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SCIENTIFIC NAME:
Piper methysticum
FAMILY NAME:
Piperaceae
COMMON NAME:
Kava
  Evidence for Efficacy (Human Data)
   Clinical Trials  (41)
   Observational Studies/Case Reports  (16)
   Traditional and Folk Use  (34)
  Safety Data
   Adverse Effects & Toxicity  (50)
   Interactions  (7)
   Contraindications  (0)
  Evidence of Activity
   Animal Studies  (17)
   Pharmacodynamics  (41)
   Analytical Chemistry  (33)
   Pharmacokinetics (ADME)  (4)
   Genetics & Molecular Biology  (3)
  Formulas/Blends
   Modern Methods of Preparation  (6)
   Patents  (13)
   Folk Blends (component)  (0)
   Contemporary Mixtures (component)  (0)
  Other Information
   Pictures & Distribution Maps  (4)
   Cultivation, Conservation & Ecology  (2)
   Related Links  (6)
  Dynamic Updates
   Live PubMed Searches  (15)
  History of Records
   History of Record (1)
 
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EVIDENCE FOR EFFICACY (HUMAN DATA)
 
Clinical Trials
  Cochrane evidence-based review of azapirones for generalized anxiety disorder was inconclusive as to whether azapirones were superior to antidepressants, psychotherapy or kava kava. Chessick 2006
  The pooled sample (n=64) from adult outpatients with DSM-IV generalized anxiety disorder including participants: kava, n=28; placebo, n=30; and venlafaxine, n=6 revealed that these three controlled trials do not support the use of kava in DSM-IV generalized anxiety disorder. Connor 2006
  Study on 31 healthy volunteers (13 Piper methysticum 30C, 11 placebo and 7 Plumbum metallicum 30C), conludes that open diaries, supervision and double-blind placebo are useful methods in homeopathic pathogenetic trials. Signorini 2005
  A double-blind randomized placebo-controlled trial involving healthy volunteers found Kava is a potent anxiolytic agent, which, additionally, can facilitate cognitive functioning and increase positive affectivity related to exhilaration. Thompson 2004
  Randomized open study investigating, in peri-menopausal women, modifications induced by calcium supplementation, calcium plus Kava-Kava at the dose of 100 mg/day, or calcium plus Kava-Kava at a dose 200 mg/day revealed improvement of mood, particularly of anxiety. Cagnacci 2003
  Update of 2001 & 2002 Cochrane evidence-based reviews found that compared with placebo, kava extract is an effective symptomatic treatment for anxiety although, at present, the size of the effect seems small. Available data suggests that it is relatively safe for short-term treatment (1-24 wks). Pittler 2003
  Analyses of a study of adults with DSM-IV generalized anxiety disorder revealed significant differences. Kava was superior on the Self Assessment of Resilience and Anxiety (SARA) in low anxiety and placebo was superior on the Hospital Anxiety and Depression Scale and SARA in high anxiety . Connor 2002
  Participants performed a standardized mental stress task. Blood pressure, heart rate and subjective ratings of pressure were assessed at rest and during the mental stress task. Results suggest that kava and valerian may reduce physiological reactivity during stressful situations. Cropley 2002
  The combined use of hormone replacement therapy and kava extract seems to be effective against menopausal anxiety. Kava extract accelerates resolution of psychological symptoms while hormone therapy safeguards against osteoporosis and cardiovascular disease. De Leo 2001
  A 5-week randomized, placebo-controlled, double-blind investigation confirmed the anxiolytic efficacy and good tolerance of kava-kava special extract WS1490 and showed that further symptom reduction is possible after a change-over from benzodiazepine treatment. Malsch 2001
  Preliminary findings suggest that kava might exert a favourable effect on reflex vagal control of heart rate in generalized anxiety disorder patients. Watkins 2001
  Total stress severity was significantly relieved by kava and valerian (p < 0.01) with no significant differences between them; as was also insomnia (p < 0.01). The proportion of patients with no side-effects was 58% with each herb respectively. Wheatley 2001
  Evidence of efficacy for St. John's wort, kava, ginkgo, and valerian in treating psychiatric conditions is growing, but translating the results into effective treatments is hampered by the chemical complexity and non-standardization of the products, and the paucity of well-controlled studies. Beaubrun 2000
