Kava
Scientific Names: Piper methysticum Other Common Names: Kava, intoxicating pepper, yagona, ava, awa, tonga, kew Overall Safety: 🙁
Therapeutic Efficacy and Considerations:
Note: Serious hepatotoxicity, including failure and death, has been reported with short- and long-term kava use over the last several years. Several countries, including Switzerland, Germany, and Canada, have banned the sale of kava. Kava is not recommended for any use at this time and patients should be counseled to avoid all kava. Descriptions of data on efficacy below are for informational purposes only.
Anxiety Disorders: 😊 A majority of the studies conducted demonstrate positive results for decreasing anxiety and symptoms in generalized anxiety disorder. Kava has similar efficacy to benzodiazepines (low-to-moderate doses) and buspirone, but fewer side effects, including cognitive dysfunction.
Anxiety Associated with Menopause: 😊 Two studies have also demonstrated kava may be effective in anxiety specifically associated with menopause.
Mood and Cognitive Performance: 😐 Although often recommended for mood and memory, only one study has examined effects on mood and cognitive performance. Some benefits were seen, but the study had multiple methodological limitations and was based on a single dose of kava. Evidence is not sufficient to determine status of efficacy.
Sleep Disturbances: 😐 Although often recommended for sleep, only one study has examined effects on sleep. Results suggests kava may be effective at aiding in sleep quality and recuperative effect after sleep.
Mood and Cognitive Performance: 😐 Although often recommended for mood and memory, only one study has examined effects on mood and cognitive performance. Some benefits were seen, but the study had multiple methodological limitations and was based on a single dose of kava. Evidence is not sufficient to determine status of efficacy.
Sleep Disturbances: 😐 Although often recommended for sleep, only one study has examined effects on sleep. Results suggests kava may be effective at aiding in sleep quality and recuperative effect after sleep.
Chemistry/Pharmacology: The active components, kavapyrones or kava-lactones, are found in the roots and rhizomes of the plant. The exact mechanism of the kava-lactone is unknown. They are thought to increase the expression of GABA receptors, especially in the limbic area of the brain, and enhance dopamine. These may contribute to seizure control activity. Inhibition of noradrenaline and effect on the limbic system are to contribute to mood enhancement, excitability, and possible psychosis. Kava may also have herbicidal and fungicidal activity and may potentially inhibit COX 1 and 2.
Drug Interactions: Hepatotoxic drugs. CNS depressants including alcohol (due to additive effects), digoxin, levodopa (due to dopamine antagonism). Although evidence is preliminary, kava may inhibit CYP3A4, 2C9, 1A2, 2D6, and 2C19, and, therefore, may increase levels of drugs metabolized by those enzymes.
Contraindications/Precautions: Not recommended for use at this time. Hepatitis or any hepatic insufficiency. Neutropenia, renal disease, thrombocytopenia, Parkinson’s disease, pregnancy/lactation, and children.
Adverse Effects: Hepatotoxicity, liver failure, death. CNS changes including Parkinsonism, headache, dizziness, vision changes, possible hypertension, shortness of breath, diarrhea, and weight loss. Kava is thought to have less cognitive impairment activity than benzodiazepines, however, it still may affect the ability to drive or operate machinery. Kava dermopathy syndrome (scale-like lesions on the palms of hands, soles of feet, and flaky, discolored skin) occurs in abusers using high doses over long term.
