Sasaki, T. T., Hewitt, J. J., and Macrae, A. A. Coca chewing and health. An epidemiologic study among residents of a Peruvian village. Am J Epidemiol. 1968 Sep;88(2):159-177.
2. Caris, L., Anthony, C. B., Ríos-Bedoya, C. F., and Anthony, J.C. Behavioral problems and the occurrence of tobacco, cannabis, and coca paste smoking in Chile: evidence based on multivariate response models for school survey data. Drug Alcohol Depend. 2009 Sep 1;104(1-2):50-55. Epub 2009 May 14.
3. Das, G. Cocaine abuse in North America: a milestone in history. J Clin Pharmacol. 1993 Apr;33(4):296-310.
4. Fairley, H. B. [Anesthesia in the Inca empire]. Rev Esp Anestesiol Reanim. 2007 Nov;54(9):556-562.
5. Favier, R., Caceres, E., Guillon, L., Sempore, B., Sauvain, M., Koubi, H., and Spielvogel, H. Coca chewing for exercise: hormonal and metabolic responses of nonhabitual chewers. J Appl Physiol. 1996 Nov;81(5):1901-1907.
6. Favier, R., Caceres, E., Koubi, H., Sempore, B., Sauvain, M., and Spielvogel, H. Effects of coca chewing on hormonal and metabolic responses during prolonged submaximal exercise. J Appl Physiol. 1996 Feb;80(2):650-655.
7. Galarza Guzmán, M., Peñaloza Imaña, R., Echalar Afcha, L., Aguilar Valerio, M., Spielvogel, H., and Sauvain, M. [Effects of coca chewing on the glucose tolerance test]. Medicina (B Aires). 1997;57(3):261-264.
8. Grzybowski A. Cocaine and the eye: a historical overview. Ophthalmologica. 2008;222(5):296-301. Epub 2008 Jun 20.
9. Hanna, J. M. The effects of coca chewing on exercise in the Quechua of Peru. Hum Biol. 1970 Feb;42(1):1-11.
10. Hurtado-Gumucio, J. Coca leaf chewing as therapy for cocaine maintenance. Ann Med Interne (Paris). 2000 Oct;151 Suppl B:B44-B48.
11. Llosa T. Double-blind trials with oral cocaine as coca tablets (CTA), used for cocaine dependence treatment. NIDA Research Monograph 1994 153, 302 (302).
12. Middleton, R. M., and Kirkpatrick, M. B. Clinical use of cocaine. A review of the risks and benefits. Drug Saf. 1993 Sep;9(3):212-217.
13. Sharkey, J., Ritz, M. C., Schenden, J. A., Hanson, R. C., and Kuhar, M. J. Cocaine inhibits muscarinic cholinergic receptors in heart and brain. J Pharmacol Exp Ther. 1988 Sep;246(3):1048-1052.
14. Spielvogel, H., Caceres, E., Koubi, H., Sempore, B., Sauvain, M., and Favier, R. Effects of coca chewing on metabolic and hormonal changes during graded incremental exercise to maximum. J Appl Physiol. 1996 Feb;80(2):643-649.
15. Weil AT. The therapeutic value of coca in contemporary medicine. J Ethnopharmacol. 1981 Mar-May;3(2-3):367-76.

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