Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 03.08.2023

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Kava-Kava; Kawa-Kawa; Kawap pepper; Peppers; piper methysticum

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The kava is a plant species of the genus pepper (probably originally from New Guinea) from the pepper family (Piperaceae), which grows as an evergreen, shrubby plant reaching heights of about 3 meters. The kava has heart-shaped leaves up to 20 cm in size. It is native to the South Sea islands, especially New Guinea.

As early as 3000 years ago, kava kava was used in religious ceremonies on the Pacific islands. The relaxing, performance-enhancing and anxiety-relieving effect up to euphoria with appropriate dosage, was known to the natives of Australia and Hawaii, up to the USA.

Kava kava extracts contain 5-12% 6-substituted beta-methoxy-lactones, the so-called kavapyrones (or kavalactones). These include: kavaine, methysticine. Kavain and dihydrokavain have sedative and analgesic effects. Flavokawain A. has antiproliferative, anticarcinogenic, as well as inhibitory effects on angiogenesis.

Phytotherapeutically, the peeled and cut dried rhizome(kava kavarhizome - kava kava rhizoma) finds its use.
The drug mostly originates from cultures in Polynesia and Melanesia.

HMPC: Risk exceeds benefit, due to liver damage, additional carcinogenic potential.

ESCOP monograph: anxiety, tension and agitation states of non-psychotic etiology. Caution: hepatotoxic effect.

Commission E-monograph: Nervous states of anxiety, tension and restlessness, in 1990 liver toxicity not yet known.

Dosage and method of use
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No longer recommended.

Limitation to 120 mg Kavalactone, maximum duration of use of two months, control of liver values, prescription required.

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Comatose states following the combination of kava with alprazolam, a diazepine derivative, have been described.

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In 2002, the approval for kava kava extracts was initially revoked by the Federal Ministry for Drugs and Medical Devices (BfArM) due to hepatotoxic side effects and lack of efficacy, but an investigation could not confirm the evidence.

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Last updated on: 03.08.2023