Areca

(USAN)

Chemical information

Areca Nuts; Arecae Semen; Arekasame; Betel; Betel Nuts; Noix d’Arec.

Pharmacopoeias.

In Chin. and Jpn.

Profile

Areca consists of the dried ripe seeds of Areca catechu (Palmae) containing the alkaloid arecoline. Areca is used in Asian countries as a masticatory. It has sialogogue properties and is chewed for its mild intoxicant and euphoriant effects. The usual custom is to chew pieces of areca seed (areca nut; betel nut) wrapped with lime (calcium hydroxide) in the leaf of the betel pepper (betelvine) (Piper betle, which is unrelated to areca). This preparation is known as ‘betel quid’ (betel) or ‘paan’ (pan-masala), and produces a red juice when chewed, which stains the saliva, teeth and mucosa. Other ingredients that might be added include catechu gum, spices, or tobacco. Arecoline and arecaidine (produced by the hydrolysis of arecoline when chewed with lime) have cholinergic activity, and adverse effects that may occur with initial or heavy use of areca include excessive salivation, sweating, lachrymation, urinary incontinence, or diarrhoea. An increased incidence of oral submucosal fibrosis, oral leucoplakia, and oral squamous cell carcinoma has been reported following habitual use. Areca was formerly used in the treatment of tapeworm infection, and arecoline has been used in veterinary medicine as a purgative and taenifuge. See also Adverse Effects of Tobacco Products under Nicotine for reference to mixtures of areca and tobacco.
1. Mack TM. The new pan-Asian paan problem. Lancet 2001; 357: 1638–9
2. Deng JF, et al. Acute toxicities of betel nut: rare but probably overlooked events. J Toxicol Clin Toxicol 2001; 39: 355–60
3. Chu NS. Effects of Betel chewing on the central and autonomic nervous systems. J Biomed Sci 2001; 8: 229–36
4. Warnakulasuriya S, et al. Areca nut use: an independent risk factor for oral cancer. BMJ 2002; 324: 799–800
5. Nelson BS, Heischober B. Betel nut: a common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands. Ann Emerg Med 1999; 34: 238–43
6. Yoganathan P. Betel chewing creeps into the New World. N Z Dent J 2002; 98: 40–5.

Carcinogenicity.

Precancerous and cancerous conditions of the oral cavity have been attributed to the chewing of preparations containing areca (see above). In betel-chewer’s mucosa, the oral mucosa is discoloured and there is desquamation or peeling of the oral epithelium from the traumatic effect of chewing and possibly a chemical action of the constituents. This condition may be a precursor of oral submucosal fibrosis, which is considered to be precancerous.1 Oral leucoplakia is another precancerous condition that is reported. The role of areca in the development of these conditions and oral squamous cell carcinoma has been debated. The effects may be due to the arecaidine content of areca, the alkalinity of the lime, presence of tobacco, or a combination of these.2,3 Results from a case-controlled study4 point to an independent association between oral squamous cell carcinoma and chewing areca seeds in preparations without tobacco compared with non-users of areca. A review5 of available evidence strongly supports this association.
1. Reichart PA, Philipsen HP. Betel chewer’s mucosa—a review. J Oral Pathol Med 1998; 27: 239–42
2. Norton SA. Betel: consumption and consequences. J Am Acad Dermatol 1998; 38: 81–8
3. Nelson BS, Heischober B. Betel nut: a common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands. Ann Emerg Med 1999; 34: 238–43
4. Merchant A, et al. Paan without tobacco: an independent risk factor for oral cancer. Int J Cancer 2000; 86: 128–31
5. Nair U, et al. Alert for an epidemic of oral cancer due to use of the betel quid substitutes gutkha and pan masala: a review of agents and causative mechanisms. Mutagenesis 2004; 19: 251–62.

Effects on the lungs.

Evidence suggesting that there is an association between betel-nut chewing and bronchoconstriction in asthmatic patients.1,2
1. Taylor RFH, et al. Betel-nut chewing and asthma. Lancet 1992; 339: 1134–6
2. Kiyingi KS. Betel nut chewing and asthma. Lancet 1992; 340: 59–60.

Effects on the nervous system.

Areca-nut (betel-nut) chewing is associated with habituation, addiction, and dependence,1and CNS symptoms of withdrawal have been described in 2 patients.2 A case of neonatal withdrawal syndrome in an infant born to a chronic areca-nut user has also been reported.3 Psychosis has also been reported.1 It has been suggested that the muscarinic action of areca alkaloids may have a beneficial effect on symptoms of schizophrenia, and a study of such patients in a Micronesian population provides some support for this idea.4 However, severe extrapyramidal symptoms followed betel-nut chewing in 2 patients with chronic schizophrenia who were also receiving antipsychotic therapy.5
1. Nelson BS, Heischober B. Betel nut: a common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands. Ann Emerg Med 1999; 34: 238–43.
2. Wiesner DM. Betel-nut withdrawal. Med J Aust 1987; 146: 453
3. López-Vilchez MA, et al. Areca-nut abuse and neonatal withdrawal syndrome. Abstract: Pediatrics 2006; 117: 203. Full version: http://pediatrics.aappublications.org/cgi/content/full/117/ 1/e129 (accessed 10/04/08
4. Sullivan RJ, et al. Effects of chewing betel nut (Areca catechu) on the symptoms of people with schizophrenia in Palau, Micronesia. Br J Psychiatry 2000; 177: 174–8
5. Deahl MP. Psychostimulant properties of betel nuts. BMJ 1987; 294: 841.
Published December 26, 2018.