"Dry January" will lead to questions about alcohol alternatives, including kava. It's a popular social drink originating in the South Pacific – known for its anxiolytic effects. But there’s some confusion about safety – help clarify appropriate use with patients.
Back in 2002, kava products were barred from markets in Europe and Canada, due to at least 100 reported cases of liver toxicity following kava use. The US FDA issued a safety warning at the time, but it was never taken off the shelves in the US. Many countries have since lifted their bans because it’s not clear if all of these cases were valid – some were reported multiple times, and in others kava likely wasn’t the cause of liver damage.
So what do patients need to know about kava? Historically there were concerns about potential liver damage, but explain toxicity seems more frequently associated with prolonged use of very high doses. For those who want to try it, suggest keeping an eye out for symptoms of liver damage like yellowed skin, fatigue, and dark urine. But patients with a history of liver disease should avoid it altogether. And it shouldn’t be used in combination with other CNS depressants or hepatotoxic drugs, due to potential additive sedative and hepatotoxic effects.
As for its possible benefits, most clinical research shows that taking kava extracts 150-400 mg, standardized to 70% kavalactones, by mouth daily is more effective than placebo for relieving symptoms of anxiety. In fact, some clinical practice guidelines support the use of kava for short-term management of general anxiety symptoms, but only products standardized to 70% kavalactones seem to be beneficial.
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