  The results of this study show that the association of Hormone Replacement Therapy and Kava-Kava extract may represent an excellent therapeutic tool for the treatment of women in stabilized menopause, in particular those suffering from anxiety and depression. De Leo 2000
  The degree of anxiety was acute in that the patients were waiting for the results of a histopathological diagnosis, carried out on account of suspect mammary findings. The preparation under investigation, Kavosporal forte, was found to be well suited for the amelioration of anxiety. Neuhaus 2000
  The meta-analysis of three trials suggests a significant difference in the reduction of the total score on the Hamilton Rating Scale for anxiety in favor of kava extract. These data imply that kava extract is superior to placebo as a symptomatic treatment for anxiety. Pittler 2000
  A review of the results of randomized, controlled trials supports the use of kava for anxiety and valerian for insomnia Fugh-Berman 1999
  Review of therapeutic efficacy, mechanisms of actions, dosages and regimens, preparations, and adverse effects for melatonin, St John's wort, valerian, and kava-kava Heiligenstein 1998
  WS 1490 kava extract reduced anxiety in a 25-week placebo-controlled double-blind trial with 101 outpatients with anxiety of non-psychotic origin Volz 1997
  Study methodology for unconventional therapies such as Kava-Kava for patients in the state of anxiety, tension and restlessness Gaus 1995
  Drug therapy of panic disorders. Kava-specific extract WS 1490 compared to benzodiazepines [Article in German] anon 1994
  Drug therapy of panic disorders. Kava-specific extract WS 1490 compared to benzodiazepines [Article in German] anon 1994
  Comparison of oxazepam with WS1490 (kava extract) on reaction time and event-related potentials in a double-blind study of young, healthy males Heinze 1994
  People with moderate 0.05% blood alcohol had better concentration when using kava extract WS 1490 (3 x 100 mg/d for 8 days) but no better performance in a placebo-controlled randomised double-blind study of 20 adults [Article in German] Herberg 1993
  Kava slightly improved a word recognition task while oxazepam reduced the scores in a double blind crossover study of 12 healthy people Munte 1993
  EEG-brain-mapping in healthy adults taking single doses of kawain showed dose-dependent increase in delta, theta and alpha 1 power, and decrease in alpha 2 and beta power. Primary peak in 1st hour and a 2nd peak in the 8th hour [Article in German] Frey 1991
  Anxiety patients benefited from WS 1490 (3 x 100 mg/day for 4 weeks) in a randomized, double-blind study with 58 people [Article in German] Kinzler 1991
  Female climacteric symptoms benefited from kava WS 1490 extract 3 X 100 mg/day for 8 weeks in a double-blind placebo-controlled study with 40 patients [Article in German] Warnecke 1991
  Kavain gave benefit equal to oxazepam in a placebo-controlled double blind trial with 38 out-patients with anxiety [Article in German] Lindenberg 1990
  400 mg/day of cavain alleviated anxiety in a 4 week double-blind placebo controlled trial with 52 patients Lehmann 1989
  Kava. anon 1988
  Continuous increase in memory, vigilance, fluency of mental functions, reaction time, and circulation during 3 weeks of taking 400 mg/d kavain in a double blind study of 84 patients [Article in German] Scholing 1977
  Mental effects of kavain [Article in German] Kretschmer 1974
  Effect of kavain on alcoholic patients in the withdrawal phase (author's transl) [Article in German] Kryspin-Exner 1974
  Studies of the vegetative action mechanism of kavain and magnesium orotate [Article in German] Prokop 1971
  Studies of the vegetative action mechanism of kavain and magnesium orotate [Article in German] Prokop 1970
  Treatment of senile hearing disorders and disorders of the inner ear with the geriatric therapeutic agent Kavaform [Article in German] Kluger 1969
  Treatment of cerebro-organic changes due to age with kavaform [Article in German] Kurz 1968
  Pharmacology of kava. 2. Buckley 1967
  Clinical studies on the geriatric agent Kavaform. Double blind tests [Article in German] Hun 1967
  Pharmacology of kava. 1. Meyer 1967
Observational Studies/Case Reports
  Among eight different herbals studied Piper methysticum and Bacopa monniera were found to associated with anxiolytic activity in humans. Ernst 2006
