Natural Standard® Patient Monograph, Copyright © 2014 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

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 have been used for reducing pain, decreasing hunger, and for their stimulating effects. Cocaine, a compound taken from the coca plant, is a highly addictive stimulant.

In the late 19th century, the use of cocaine for local anesthesia was popularized. Cocaine found its way into many different products including prescription drugs, medicine, and popular soda drinks (including the original Coca-Cola®). In modern times, cocaine's use in anesthesia is limited, due to the negative effects of cocaine and risk for addiction and death.

Coca leaves have been used for treating cocaine dependence. Coca leaves have also been used for exercise tolerance and hypoglycemia (low blood sugar). Illegal use of cocaine has had negative effects on antisocial behavior and general health. Further study is needed.

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)

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

For cocaine dependence, chewing 100-200 grams of coca leaf per week for about 27 months has been used.

For exercise performance, 15-16 grams of coca leaves (providing 0.4%-0.7% cocaine) has been chewed for one hour; "unlimited" or "usual" amounts of coca leaves for chewers and 4.5 grams non-chewers have been chewed for one hour.

For hypoglycemia (low blood sugar), an unknown amount of coca leaves has been chewed for thirty minutes.

Children (under 18 years old)

There is no proven safe or effective dose for coca in children.

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.

Key to grades

A
Strong scientific evidence for this use
B
Good scientific evidence for this use
C
Unclear scientific evidence for this use
D
Fair scientific evidence against this use (it may not work)
F
Strong scientific evidence against this use (it likely does not work)

Grading rationale

Evidence gradeCondition to which grade level applies
C

Altitude sickness

In athletes training in the Andes, coca infusions have been studied for their use in helping to adapt to high altitudes. Coca leaf tea has displayed promising effects on exercise performance and improving low blood sugar in high-altitude settings. Further study is needed.
C

Anesthetic

Coca leaves have been used in mixtures for surgery due to their anesthetic effects. The Inca used maize, datura (of the nightshade family), espingo (a psychotropic fruit), tobacco, San Pedro cactus, and coca to prepare an alcoholic beverage used to induce unconsciousness for surgeries. Further study is needed on the use of the coca plant alone.
C

Cocaine dependence

Coca leaves have been suggested as a possible treatment for cocaine and cocaine base abuse. Further study is needed before a conclusion may be drawn.
C

Exercise performance

The effects of coca use on responses to exercise have been studied. Preliminary evidence shows that coca use may boost exercise tolerance. Further study is needed before conclusions may be drawn.
C

Hypoglycemia (low blood sugar)

Early studies show that chewing coca leaves may improve low blood sugar. Although not well studied in humans, some parts of coca have caused high blood sugar. Further study is needed before a firm conclusion may be drawn.

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), antidepressant, appetite suppressant, arthritis, asthma, bleeding, broken bones, bruises, cachexia (tissue wasting), colds, constipation, diarrhea, diaphoresis (sweating), digestion, fatigue, food additive, headaches, hemorrhoids, insecticide, joint pain, malaria, myalgia (muscle pain), nausea and vomiting, nosebleeds, pain, rashes, sexual dysfunction, stimulant, stomach problems, swelling (feet), thirst, tonic, toothache, ulcers, wounds.

Interactions

Interactions with Drugs

Coca (including cocaine) may raise blood sugar levels. Caution is advised when using medications that may also alter blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Coca (including cocaine) may cause high blood pressure. Caution is advised in people taking drugs that raise blood pressure.

Coca (including cocaine) may also interact with agents that affect the nervous system, agents that induce muscle breakdown, alcohol, anesthetics, caffeine, calcium salts, cannabinoids, insecticides, iron salts, progestins, stimulants, or weight loss agents.

Interactions with Herbs and Dietary Supplements

Coca (including cocaine) may raise blood sugar levels. Caution is advised when using herbs or supplements that may alter blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Coca (including cocaine) may cause high blood pressure. Caution is advised in people using herbs and supplements that raise blood pressure.

Coca (including cocaine) may also interact with alcohol, anesthetics, caffeine-containing herbs and supplements, calcium salts, copper, herb and supplements that affect the nervous system, insect repellants, iron, marijuana, phytoprogestin, stimulants, tannin-containing herb and supplements, tobacco, weight loss herbs and supplements, or zinc.

Methodology

This information is based on a systematic review of scientific literature and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

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), kokacserje (Hungarian), kokainovník pravý (Czechoslovakian), kokaplante (Danish), Kokastrauch (German), mamas coca (Quechua), mumus (Quechua), pitillo (Spanish).

Note: There are four types of plants from the coca plant family that are typically grown 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 products. Cocaine is a compound present in the leaves of the coca plant and is an addictive stimulant that is potentially 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 culture. To prevent cocaine production, coca plant farming is often limited in these countries.

This monograph does not include information on prescription cocaine hydrochloride.

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 a known allergy or sensitivity to coca (Erythroxylum coca), its constituents (including cocaine), or other members of its plant 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 (including cocaine) may raise blood sugar levels. Caution is advised in people with diabetes or hyperglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

Coca (including cocaine) may cause high blood pressure. Caution is advised in people taking agents that affect blood pressure.

Avoid in people using agents that affect the central nervous system.

Avoid in people with a known allergy or sensitivity to coca (Erythroxylum coca), its constituents (including cocaine), or other members of its plant family.

Avoid cocaine or coca leaf products in pregnant women and children, due to a lack of available safety evidence.

Reports suggest that using alcohol, tobacco, and cocaine together increased the risk of liver problems, heart problems, and death.

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.

Coca (including cocaine) may cause abnormal heart rhythms, abnormal pH levels following low blood oxygen levels, anxiety, artery tearing, changes in brain function, changes in breathing rates, changes to the nervous system, cold symptoms, convulsions, cycloplegia (eye paralysis), damage to the nose, death, delirium, delusions, dental problems, diarrhea, dizziness, dysphoria (state of feeling unwell), electrolyte imbalance, emaciation (extreme weight loss), euphoria, fatigue, formation of blood clots inside blood vessels, hallucinations, headache, heart attack, heart complications, heart failure, hematuria (blood in the urine), hookworm disease, hyperreflexia (overactive reflexes), hyperthermia (increased body temperature), impaired work performance, increased heart rate, increased illness, intestinal problems, irritability, kidney problems, lesions inside the mouth, leukocytosis (increased white blood cell count), leukoedema (swelling inside the mouth), liver inflammation, loss of fluids, lower levels of albumin in blood, lower levels of cholesterol, lower hematocrit (proportion of red blood cells), lung damage, malnutrition, memory loss, migraines, mood swings, narrowing of the blood vessels, nausea, numbness, psychosis (mental disorder), pupil dilation, restlessness, rhabdomyolysis (muscle breakdown), seizures, sexual dysfunction, skin problems, sleeplessness, sneezing, smaller body weight-to-height ratio, smaller skinfold thickness, stomach cramps, stroke, tachypnea (rapid breathing), transmission of disease (via dirty needles), tremor, ulcers, or vomiting.

Pregnancy and Breastfeeding

Avoid cocaine or coca plant products in pregnant women. 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 because cocaine has been found in breast milk.

In newborns exposed to cocaine, hearing problems and impaired responses to surroundings were observed.

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. Lippi, G., Plebani, M., and Cervellin, G. Cocaine in acute myocardial infarction. Adv.Clin.Chem. 2010;51:53-70.
  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. Zimmerman, J. L. Cocaine intoxication. Crit Care Clin 2012;28(4):517-526.

This evidence-based monograph was prepared by The Natural Standard Research Collaboration

www.naturalstandard.com