Kava Poses Significant Health Risks and Should Be Avoided
Kava should be avoided due to its potential for liver toxicity, sedative effects, and dangerous drug interactions. 1
Health Risks of Kava
Liver Toxicity
- Kava has been linked to severe liver toxicity, with approximately 35 cases reported in Europe and the US 2
- Risk factors for kava-induced liver damage include:
- Overdose
- Prolonged treatment
- Poor raw material quality
- Comedication with other drugs or supplements 3
- Liver toxicity occurs regardless of the extraction method (aqueous, ethanolic, or acetonic) 3
Sedative Effects and Drug Interactions
- Kava may act additively or synergistically with anesthetics, benzodiazepines, and opiates, causing excessive sedation 1
- Kava decreases blood flow to the kidneys, potentially through inhibition of cyclooxygenase 1
- Kava significantly inhibits multiple cytochrome P450 enzymes (CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP4A9/11), leading to numerous potential drug interactions 1
- Kava potentiates acetaminophen-induced cytotoxicity in liver cells by increasing glutathione depletion, causing oxidative stress and mitochondrial dysfunction 4
Other Adverse Effects
- Long-term use can lead to kava dermopathy (a skin condition) that is reversible upon cessation 2
- Kava may have carcinogenic potential in experimental animals through a non-genotoxic mode of action 5
Clinical Guidelines on Kava Use
Perioperative Recommendations
- The Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends holding kava for at least 2 weeks before surgery due to its potential for excessive sedation when combined with anesthetics 1
Sleep Medicine Recommendations
- Major sleep medicine organizations do not recommend kava for insomnia treatment due to safety concerns and limited efficacy evidence 6
- Cognitive Behavioral Therapy for Insomnia (CBT-I) and FDA-approved medications are preferred for insomnia treatment 6
Special Considerations
Potential Benefits vs. Risks
- While kava has shown some efficacy as an anxiolytic in clinical studies 2, 7, the risk of severe adverse effects outweighs potential benefits
- Unlike pharmaceutical anxiolytics, kava lacks standardization and quality control, increasing unpredictability of effects 3
Monitoring for Patients Using Kava
- For patients who choose to use kava despite risks:
- Monitor liver function tests regularly
- Discontinue immediately if signs of liver dysfunction appear
- Avoid combining with medications metabolized through CYP450 enzymes
- Avoid combining with acetaminophen and other potentially hepatotoxic substances 4
- Limit duration of use to minimize risk
Bottom Line
Kava should be avoided due to its potential for serious liver toxicity, significant drug interactions, and sedative effects. The risks outweigh any potential benefits, especially when safer, more effective FDA-approved alternatives exist for anxiety and sleep disorders.