  Review discussing the proposed uses, dosing parameters, adverse effects, toxicology, interactions and mechanism of action of kava (Piper methysticum) detailed. Ulbricht 2005
  A systematic search using computerized databases shows that Kava is effective in the treatment of tension and anxiety. There may be risk-factors for severe motor and psychiatric responses to kava use. Cairney 2002
  This validation study found that self-reported kava use may be a poor estimate of current use when obtained from interviews away from a confidential clinic setting. Consensus classification by knowledgeable Aboriginal health workers provided comprehensive coverag with greater reliability. Clough 2002
  Piper methysticum (kava) under discussion: observations on quality, effectiveness and safety with reference to possible hepatic side effects ratio. [Article in German] Schmidt 2002a
  This paper systematically reviews the clinical evidence relating to the safety of extracts of the herbal anxiolytic kava (Piper methysticum). Serious adverse events have been reported and further research is required to determine the nature and frequency of such events. Stevinson 2002
  Echinacea, ephedra, garlic, ginkgo, ginseng, kava, St John's wort, and valerian are commonly used herbal medications that may pose a concern during the perioperative period. Pharmacodynamic herb-drug interactions include potentiation of the sedative effect of anesthetics by kava and valerian. Ang-Lee 2001
  A 37-year-old female outpatient with generalized anxiety disorder, a simple phobia and a specific social phobia was treated with phytotherapy (Kava kava). Within 4 weeks, symptoms had improved by 75% and by 6 months an almost total remission of symptoms was observed. Boerner 2001
  Safety parameters including withdrawal symptoms, effect on heart rate, blood pressure, laboratory assessments, and sexual function between kava and placebo revealed usage in treating anxiety at 280 mg of kava lactones/day for 4 weeks to be safe. Connor 2001
  An analysis of a Germany database providing anonymous access to a panel of physicians and patients indicated that prescriptions of kava overstepped the recommended daily dose in 78% of the cases, explaining why kava prescriptions are associated with high incidence of adverse drug reactions. Schroder-Bernhardi 2001
  Kava alone has little effect on performance skills on a number of cognitive and visuomotor tests but appears to potentiate both perceived and measured impairment when combined with alcohol. Foo 1997
  Kava-kava may be indicated in special cases, e.g. low degree of anxiety, abuse or tolerance problems with the drugs of first choice, benzodiazepines and antidepressants [Article in German] Laux 1997
  The effect of kavaine and magnesium orotate combination in the psycho - organic disorders of the elderly. Sukyasyan 1980
  The therapeutic effect of kavain and magnesium orotate on traumatic and vascular brain lesions [Article in German] Wenzel 1971
  Effect of kava in normal subjects and patients. Pfeiffer 1967
  Kavain in diseases of the aged [Article in German] Schliack 1967
Traditional and Folk Use
  Plants including Piper methysticum possessing central activities such as analgesic, anxiolytic, psychoanaleptic, psycholeptic & psychodysleptic effects have been reviewed & crude or semipurified extracts instead of active substances seemingly responsible for therapeutic effect is discussed. Carlini 2003
  Traditional use of sakau (kava) in Pohnpei: lessons for integrative medicine. [no abstract] Balick 2002
  Kava and kavalactones are shown to be effective in the treatment of anxiety at subclinical and clinical levels, anxiety associated with menopause and anxiety due to various medical conditions. Their possible mechanism of action and adverse effects are detailed. Singh 2002
  Traditional preparation of kava in the Oceanic Islands involves maceration of the root or root bark in cold water and/or a coconut milk solution. The average use of kava in the Northern Territories of Australia is reported to average approximately 37g of kava powder per day. Denham 2002a
  Bioavailability of kavalactones vary with extraction methods. Traditional 25% ethanol tinctures contain less lactones as well as a 1:1 ratio of glutathione, which protect hepatocytes from damage. German standardized methods extract more of the lactones and less of the glutathione. Denham 2002c
         Usage and other info at Lee Kagan's Kava Page
