From the Guidelines
Kava is not recommended for treating anxiety and insomnia due to the risk of acute fatal liver toxicity and lack of evidence supporting its efficacy. The U.S. Food and Drug Administration has warned health care providers and the public about the risk for acute liver damage and death associated with kava 1. Several studies have shown no benefit of using kava to treat chronic insomnia disorder compared with placebo, and the work group decided on a “strong against” recommendation for kava 1.
Some key points to consider:
- Kava has been associated with rare but serious liver damage, leading to restrictions in some countries.
- People with liver disease, those who drink alcohol regularly, or take medications processed by the liver should avoid kava.
- Side effects can include stomach upset, headache, dizziness, and mouth numbness.
- The quality and preparation method of kava products significantly impact safety, with water-based extracts generally considered safer than those using alcohol or acetone.
- Consulting with a healthcare provider before starting kava is essential, especially if you take other medications or have existing health conditions.
It's also important to note that other herbal over-the-counter therapies, such as valerian and chamomile, have also been found to be ineffective for treatment of chronic insomnia disorder 1.
In terms of alternative treatments, cognitive-behavioral therapies and benzodiazepine agonists have been found to be effective in the short-term management of insomnia, but the evidence for long-term usage is limited 1. Melatonin has also been found to be effective in improving sleep quality, but the evidence is not strong enough to support its use as a first-line treatment for chronic insomnia 1.
Ultimately, it's essential to consult with a healthcare provider before starting any new treatment for anxiety and insomnia, as they can help determine the best course of treatment based on individual needs and health status.
From the Research
Safety and Efficacy of Kava for Treating Anxiety and Insomnia
- Kava, specifically its kavalactones, has been shown to be effective in treating anxiety disorders, including generalized anxiety disorder (GAD) 2, 3, 4.
- The pharmacological properties of kava include sedative, anxiolytic, antistress, analgesic, local anaesthetic, anticonvulsant, and neuroprotective effects, which are attributed to its ability to modulate GABA activity and interact with various neurotransmitters 2, 3.
- Clinical studies have demonstrated that kava is effective in reducing anxiety symptoms, with a significant result occurring in four out of six studies reviewed (mean Cohen's d = 1.1) 3.
- However, safety concerns have been raised due to reports of severe liver toxicity associated with kava intake, although a direct causal relationship has been difficult to establish 2, 5, 6.
- The risk of liver toxicity appears to be idiosyncratic, and the risk-to-benefit ratio of kava extracts remains good in comparison with that of other drugs used to treat anxiety 5.
- To minimize potential risks, it is recommended to use traditional water-soluble extracts of the rhizome (root) of appropriate kava cultivars, avoid use with alcohol, and exercise caution when taking other psychotropic medications 3.
- Regular users of kava are advised to undergo routine liver function tests, and high doses should be avoided when driving or operating heavy machinery 3.
Potential Side Effects and Interactions
- Common side effects of kava use include mild or negligible adverse effects, except for the occurrence of a skin lesion called kava dermopathy, which is reversible on reduced intake or cessation 2.
- Rare cases of interactions have occurred with pharmaceutical drugs that share one or more mechanisms of action with the kavalactones 2.
- The potential for drug interactions and/or the potentiation of the toxicity of other compounds is large, and kava toxicity appears to be idiosyncratic 5.
Recommendations for Use
- Kava appears to be a short-term treatment for anxiety, but not a replacement for prolonged anti-anxiety use 4.
- Although not witnessed in the reviewed studies, liver toxicity is especially possible if taken longer than 8 weeks 4.
- Further research is needed to assess comparative efficacy and safety (on the liver, cognition, driving, and sexual effects) versus established pharmaceutical comparators 3.