Can coca tea (mate de coca) help treat postural orthostatic intolerance?

Coca Tea (Mate de Coca) for Postural Orthostatic Intolerance

Coca tea should not be used to treat postural orthostatic tachycardia syndrome (POTS) or other forms of postural orthostatic intolerance, as there is no evidence supporting its efficacy and one study specifically demonstrates it does not prevent orthostatic symptoms.

Evidence Against Coca Tea

The only available study examining coca leaf tea for orthostatic symptoms found no protective effect. In a cohort of 142 travelers to high altitude (Cusco, Peru at 3350m), 34% consumed coca leaf tea for prevention of acute mountain sickness (which shares orthostatic intolerance features), yet consumption was not associated with decreased risk of developing symptoms 1. This directly contradicts any theoretical benefit for postural orthostatic conditions.

Evidence-Based Treatment Approach

The 2020 Canadian Cardiovascular Society guidelines provide a clear algorithmic approach for managing POTS and orthostatic intolerance 2:

First-Line Non-Pharmacological Interventions

Start with these measures before considering medications:

• Withdraw aggravating substances: Eliminate any medications or substances that worsen orthostatic tachycardia or symptoms (Strong Recommendation) 2

• Volume expansion (Strong Recommendation) 2:

  • Increase daily fluid intake to at least 3 liters
  • Increase daily sodium intake to 10 grams via high-salt foods, salt tablets, or salt sticks

• Exercise training (Strong Recommendation, Moderate-Quality Evidence) 2:

  • Begin in semi-recumbent position (rowing machines, recumbent cycles, swimming)
  • At least 4 days per week, minimum 30 minutes per session
  • May take 4-6 weeks to see improvement
  • Can achieve symptom remission in a proportion of patients

• Compression garments (Weak Recommendation) 2:

  • Use waist-high compression stockings or abdominal binders
  • Start with 20-30 mm Hg pressure, increase as tolerated
  • Compression below thighs is ineffective

• Positional strategies 2:

  • Sleep with head elevated >10° to promote volume expansion
  • Learn counter-pressure maneuvers for acute symptoms
  • Avoid warm environments and prolonged standing

Second-Line Pharmacological Interventions

If symptoms persist despite non-pharmacological measures:

• Midodrine (Strong Recommendation, Moderate-Quality Evidence) 2:

  • Dose: 2.5-15 mg every 4 hours, up to 3 times daily
  • Most beneficial for patients with hypotensive tendency
  • Less effective in hyperadrenergic phenotypes

• Low-dose propranolol (Strong Recommendation, Moderate-Quality Evidence) 2:

  • Dose: 10-20 mg four times daily (non-selective β-blocker)
  • Reduces standing heart rate and improves exercise capacity
  • Avoid high doses and long-acting formulations (ineffective for symptoms)
  • Most beneficial for patients with high standing heart rates
  • Caution: May worsen exercise tolerance and fatigue

• Pyridostigmine 2:

  • Peripheral acetylcholinesterase inhibitor
  • Often combined with β-blocker
  • Common side effect: diarrhea (may benefit constipated patients)

• Fludrocortisone 2:

  • For patients unable to optimize oral salt intake
  • Monitor electrolytes, especially potassium
  • Avoid in migraine patients

• Acute IV saline bolus (Weak Recommendation) 2:

  • 1-2 liters over 1-2 hours as rescue therapy
  • Not recommended for chronic treatment due to infection/thrombosis risks

Critical Caveats

• No pharmacologic therapies are currently approved specifically for POTS in Canada 2
• No single treatment is effective in all patients 2
• Treatment requires individualized combination strategies based on phenotype (hypotensive vs. hyperadrenergic) 2
• Recent systematic reviews confirm limited high-quality evidence, with most trials being small 3, 4

The bottom line: Coca tea has no role in treating postural orthostatic intolerance. Begin with volume expansion, salt supplementation, and exercise training, then add midodrine or low-dose propranolol if symptoms persist.