  The data shows that the more kava consumed by a population the lower the cancer incidence for that population, suggesting a close, inverse relationship between cancer incidence and kava consumption. Steiner 2000
  [Kava: Piper methysticum.] Pepping 1999
  Kava, now widely available as a relaxant, was a ceremonial Hawaiian psychoactive causing tranquil intoxication in which thoughts and memory remain clear Norton 1998
  Review: from Cook's reports (1772-1775) to modern pharmacology and toxicology [Article in Polish] Nowakowska 1998
         Brief description at Amazon.com. Describes traditional technique of emulsifying the resinous root material in water. Lebot 1997
  Smoking cessation program in Fiji was successful with combination of group pledge, village rapid inhalation ceremony, social contracting through notices and media, and a tabu formalized through a kava ceremony Groth-Marnat 1996
  Ceremonially used by many traditional societies of the Southern Pacific, the beverage induces relaxation, enhances a sense of sociability and promotes sleep [Article in German] Suss 1996
         Article on kava in Vanutu by Combs 1995
  This review introduces clinicians to what GSH is, its basic chemistry, and some areas of active research. See Whitton 2002. Lomaestro 1995
  Kava, a nonfermented psychoactive beverage, has been used ceremonially for thousands of years by Pacific Islanders. The skin eruptions were first reported by members of Captain James Cook's Pacific expeditions Norton 1994
  Kava lactones were detected in a number of Pacific Island archaeological artefacts using selected-ion monitoring techniques with GC/EI-MS Hocart 1993
  58 herbs were commonly used by Hawaiians for asthma; noteworthy are Sophora chrysophylla, Piper methysticum, solanum americanum, and Aleurites molucana Hope 1993
  Multidisciplinary review of kava: from ceremonial usage to modern pharmacology Singh 1992
  Indiginous psychoactive use of betel, kava and pituri Cawte 1985
  In Tonga kava use is mainly by men. In urban areas usage is somewhat replaced by alcohol Finau 1982
  Kava and prohibition in Tanna, Vanuatu. Gregory 1981
  The effects of D, L-Kavain. Kretschmer 1981
  Koni, kona, kava. orange-beer culture of the Cook islands: drinking customs have cultlike forms, provide for social integration, and control drunken aggression Lemert 1976
  Kava kava. Mental health in Papua New Guinea. Burton-Bradley 1974
  Ethnographical aspects of kava. Ford 1967
  Piper methysticium (kava). The function of kava in modern Samoan culture. Holmes 1967
  Secular use of kava in Tonga. Lemert 1967
  Ancient kava ceremony re-enacted on Pahn Kedira, Ponape. Riesenberg 1967
         Monograph on Henriette's Herbal website King's American Dispensatory 1898
         Monograph in "A Modern Herbal" by Mrs. M. Grieve botanical.com
         Information on buying kava and kava ceremonies courtesy of fijibure.com
         Type "piper methysticum" in the search field of D. Moerman's Native American Ethnobotany
         Search for ethnobotanical uses of Piper methysticum (methystichum) in Dr. Duke's Phytochem and Ethnobot DB
SAFETY DATA
 
Adverse Effects & Toxicity
  The no observed adverse effect levels of kava (Piper methysticum) were decided as 0.25g/kg in both genders, based on neurotoxic effects, increase in GGT, cholesterol, liver weight, and HP and decrease in body weight.in groups of 10 male and 10 female rats. Clayton 2007
  Kavalactones (+/-)-kavain, methysticin,yangonin and demethyoxy yangonin, (all 4 of Piper methysticum) failure to inhibit alcohol dehydrogenase in vitro at 1,10 or 100 microM concentrations explains mechanism of hepatotoxicity of kava a folkloric beverage. Anke 2006
  No satisfactory answer was obtained to ascertain major liver failure cases in which kava kava ( Piper methysticum, Forst. f., Piperaceae) has been implicated in spite of summarizing the major theories and hypotheses as to the mechanism of kava hepatotoxicity. Anke 2004b
  Kava toxicity appears to be "idiosyncratic" and risk-to-benefit ratio of kava extracts, nevertheless, remains good in comparison with that of other drugs used to treat anxiety. Clouatre 2004
  After case reports of liver toxicity allegedly associated with its nontraditional use of 'awa (Piper methysticum) the remedy was banned in several European countries. O'Sullivsan 2004
  3 kava lactones and ethanolic extract of dried kava root produce cell toxicity without being influenced by CYP 1A1, 1A2, 2A6, 2E1, and 3A4 or epoxide hydroxylase suggesting non activation into toxic metabolites. Zou 2004a
