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kava preparation (generic name)

an herbal product - treats Insomnia, Anxiety, Parkinson's disease, and Stress
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Alternate Title

Piper methysticum

Category

Herbs & Supplements

Synonyms

(+) -dihydrokawain-5-ol, 11-methoxy-5, 5-hydroxydihydrokawain, 6-dihydroyangonin, antares, ava, ava pepper, ava pepper shrub, ava root, awa, bornyl cinnamate, cavain, flavokavines A and B, Fijian kava, gea, gi, grog, intoxicating long pepper, intoxicating pepper, kao, kava kava extract LI 140, kava kava rhizome, kavakava, kavalactones, kavapiper, kavapyrones, kavarod, kava root, kavasporal forte, kavain, kave-kave, kawa, kawa kawa, kawa pepper, Kawa Pfeffer, kew, LI150, long pepper, Macropiper latifolium, malohu, maluk, maori kava, meruk, milik, pepe kava, olanzapine, Piper methysticum, pipermethystine, piperis methystici rhizoma, Rauschpfeffer, rhizoma piperis methystici, rhizome di kava-kava sakaua, risperidone, sakau, sakua, tonga, wurzelstock, WS 1490, yagona, yangona, yaqona, yongona.

Background

Kava beverages, made from dried roots of the shrub Piper methysticum, have been used ceremonially and socially in the South Pacific for hundreds of years and in Europe since the 1700s.

Several well-conducted human studies have demonstrated kava's efficacy in the treatment of anxiety with effects observed after as few as one to two doses and progressive improvements over one to four weeks. Preliminary evidence suggests possible equivalence to benzodiazepines.

Many experts believe that kava is neither sedating nor tolerance-forming in recommended doses. Some trials report occasional mild sedation, although preliminary data from small studies suggest lack of neurological-psychological impairment.

There is growing concern regarding the potential for liver toxicity from kava. Multiple cases of liver damage have been reported in Europe, including hepatitis, cirrhosis, and liver failure. Kava has been removed from shelves in several countries due to these safety concerns. The U.S. Food and Drug Administration (FDA) has issued warnings to consumers and physicians. It is not clear what dose or duration of use is correlated with the risk of liver damage. The quality of these case reports has been variable; several are vague, describe use of products that do not actually list kava as an ingredient, or include patients who also ingest large quantities of alcohol. Nonetheless, caution is warranted.

Chronic or heavy use of kava has also been associated with cases of neurotoxicity, pulmonary hypertension, and dermatologic changes. Most human trials have been shorter than two months, with the longest study being six months in duration.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Anxiety: Human studies have found at least moderate benefit of kava in the treatment of anxiety, and early evidence suggests that kava may be as effective as benzodiazepine drugs such as diazepam (Valium®). Kava's effects were reported to be similar to the prescription drug buspirone (Buspar®) used for Generalized Anxiety Disorder (GAD) in one study. However, there is concern regarding the potential danger from taking kava based on multiple reports from Europe and the United States that included hepatitis, cirrhosis, and liver failure. The U.S. Food and Drug Administration (FDA) has issued warnings to consumers and physicians. Many products have been pulled from the market. Natural Standard has collaborated with the World Health Organization (WHO) to prepare a detailed report of kava and associated adverse effects, which is now available.
Grade: A

Insomnia: Kava may cause sedation or lethargy. However, early research suggests that kava may not be effective for insomnia.
Grade: C

Parkinson's disease: There is unclear evidence for the use of kava for Parkinson's disease. Kava has been shown to increase 'off' periods in Parkinson's patients taking levodopa and can cause a semicomatose state when given with alprazolam. Consult with a qualified healthcare professional before taking kava due to the risk of harmful side effects.
Grade: C

Stress: Early study results suggest that kava and valerian may be beneficial to health by reducing the body's reactions during stressful situations and stress induced insomnia. Further research is needed to confirm these results.
Grade: C

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Addiction, anesthesia, anorexia, antifungal, anti-inflammatory, antipsychotic, aphrodisiac, arthritis, asthma, birth control, bladder inflammation, brain damage, bust enhancement, cancer, colds, depression, diuretic, dizziness, gonorrhea, hemorrhoids, incontinence, indigestion, infections, inflammation (ear), jet lag, joint pain or stiffness, kidney stones, leprosy, menopausal symptoms (hot flashes, sleep disturbances), menstrual disorders, migraine headache, muscle spasms, neuroprotective, pain, parasite infection, premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), protection of brain tissue against ischemic damage, renal colic, respiratory tract infections, rheumatism, seizures, stroke, syphilis, toothache, tuberculosis, urinary tract disorders, uterus inflammation, vaginal prolapse, vaginitis, weight reduction, wound healing.

