What is it?

Kava is an herbal medicine used for treating anxiety (feeling nervous) and stress.

Other names for Kava include: Piper methysticum, Ava, Intoxicating Pepper, Kao, Kava-Kava, and Kawa.

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using:

Tell your doctor if you

• are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement)
• are pregnant or plan to become pregnant while using this medicine
• are breastfeeding
• have depression
• have any other health problems, such as liver disease

Dosage:

Talk with your caregiver about how much Kava you should take. The amount depends on the strength of the medicine and the reason you are taking Kava. If you are using this medicine without instructions from your caregiver, follow the directions on the medicine bottle. Do not take more medicine or take it more often than the directions tell you to.

To store this medicine:

Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Drug and Food Interactions:

Do not take Kava without talking to your doctor first if you are taking:

• Medicines used to treat depression or Parkinson's disease (examples: moclobemide (Manerix(R)); phenelzine (Nardil(R)); selegiline (Deprenyl(R), Eldepryl(R)))
• Medicines used to treat mental illness (examples: haloperidol (Haldol(R)); mesoridazine (Serentil(R)); thioridazine (Mellaril(R)))
• Medicine to help you sleep or relax (examples: alprazolam (Xanax(R)), lorazepam (Ativan(R)), diazepam (Valium(R)))
• Medicines used for sleep, headache, seizures, or muscle relaxants (examples: butalbital (Amaphen(R), Esgic(R), Fioricet(R), Fiorinal(R), Fiortal(R), Phrenilin(R), Sedapap(R)); Mephobarbital (Mebaral(R)); Phenobarbital (Barbita(R), Luminal(R)))
• Medicines used to treat cancer or rheumatoid arthritis (examples: Carmustine (BiCNU(R)); Methotrexate (Folex(R), Rheumatrex(R)); Mercaptopurine (Purinethol(R)); Plicamycin (Mithracin(R)))
• Male hormones (examples: Danazol (Danocrine(R)); Fluoxymesterone (Halotestin(R)); Methyltestosterone (Android(R), Metandren(R), Oreton(R)); Oxandrolone (Oxandrin(R)); Oxymetholone (Anadrol(R)); Stanozolol (Winstrol(R)); Testosterone (Androderm(R), Testoderm(R)))
• Medicines used for high cholesterol: Atorvastatin (Lipitor(R)); Cerivastatin (Baycol(R)); Fluvastatin (Lescol(R)); Lovastatin (Mevacor(R)); Pravastatin (Pravachol(R)); Simvastatin (Zocor(R)))
• Blood thinning medicine (examples: warfarin (Coumadin(R)), aspirin, sulfinpyrazone (Anturan(R)), dipyridamole (Persantin(R), Aggrenox (R)), anagrelide (Agrylin(R)), ticlopidine (Ticlid(R)))
• Amiodarone (Cordarone(R), Pacerone(R))
• Isoniazid (Laniazid(R), Nydrazid(R))
• Medicines used to treat fungal infections (examples: Itraconazole (Sporanox(R)); Ketoconazole (Nizoral(R)); Terbinafine (Lamisil(R)))
• Medicines used to treat pain (examples: Fentanyl (Duragesic(R)); Hydrocodone (Lortab(R), Vicodin(R)); Morphine (MS Contin(R), MS-IR(R), Roxanol(R)); Oxycodone (Endocet(R), Oxy-IR(R), Oxycontin(R), Percocet(R), Roxicet(R), Roxicodone(R), Tylox(R)); Propoxyphene (Darvocet(R), Darvon (R)))
• Medicines used for muscle spasms (examples: Carisoprodol (Soma(R)); Methocarbamol (Robaxin(R)); Metaxalone (Skelaxin(R)))
• Tacrine (Cognex(R))
• Valproic acid (Depacon(R), Depakene(R), Depakote(R))
• Other herbs (examples: comfrey, chaparral, eucalyptus, germander, jin bu huan, pennyroyal, skullcap, valerian)

Warnings:

• Do not use Kava if you are going to be driving a car or using heavy machinery
• Talk to your caregiver about using Kava longer than 3 months
• Kava may cause liver damage so do not use if you have liver problems
• Do not use Kava if you have depression
• Do not use Kava with alcohol

Side Effects:

Stop taking your medicine right away and talk to your doctor if you have any of the following side effects. Your medicine may be causing these symptoms which may mean you are allergic to it.