  Hepatotoxic risks under the treatment with kavapyrones might be minimized by limiting to a dose of 120, maximally 210 mg kavapyrones per day for 1 month, or 2 months, monitoring by lab. tests like ALT and gamma-GT estimation and by avoiding co-medication & alcohol consumption.[Article in German] Teschke 2003
  [Acute liver failure after administration of herbal tranquilizer kava-kava (Piper methysticum).] Brauer 2003
  No impairment was found in cognitive or saccade function in individuals who were currently heavy kava users but current and ex-kava users showed a higher rate of kava dermopathy, lower body mass index, lowered blood lymphocytes and, showed elevated liver enzymes. Cairney 2003
  Individuals intoxicated from drinking kava (n=11) when compared with a control group (n=17) using saccade and cognitive tests showed ataxia, tremors, sedation, blepharospasm and elevated liver enzymes (GGT and ALP). Cairney 2003
  Neurological syndromes associated with the ingestion of plants including Kava and fungi with a toxic component (II).detailed. [Article in Spanish] Carod Artel 2003
  A case of acute liver failure and death associated with the use of a preparation containing the "natural" anxiolytic kava (Piper methysticum) and passion flower (Passiflora incarnata). Gow 2003
  A case of acute hepatitis( previously healthy 14-year-old female) associated with the use of kava kava, derived from the root of the pepper plant, Piper methysticum detailed cautioning the clinicians to remain aware of the toxic potential of herbal products. Humberston 2003
  Due to various reports of liver toxicity, including liver failure, associated with extracts from the Pacific islands plant kava (Piper methysticum), it has been banned from sale as a herbal anxiolytic in many Western countries, to the detriment of Pacific island economies. Moulds 2003
  Analysis of 29 novel cases of hepatitis along with Kava ingestion revealed hepatic necrosis or cholestatic hepatitis were noticed with both alcoholic and acetonic Kava extracts. Stickel 2003
  No studies explain liver toxicity of kavalactones and it is unknown which compound might provoke liver disease. It is possible that unknown or unexpected constituents are responsible or contributed to reported liver toxicity. Bilia 2002
  Kava-induced acute icteric hepatitis. [no abstract[ [article in spanish] Bujanda 2002
  Kava-induced fulminant hepatic failure. [no abstract] Campo 2002
  A total of 11 patients who used kava products had liver failure and underwent subsequent liver transplantation in Germany, Switzerland, and the United States due to occurrence of severe hepatic toxicity possibly associated with the consumption of products containing kava. Centre for diseases control and prevention 2002
  This paper argues that many of the adverse events cited by the German Federal Institute for Drugs and Medical Products should not be attributed to kava, rather that the properties of concentrated standardized kava extracts as opposed to traditional extracts, contribute to adverse events. Denham 2002
  Kava and severe liver injury. [no abstract] FDA Consumer
         The Food and Drug Administration (FDA) is advising consumers of the potential risk of severe liver injury associated with the use of Kava (Piper methysticum) - containing dietary supplements. FDA/CFSAN
  A 45-year-old female, who had a family history of essential tremor, developed severe and persistent parkinsonism after days of treatment with kava extract for anxiety. The symptoms improved with anticholinergics. Meseguer 2002
  The kavapyrone (+/-) kavain is neurotoxic only at high concentrations when exposed alone to the developing hippocampus,and it appears to adversely affect neuronal recovery following excitotoxic insults. Mulholland 2002
  Another FDA warning: Kava supplements. [no abstract] Parkman 2002
         In this analysis, only 4 of 22 case reports established certain probablility of kava hepatotoxicity. In only one case was kava was taken according dosage recommendations of the German commission E monograph. The risk of adverse liver effects from kava seems very low. Schmidt 2002
  Herbal kava: reports of liver toxicity. [no abstract] Wooltorton 2002
         The responses include data on contemporary extracts of kava lactones using either acetone or 95% ethanol versus tradtional methods using 25% ethanol. eBMJ rapid response to Escher 2001
