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Piper methysticum (Kava-Kava)

A robust, well-branched perennial shrub with heart-shaped leaves. Uses: Traditional use: 1) used in Polynesia, Melanesia, Micronesia 2) served as beverage during important meetings & ceremonies 3) served at welcoming ceremonies 4) religious ceremonies as a gift to the gods 5) used to induce relaxation & sleep & calm nerves 6) asthma 7) weight loss 8) gonorrhea 9) urinary tract infections Current uses: - anxiety - likely effective [9] - relaxation, sedation Contraindications: No safety data in pregnancy. Dosage: 1) kava extract (WS 1490) 100 mg TID 2) extract standardized to 70% kavapyrones 3) fluid extract 1:1, 1-3 mL BID-TID 4) discontinue 24 hours before surgery Monitor: liver function tests [4] Adverse effects: 1) yellow scaly rash (> 9 gm/day) 2) increased liver function tests, decreased albumin, increased cholesterol with heavy use 3) acute hepatitis 4) sedation 5) avoid driving under the influence of high doses Drug interactions: 1) reports of disorientation when used in conjunction with benzodiazepines 2) conflicting data regarding potentiate of kava effect by alcohol & visa versa 3) may increase effects of anticonvulsants [8] Mechanism of action: - active ingredients: a) methystcin (a kavalactone) b) ynagonin - kava resins & pyrone exert weak effects on benzodiazepine receptors in vitro

General

pharmaceutical herb; medicinal herb; herbal supplement; botanical

References

  1. Victoria Rand, UCSF Fresno Lecture, 10/7/98
  2. Volz et al, Pharmacopsychotherapy, 1997
  3. Prescriber's Letter 8(3):16 2001
  4. Prescriber's Letter 8(8):48, 2001
  5. Prescriber's Letter 9(1):6, 2002
  6. Kava Linked to Liver Damage http://www.nccam.nih.gov/health/alerts/kava/
  7. FDA Consumer Advisory KAVA-CONTAINING DIETARY SUPPLEMENTS MAY BE ASSOCIATED WITH SEVERE LIVER INJURY http://www.cfsan.fda.gov/~dms/addskava.html
  8. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  9. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018