What is the optimal time to take kava (kava extract) for anxiety and sleep?

Optimal Timing for Taking Kava

Kava should not be taken at all for anxiety or insomnia due to its lack of proven efficacy and significant risk of acute fatal liver toxicity. 1

Safety Concerns and Recommendations

• The U.S. Food and Drug Administration recommends against using kava for anxiety or insomnia due to its lack of proven efficacy and significant risk of acute fatal liver toxicity 1
• Kava has a "strong against" recommendation for insomnia treatment in clinical practice guidelines 1
• While the FDA label indicates a dosing schedule of 6 drops orally 4 times a day 2, this contradicts current safety recommendations from major medical organizations 1

Alternative First-Line Treatments

• For anxiety, evidence-based psychotherapy (such as cognitive behavioral therapy) and/or FDA-approved medications with established safety profiles are recommended as first-line treatments 1
• For insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I) is strongly recommended as first-line treatment 1

Potential Risks of Kava Use

• Kava can cause significant inhibition of multiple cytochrome P450 enzymes (CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP4A9/11) leading to numerous drug interactions 1
• Liver toxicity is possible, especially if taken longer than 8 weeks 3
• Kava should be discontinued at least 2 weeks prior to any surgical procedure due to its potential for central nervous system depression 1
• Side effects reported in clinical trials include poorer memory and tremor/shakiness 4

Research Evidence on Efficacy

• Research on kava for anxiety shows mixed results:
  • Some shorter-term studies (3-6 weeks) have shown modest efficacy for anxiety reduction 5, 6
  • A larger, longer-term (16-week) trial found kava was not effective for diagnosed generalized anxiety disorder 4
• Kava may be more effective for short-term or situational anxiety rather than chronic anxiety disorders 4

Important Considerations

• If a patient insists on using kava despite recommendations against it:
  • Limit use to short-term only (less than 8 weeks) 3
  • Monitor liver function regularly 4
  • Avoid combining with other medications, especially those metabolized by cytochrome P450 enzymes 1
  • Discontinue immediately if any signs of liver problems occur 1, 3