         A 50 year old man with jaundice had consumed kava extracts capsules (210-280 mg lactones)daily for two months. The patient received a liver transplant two days later and recovered uneventfully. Histology showed extensive and severe hepatocellular necrosis. See eBMJ rapid response to Escher 2001. Escher 2001
  A 60 year-old woman was admitted to hospital because of jaundice, fatigue, weight loss over several months and icteric skin. The exclusion of other causes and the histological diagnosis made Kava-Kava as the cause of acute liver failure most likely. Kraft 2001
  This paper reports on adverse drug reactions, its definitions, diagnosis, management and in particularly the timing, pattern of illness, results of investigations, and rechallenge can help attribute causality to a suspected adverse drug reaction. See Denham 2002. Edwards 2000
  Adverse effects of herbal medicines are an important albeit neglected subject in dermatology, which deserves further systematic investigation, including St John's Wort, kava, aloe vera, eucalyptus, camphor, henna and yohimbine. Ernst 2000
  An extensively studied genetic polymorphism involves cytochrome P450 2D6. CYP2D6 metabolizes a number of antidepressants, antipsychotics, beta-adrenoceptor blockers, and antiarrhythmic drugs. About 7% of Caucasians and 1% of Asians are poor metabolizers of CYP2D6 substrates. See Denham 2000. Poolsup 2000
  Sebotropic drug reaction resulting from kava-kava extract therapy: a new entity? Jappe 1998
  Two unrelated women (aged 39 and 42) had been admitted (at different times) to hospital because of acute hepatitis. Both patients had a history of acute hepatitis. The liver function tests normalized when herbal medication was stopped [Article in German]. See Denham 2002. Strahl 1998
  Herbal xenobiotics can lead to the brreakdown of hepatocytes, leading to centribular necrosis. See Denham 2002. Kaplowitz 1997
  Neurological manifestations of kava intoxication. Spillane 1997
  Coma associated with a mixture of alprazolam and kava Almeida 1996
  The ichthyosiform kava dermopathy is a well-known side effect of excessive use of kava; a case of such systemic contact-type dermatitis after oral administration of kava extract is reported here [Article in German] Suss 1996
  Heavy kava drinkers acquire a peculiar reversible scaly ichthyosiform eruption, kava dermopathy. The cause is unknown but may relate to interference with cholesterol metabolism Norton 1994
  Ten metabolites seen by GC/MS in human urine indicate hydroxylation of the phenyl ring, reduction of the 7,8-double bond, hydroxylation of the lactone ring with subsequent dehydration and opening of the lactone ring. Most are excreted as conjugates Koppel 1991
  Heavy chronic consumption of kava is associated with a pellagroid dermopathy. Of 200 Tonga drinkers, 29 with skin changes put in niacin trial 100 mg or placebo for 3 weeks revealed no benefit Ruze 1990
  The effects of heavy usage of kava on physical health. anon 1988
  Macabre effects of a "cult" for kava. Cawte 1988
  5-Hydroxydihydrokawain found in roots from Vanuatu but not Fiji. N-cinnamoyl pyrrolidine alkaloids & stigmasterol found in kava resin from Fiji and Vanuatu. Efficiency of water extraction (traditional) is only 5-10% of organic solvent Cheng 1988
  Kava use associated with poor health, "puffy" face, scaly rash, increased patellar reflexes, haematuria, red-cell volume, gamma-glutamyl transferase and HDL cholesterol and decreased weight, albumin, plasma protein, lymphocytes, lung volume, bilirubin Mathews 1988
  Kava bowl adoption by Australian Aboriginal communities to challenge alcohol usage brought about a new "blissful indolence" condition of detachment and pellagrinous skin reaction Cawte 1986
  A case report of visual disturbance with reduced near point of accommodation and convergence, increased pupil diameter and disturbance to the oculomotor balance Garner 1985
  Half of dihydrokawain was eliminated in rat urine in 48 h: 2/3 hydroxylated (esp. para) plus some pryrone ring breakage yielding 9-13% hippuric acid. Less urinary methysticin and yangonin, which are largely demethylated Rasmussen 1979
  Toxicological studies with Kavaform. Hapke 1971
Interactions
  Review on the existing data on interactions of kava and St. John's wort with pharmaceutical agents revealing urgent need for detailed investigations to identify clinically significant interactions that have the potential to cause adverse effects. Singh 2005