Dosing

Adults (18 years and older)

Many doctors recommend starting with a low dose and gradually increasing intake over time. Typical doses range from 50 to 280 milligrams of kava lactones per day at bedtime. Sixty to 120 milligrams of kavapyrones have been taken daily. A dose of 50 to 100 milligrams taken by mouth has been used for up to two months. A dose of 100 milligrams of kava extract (WS 1490) has been taken three times daily. Doses as high as 800 milligrams daily of kava extract have been taken for short periods, but have not been studied over the long term and safety is not clear.

Children (younger than 18 years)

There is not enough scientific evidence to recommend the use of kava in children.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

People with allergies to kava or kavapyrones should not take kava. Skin rashes have been reported after taking kava.

Side Effects and Warnings

Until recently, kava was generally thought to be safe: when used in otherwise healthy people not taking any other drugs, herbs, or supplements; over short periods of time (one to two months); and at recommended doses. However, there have been numerous reports of severe liver problems in people using kava. Multiple cases of liver toxicity, including liver failure, have been reported following the use of kava in Europe. The U.S. Food and Drug Administration (FDA) has issued warnings to consumers and physicians and has requested that physicians report cases of liver toxicity that may be related to kava use. Although many natural medicine experts still believe that kava is safe at recommended doses, there is not enough scientific information to make a clear conclusion. Therefore, kava should be used only under the supervision of a qualified healthcare professional, should never be used above recommended doses, and should be avoided by people with liver problems or taking drugs that affect the liver.

Other serious side effects that have been observed with chronic or heavy use of kava include: skin disorders, blood abnormalities, apathy, kidney damage, seizures, psychotic syndromes, and increased blood pressure in the lungs (pulmonary hypertension). Blood in the urine has also been reported.

Mild side effects may include gastrointestinal (stomach) upset, allergic rash, or mild headache.

Several cases of abnormal muscle movements have been reported after short-term use of kava (one to four days), including tightening, twisting, or locking of the muscles of the mouth, neck (torticollis), and eyes (oculogyric crisis). Worsening of symptoms of Parkinson's disease and several cases of abnormal whole body movements (choreoathetosis) following high doses of kava have also been noted. Tremor, poor coordination, headache, drowsiness, and fatigue have uncommonly been reported, particularly with large doses. A case of muscle cell breakdown (rhabdomyolysis) was reported in a 29 year-old man after taking an herbal combination of ginkgo, guarana, and kava.

Sedation (drowsiness) has occasionally been reported with kava use, although there is early evidence from several small human studies that kava may not significantly cause this effect. Because this issue remains unclear, driving and operating heavy machinery is not recommend while taking kava.

Eye disturbances and eye irritation have rarely been associated with chronic or heavy kava use. Rapid heart rate, electrocardiogram (ECG) abnormalities, and shortness of breath have been reported in heavy kava users. Laboratory tests suggest that kava may increase the risk of bleeding through effects on blood platelets.

Kava may affect electroconvulsive therapy (ECT) outcome. It has also been associated with meningismus (pain caused by irritation in the layers around the brain and spinal cord), urinary retention, skin lesions, enhanced or decreased cognitive performance, anorexia, sleeplessness, abnormal sensations called paresthesias, vomiting, and dangerously high blood pressure.

Pregnancy & Breastfeeding

Use of kava cannot be recommended during pregnancy or breastfeeding. There may be decreases in the muscle strength of the uterus with the use of kava, which may have harmful effects on pregnancy. Chemicals in kava may pass into breast milk with unknown effects, and therefore this herb should be avoided during breastfeeding.

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