Kava (ava pepper, awa, intoxicating pepper, kao, kawa, kew, piper methysticum, sakau, tonga, yagona)
Classes: Neurology & Psychiatry, Herbals
Suggested dosing of Ava pepper, awa (kava)
Anxiety disorders
70% standardized extract: 100 mg PO TId
Kava-lactones: 60-120 mg/day PO
Root tea: 1 cup PO qD-TID; 2-4 g root/150 ml water
Benzodiazepine withdrawal, prevention
70% stdzd extract
- Initial: 50 mg PO qD, THEN
- Titrate up over 1 week while tapering benzodiazepine over 2 weeks
- No more than 300 mg/day titrated over 1 week
Insomnia
Kava-lactones: 180-210 mg PO qHs
Suggested uses of Ava pepper, awa (kava)
Anxiety disorders, benzodiazepine withdrawal, common cold/URIs, depression, epilepsy, headaches/migraines, insomnia, musculoskeletal pain, psychosis, stress
Efficacy
Likely effective for anxiety, insomnia (short-term)
Ava pepper, awa (kava) adverse (side) effects
Frequency not defined
Allergic skin reactions
Dizziness
Drowsiness
Enlarged pupils
Gastrointestinal upset
Headache
Hepatitis (acute)
Hepatotoxicity
Liver failure
Motor reflex impairment
Oculomotor equilibrium disturbances
Parkinsonism
Visual accommodation disturbances
Body weight decreases (chronic use)
Facial puffiness (chronic use)
Hematuria (chronic use)
Kava dermopathy (chronic use)
Lymphocytopenia (chronic use)
Movement disorders (chronic use)
Protein levels decrease (chronic use)
Pulmonary hypertension (chronic use)
Rash (chronic use)
Red blood cell volume increases (chronic use)
Thrombocytopenia (chronic use)
Warnings
Contraindications
Hepatitis, acute or hx
Cautions
Depression
Risk of liver failure: banned in many countries (UK, Sweden, Netherlands etc)
Pregnancy and lactation
Pregnancy category: unsafe
Lactation: unsafe
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Ava pepper, awa (kava)
Metabolism: N/A
Excretion: N/A
Mechanism of action
Kavalactones act on limbic system
No evidence of binding to GABA or opioid receptors