  Kavalactones, active principles of kava extracts, are potent inhibitors of several enzymes of the CYP 450 system which indicates that kava has a high potential for causing pharmacokinetic drug interactions with other herbal products or drugs. Anke 2004a
  6 Herbs including kava significantly modulate the activity of drug-metabolizing enzymes (notably cytochrome p450 isozymes) and/or the drug transporter P-glycoprotein participate in potential pharmacokinetic interactions with anticancer drugs. Sparreboom 2004
  A review emphasizes the additive and supra-additive effects of a plant's multiple constituents. Using examples, synergistic action in St. John's wort, kava kava, and valerian has been explained. Spinella 2002
  This review identified a series of potential interactions between herbal therapies (St. John's wort, ginkgo biloba, kava, valerian, and ginseng) most likely to be used for the treatment of dementia and conventional drug therapy that place older people at risk for an adverse drug event. Gold 2001
  Kava (Piper methysticum) increases 'off' periods in Parkinson patients taking levodopa and can cause a semicomatose state when given concomitantly with alprazolam. Izzo 2001
  Ethanol and the lipid soluble extract (kava resin) increase each other's hypnotic action in mice Jamieson 1990
Contraindications
No Records
 
EVIDENCE OF ACTIVITY
 
Animal Studies
  No suspicion of potential liver toxicity was observed when Wistar rats of both sexes were fed 7.3 or 73 mg/kg body weight of ethanolic kava (Piper methysticum extract for 3 and 6 months. Sorrentino 2006
  Using chick, social separation-stress procedure as an anxiolytic bioassay, P. methysticum samples containing total kavalactones & fractions containing 1-6 kavalactones of varying concentrations were screened and found that dihydrokavain mediates anxiolytic properties. Feltenstein 2003
  When various doses of ethanolic extract of kava root administered intraperitoneally to BALB/cByJ inbred mice, production of significant murine anxiolytic-like behavioral changes & sedation that are not mediated through benzodiazepine binding site on GABA(A) receptor complex were observed. Garrett 2003
  Elevation of none of the markers of liver toxicity (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and lactate dehydrogenase, nor malondialdehyde) observed in rats administered with active kavalactones. Singh 2003
  Acute effects of diazepam and a Kava-Kava preparation, were examined in Wistar rats using the elevated plus maze and at LI 150 (120-240 mg/kg p.o.) kava affected the behaviour measured in the X-maze test, inducing an anxiolytic like behaviour similar to diazepam. Rex 2002
  This experiment sought to characterize the putative anxiolytic properties of Piper methysticum extract and its six principle kavalactones in the chick social separation-stress paradigm. Findings suggest that the anxiolytic effects may be mediated by dihydrokavain. Smith 2001
  Kava-kava, a shrub, contains kavapyrones as active substances; these have been pharmacologically investigated in detail and are comparable with the benzodiazepine tranquilizers with regard to their mode and strength of action. [Article in German] Muller 1999
  [Inhibition of haloperidol-induced catalepsy in rats by root extracts from Piper methysticum F.] Noldner 1999
  Neither a single oral dose of 100 mg (+)-dihydromethysticin/kg nor chronic feeding for 78 days altered the dopaminergic or serotonergic tissue levels in rat brain significantly Boonen 1998
  (+/-)-kavain (100 mg/kg, p.o.) reduced veratridine-induced glutamate release from 301% to 219% Ferger 1998
  Kava extract, methysticin and dihydromethysticin reduced ischemia induced brain infarct as well as memantine (anticonvulsant) while kawain, dihydrokawain, and yangonin failed Backhauss 1992
  Kavain reduced muscle tone. Effects on EEG indicates limbic structures and, especially, the amygdalar complex as the target, which may explain the promotion of sleep, even in the absence of sedation [Article in German] Holm 1991
  Aqueous or lipid (resin) extracts had analgesic effects in mice. Of 8 pyrones, kawain, dihydrokawain, methysticin and dihydromethysticin were effective and not reversed by nalaxone Jamieson 1990
  Both aqueous and lipid kava extracts reduced amphetamine-induced hypermotility in mice. 125 mg/kg of resin i.p. was necessary to decrease avoidance responses by 18%. Increasing to 150 mg/kg caused ataxia and sedation Duffield 1989