• Breathing problems or tightness in your throat or chest
• Chest pain
• Skin hives, rash, or itchy or swollen skin

Other Side Effects:

You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

• You have eye problems, such as not being able to control how your eyes move. Your pupils may get larger and you may have near vision problems.
• A rash or darkening or yellowing of the skin with whitish scaling and flaking may occur with the use of large amounts of Kava
• You may have a morning hangover or fatigue (feeling tired) when you start using Kava
• Loss of use of muscle tension and some limits in movement may occur
• Weight loss after using too much Kava extract for too long may occur
• You could have liver damage (hepatitis or cirrhosis) or liver failure
• Headaches and dizziness
• Dry mouth, diarrhea (loose stools), abdominal (belly) pain

References:

1. Almeida JC & Grimsley EW: Coma from the health food store: interaction between kava and alprazolam (letter). Ann Intern Med 1996; 125:940-941.

2. Blumenthal M, Gruenwald J, Hall T et al: German Commission E Monographs. American Botanical Council, Austin, TX; 1998.

3. Brinker F: Herb Contraindications and Drug Interactions, 2nd ed. Eclectic Medical Publications, Sandy, OR; 1998.

4. Cawte J: Parameters of kava used as a challenge to alcohol. Aust N Z. J. Psychiatry 1986; 20:70-76.

5. Chavallier A: The Encyclopedia of Medicinal Plants. DK Publishing Company, New York, NY; 1996.

6. Escher M, Desmeules J, Giostra E et al: Hepatitis associated with kava, a herbal remedy for anxiety. BMJ 2001; 322(7279):139.

7. Fachinformation: Antares(R) 120, kava-kava extract. Krewel Meuselbach GmbH, Eitorf, Germany; 1996.

8. Fachinformation: Kavosporal(R) forte, kava-kava extract. Mueller Goeppingen Gmbh & Co KG, Goeppingen, Germany; 1996.

9. Gleitz J, Beile A & Wilkens P et al: Antithrombotic action of the Kava pyrone kavain prepared from Piper methysticum on Human Platelets. Planta Medica 1997;63:27-30.

10. Jamieson DD & Duffield PH: Interaction of kava and ethanol in mice. Eur J Pharmacol 1990; 183:559.

11. Jamieson DD & Duffield PH: Positive interaction of ethanol and kava resin in mice. Clin Exp Pharmacol Physiol 1990; 17:509-514.

12. Jussofie B, Schmiz A & Hiemke C: Kavapyrone enriched extract from Piper methysticum as modulator of the GABA binding site in different regions of rat brain. Psychopharmacol 1994; 116:469-474.

13. Kraft M, Spahn TW, Menzel J et al: Fulminant liver failure after administration of the herbal antidepressant kava-kava (Abstract). Dtsch Med Wochenschr 2001; 126(36):970-972.

14. Lewis-Taylor C: FDA Letter to Healthcare Professionals. Dec 19, 2001. Available at: http://www.fda.gov/medwatch/safety/2001/safety01.htm#kava (cited 12/20/2001).

15. Mathews JD, Riley MD, Fejo L et al: Effects of the heavy usage of kava on physical health: summary of a pilot survey in an Aboriginal community. Med J Aust 1988; 148:548-555.

16. Norton SA & Ruze P: Kava dermopathy. J Am Acad Dermatol 1994; 31:89-97.

17. Schelosky L, Raffauf C, Jendroska K et al: Kava and dopamine antagonism. J Neurol Neurosurg Psych 1995; 58:639-640.

18. Strahl S, Ehret V, Dahm HH et al: Necrotizing hepatitis after taking herbal remedies (abstract). Dtsch Med Wochenschr 1998; 123(47):1410-1414.

19. Uebelhack R, Franke L & Schewe JH: Inhibition of platelet MAO-B by kava pyrone-enriched extract from Piper methysticum Forster (kava-kava). Pharmacopsychiatry 1998; 31:187-192.