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Kava Kava Side Effects, Interactions and Warnings

  • Do not use if pregnant, nursing, or being treated for depression. Don't take kava in combination with alcohol and do not take it for prolonged periods of time without medical supervision to monitor for possible liver changes.
    - Murray, M. -- The Pill Book Guide to Natural Medicines: Vitamins, Minerals, Nutritional Supplements, Herbs, and Other Natural Products. -- Bantam, 2002. 723.

  • May worsen Parkinson's disease and should not be used by individuals with Parkinson's disease.
    - Murray, M. -- The Pill Book Guide to Natural Medicines: Vitamins, Minerals, Nutritional Supplements, Herbs, and Other Natural Products. -- Bantam, 2002. 723.

  • Health status was assessed in 39 kava users and 34 non-users in a coastal Aboriginal community. Twenty (27%) respondents were very heavy (mean consumption, 440 g/week) users of kava; 15 (21%) respondents were heavy (310 g/week) users of kava and four (5%) respondents were occasional (100 g/week) users of kava. Kava users were more likely to complain of poor health and a "puffy" face, and were more likely to have a typical scaly rash, and slightly-increased patellar reflexes. Very heavy users of kava were 20% underweight and their levels of gamma-glutamyl transferase were increased greatly. Albumin, plasma protein, urea and bilirubin levels were decreased in kava users, and high-density lipoprotein cholesterol levels were increased. Kava users were more likely to show haematuria, and to have urine which was poorly acidified and of low specific gravity. The use of kava was also associated with an increased red-cell volume, with a decreased platelet volume and with a decreased lymphocyte count. Shortness of breath in kava users was associated with tall P waves on a resting electrocardiogram, which provided suggestive evidence of pulmonary hypertension. In common with other Aboriginal communities, there was evidence of decreased lung volumes and a high carriage rate of hepatitis B surface antigen.
    - Med J Aust. 1988 Jun 6;148(11):548-55. -- Effects of the heavy usage of kava on physical health: summary of a pilot survey in an aboriginal community. -- Mathews JD, Riley MD, Fejo L, Munoz E, Milns NR, Gardner ID, Powers JR, Ganygulpa E, Gununuwawuy BJ.

  • Increases 'off' periods in Parkinson patients taking levodopa and can cause a semicomatose state when given concomitantly with alprazolam.
    - Drugs 2001;61(15):2163-75 -- Interactions between herbal medicines and prescribed drugs: a systematic review. -- Izzo AA, Ernst E.

  • Four lactones in kava have been found to have significant analgesic and anesthetic effects via non-opiate pathways. In vitro kava has been found to block norepinephrine uptake. The most common side effect, usually seen only with long-term, heavy usage of the herb, is a scaly skin rash called "kava dermopathy." It has also been know to potentiate other medications such as barbiturates and Xanax.
    - Altern Med Rev 1998 Dec;3(6):458-60 -- Piper methysticum (kava kava).

  • Animal studies show that kava lactones alter neuronal excitation through direct interactions with voltage-dependent ion channels, giving rise to kava's muscle relaxant, anaesthetic, anxiolytic and anticonvulsive properties. Several isolated cases of psychotic and severe dystonic reactions following kava use suggest that kava also has psychoactive properties, yet there is no conclusive evidence that kava interferes with normal cognitive processes. There may be risk-factors for severe motor and psychiatric responses to kava use, although these are not well-understood. Given the increasingly widespread use of kava, further investigation is necessary to gain an understanding of its immediate neuropsychiatric effects and long-term cognitive effects.
    - Aust N Z J Psychiatry 2002 Oct;36(5):657-62 -- The neurobehavioural effects of kava. -- Cairney S, Maruff P, Clough AR.

  • Its biological effects, due to a mixture of compounds called kavalactones, are reported to include sedative, anxiolytic, antistress, analgesic, local anaesthetic, anticonvulsant and neuroprotective properties. Until recently, the adverse effects attributed to kava use were considered mild or negligible, except for the occurrence of a skin lesion. This disorder, called kava dermopathy, occurs only with prolonged use of large amounts of kava and is reversible on reduced intake or cessation. In the past few years, about 35 cases of severe liver toxicity associated with kava intake have been reported in Europe and the US.
    - CNS Drugs 2002;16(11):731-43 -- Therapeutic potential of kava in the treatment of anxiety disorders. -- Singh YN, Singh NN.

  • Reports of the occurrence of severe hepatic toxicity possibly associated with the consumption of products containing kava (i.e., kava kava or Piper methysticum). A total of 11 patients who used kava products had liver failure and underwent subsequent liver transplantation. FDA continues to advise consumers and health-care providers about the potential risk associated with the use of kava-containing products.
    - MMWR Morb Mortal Wkly Rep 2002 Nov 29;51(47):1065-7 -- Hepatic toxicity possibly associated with kava-containing products--United States, Germany, and Switzerland, 1999-2002.

  • Kava kava may potentiate the effects of antiepileptic medications, increasing their sedative and cognitive effects.
    - 2001 Dec;2(6):524-532 -- Herbal Medicines and Epilepsy: The Potential for Benefit and Adverse Effects. -- Spinella M.

  • Kava when used with alprazolam has resulted in coma.
    - Arch Intern Med 1998 Nov 9;158(20):2200-11 -- Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. -- Miller LG.

  • Incidences of hepatotoxicity and nephrotoxicity may be augmented by acetaminophen when concomitantly used with the potentially hepatotoxic herbs Echinacea and kava, and with herbs containing salicylate (willow, meadowsweet), respectively.
    - J Clin Pharm Ther 2002 Dec;27(6):391-401 -- Herbal medication: potential for adverse interactions with analgesic drugs. -- Abebe W.

  • The concomitant use of opioid analgesics with the sedative herbal supplements, valerian, kava and chamomile, may lead to increased central nervous system (CNS) depression.
    - J Clin Pharm Ther 2002 Dec;27(6):391-401 -- Herbal medication: potential for adverse interactions with analgesic drugs. -- Abebe W.

  • Some doctors have cautioned against use when driving.
    - Murray, M. -- The Pill Book Guide to Natural Medicines: Vitamins, Minerals, Nutritional Supplements, Herbs, and Other Natural Products. -- Bantam, 2002. 723.

last update: February 2014

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