From the Guidelines
Kava kava should not be used for the treatment of chronic insomnia disorder due to its lack of efficacy and potential risk of acute fatal liver toxicity. The 2020 study published in the Annals of Internal Medicine 1 found that kava was ineffective in treating chronic insomnia disorder compared to placebo, and it carries a known risk of acute fatal liver toxicity. The U.S. Food and Drug Administration has also warned healthcare providers and the public about the risk of acute liver damage and death associated with kava 1.
Some key points to consider when evaluating kava kava include:
- The lack of evidence supporting its use for chronic insomnia disorder, with no between-group differences found in critical outcomes compared to placebo 1
- The potential for serious harm, including acute fatal liver toxicity, which has led to restrictions or bans on kava products in several countries
- The importance of avoiding kava in certain populations, such as those with existing liver problems, pregnant or breastfeeding women, and people taking medications that may interact with kava
Instead of kava kava, other treatments for chronic insomnia disorder may be considered, such as cognitive-behavioral therapy for insomnia (CBT-I) or prescription medications with established safety profiles. It is essential to consult with a healthcare provider to determine the best course of treatment for individual cases of insomnia.
From the Research
Kava Kava Overview
- Kava kava is a perennial shrub native to the South Pacific, used for centuries to prepare a psychoactive beverage from its rhizoma 2.
- Kava extracts are commonly used as herbal anxiolytic drugs worldwide, including in European countries and the USA 2.
Safety and Efficacy
- Toxicological and clinical studies have shown that kava extracts are virtually devoid of toxic effects, with the exception of rare hepatotoxic side effects 2.
- A systematic review and analysis of randomized clinical trials found that kava kava is an effective treatment for combating symptoms of anxiety, with a final risk ratio of 1.50 (95% CI: 1.12,2.01) in favor of the intervention 3.
- Adverse events were shown to be the same as placebo, and laboratory values analyzing hepatotoxicity were no different when compared to baseline, except in two studies 3.
Comparison to Other Treatments
- A meta-analytic review found that benzodiazepines are the most effective drug for treating generalized anxiety disorder, with a moderate to large effect size (Hedges' g = 0.50) 4.
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) also demonstrated efficacy, but with lower effect sizes (Hedges' g = 0.33 and 0.36, respectively) 4.
- A network meta-analysis found that cognitive behavioral treatment, SSRIs, and the combination of the two are effective treatments for childhood anxiety disorders, with no significant difference between the three treatment forms 5.
Hepatotoxicity Risks
- Rare hepatotoxic side effects have been reported in patients taking kava extracts, with only one case establishing a very probable causal relationship between kava treatment and the development of toxic liver disease 2.
- The risk of hepatotoxicity is especially possible if kava is taken for longer than 8 weeks 3.