Cola

Bissy nut, Cola acuminata, C. nitida, cola nut, cola seeds, guru nut, kola nut, kola tree

The medicinal components of cola are found in the seeds of Cola acuminata and C. nitida, trees of the cocoa family. The seed contains theobromine, theophylline, and 1.5% to 2.5% caffeine-all of which are central nervous system (CNS) stimulants.

Cola also has a diuretic effect, stimulates gastric acid production and gastric motility, and has mild chronotropic activity. It may contain potentially carcinogenic primary and secondary amines as well as tannins. Cola is available as liquid extract, cola nut, cola extract, tea, tincture, and wine, in products such as soft drinks, Starter, and Ultra Diet Pep.

Reported uses.

Cola is used as a stimulant to counteract mental and physical fatigue and depression. Cola seeds are chewed to suppress hunger, thirst, morning sickness, and migraines. It's also used to flavor many popular carbonated soft drinks.

Administration

• Cola extract: 0.25 to 0.75 g per day
• Cola nut: 2 to 6 g every day in divided doses
• Fluid extract: 2.5 to 7.5 g per day
• Tea: 1 to 2 g of cola nut in 5 ounces of water three times a day
• Tincture: 10 to 30 ml per day
• Wine: 60 to 180 ml per day.

Hazards

Adverse effects associated with the use of cola include insomnia, restlessness, nervousness, excitability, tachycardia, palpitations, elevated blood pressure, and gastric irritation.

When cola is used in conjunction with beta agonists, such as albuterol, metaproterenol, salmeterol, and terbutalin, enhanced cardiac stimulation may occur. Enhanced cardiac and CNS stimulation may occur if cola is used with CNS stimulants, such as phenylpropanolamine or pseudoephedrine, or with decongestants. Cola may enhance the effect of diuretics. Abrupt caffeine withdrawal can increase the risk of lithium toxicity. Recommend consistent intake of caffeine-containing products during lithium therapy.

Hypertensive crisis can be precipitated if a person who's taking a monamine oxidase inhibitor consumes excessive amounts of caffeine. Using cola in conjunction with quinolone antibiotics can result in decreased caffeine clearance leading to increased risk of adverse effects such as increased blood pressure and heart rate and excessive CNS stimulation. Enhanced adverse effects may occur if cola is used with theophylline, or with other caffeine-containing products. Grapefruit juice may cause increase caffeine levels, leading to increased risk of adverse effects.

Those with underlying cardiac disease or renal insufficiency, geriatric patients, and those with a history of gastric or duodenal ulcers should avoid using cola. Pregnant and breast-feeding patients should limit use. Cola nut is contraindicated in those with chocolate allergy due to cross-sensitivity. Those with renal dysfunction should use cola cautiously.

Clinical considerations

• Monitor patient's heart rate and blood pressure.
• The diuretic effect of excessive cola may result in dehydration.
• Observe patient for signs of excess CNS stimulation. Before using a drug to treat symptoms of excitability such as insomnia, check to see if the patient should simply decrease his intake of cola.
• Because some cola preparations contain significant amounts of alcohol, children, alcoholic patients, patients with liver disease, patients receiving metronidazole or disulfiram, and pregnant and breast-feeding patients should avoid them.
• Stopping cola abruptly can sometimes lead to signs and symptoms of physical withdrawal, including headache, irritability, dizziness, and anxiety.
• Geriatric patients may be especially prone to adverse cardiac and CNS effects. Advise patient to limit his sources of caffeine, to avoid excessive cardiac and CNS stimulation.
• Advise patient who has hypertension or heart disease or is pregnant or breast-feeding to avoid cola preparations.
• Advise patient to consult his health care provider if he experiences palpitations or dyspepsia.
• Tell patient to inform all his health care providers about his use of cola.
• Instruct patient and family to avoid using alcohol preparations of cola in children, those with a history of alcohol abuse or liver disease, and those taking disulfiram or metronidazole.
• Advise patient that yellow staining of oral mucosa has been associated with chewing cola nuts.
• Tell patient to remind prescriber and pharmacist of any herbal or dietary supplement that he's taking when obtaining a new prescription.
• Advise patient to consult his health care provider before using an herbal preparation because a treatment with proven efficacy may be available.

Research summary

The concepts behind the use of cola and the claims made regarding its effects have not yet been validated scientifically.