Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

• Anxiety, stress, restlessness, insomnia, benzodiazepine withdrawal
• Mild muscle aches and pains
• Menstrual cramps and PMS

Contraindicated in:

• OB: Lactation: Pregnancy (may affect uterine tone) and lactation
• Patients with endogenous depression (may ↑ risk of suicide)
• Children <12 yr
• Hepatitis or other liver disease.

Use Cautiously in:

• Concurrent use of other hepatotoxic agents
• Depression and Parkinson's disease (may worsen symptoms)
• Should not be used for >3 mo to prevent psychological dependence.

Derm: allergic skin reactions, pellagroid dermopathy, yellow discoloration of skin.

EENT: Pupil dilation, red eyes, visual accommodation disorders.

GI: gastrointestinal complaints, HEPATOTOXICITY.

Hemat: ↓lymphocytes, decreased platelets.

Metab: weight loss (long term, high dose).

Neuro: ataxia , dizziness, drowsiness, extrapyramidal effects, headache, muscle weakness, sensory disturbances.

Natural-Drug Products:

• Additive effect when used with alprazolam.
• Potentiates effect of CNS depressants (ethanol, barbiturates, benzodiazepines, opioid analgesics).
• Has ↓ effectiveness of levodopa in few cases.
• May have additive effects with antiplatelet agents.
• May ↑ risk of liver damage with other hepatotoxic agents.

Natural-Natural Products:

• Concurrent use with other hepatotoxic products such as DHEA, coenzyme Q-10 (high doses), and niacin can ↑ risk of liver damage.
• May have additive sedative effects when used with other herbs with sedative properties.

(Generic available)

• Dried root extracts (alcohol or acetone based) containing 30–70% kavapyrones: ;

• PO (Adults): Antianxiety: 50–100 mg (70 mg kavalactones) 3 times daily; Benzodiazepine withdrawal: 50–300 mg/day over one wk while tapering benzodiazepine over 2 wk (use 70% kavalactone extract). Insomnia: 180–210 mg kavalactones. Typically taken as a tea by simmering the root in boiling water and then straining.

Ava pepper, intoxicating pepper, kao, kew, tonga, wurzelstock, yagona

• Alters the limbic system modulation of emotional processes.
• Shown to have centrally acting skeletal muscle relaxant properties activated.

• Relief of anxiety.
• Sedation.

Therapeutic Classification: antianxiety agents, sedative/hypnotics

Absorption: Peak plasma level occurs about 1.8 hr after an oral dose.

Distribution: Enters breast milk.

Metabolism/Excretion: Elimination occurs primarily by renal excretion (both unchanged and metabolites) and in the feces. Metabolized by the liver (reduction or demethylation).

Half-life: Approximately 9 hr.

• Inform patient that significant, serious side effects may occur with prolonged use. Use for longer than 1 mo is not recommended without supervision of health care professional.
• Caution patient to avoid alcohol or other CNS depressants while taking this herb; may increase sedative effect.
• May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to herb is known.
• Caution patients to stop use of the herb immediately and notify health care professional if shortness of breath or signs of liver disease (yellowing of the skin or whites of the eyes, brown urine, nausea, vomiting, light-colored stools, unusual tiredness, weakness, stomach or abdominal pain, loss of appetite) occur.
• Instruct patients with liver disease, or taking drug products that can affect the liver, to consult health care professional before using kava-containing supplements.
• Inform patient that although there is no evidence of physiological dependence, the risk of psychological dependence still exists.
• Instruct patient to consult health care professional before taking any Rx, OTC, or other herbal products concurrently with kava-kava.
• Advise females of reproductive potential to use effective contraception during therapy and to notify health care professional immediately if pregnancy is planned or suspected or if breast feeding.
• Kava has been banned in other countries due to hepatotoxicity.

KA-va KA-va