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Kava; Piper methysticum

Proposed Uses: Anxiety, Alcohol Withdrawal; Insomnia; Tension Headaches

Kava has long been cultivated by Pacific Islanders for use as a social and ceremonial drink. The first description of kava came to the West from Captain James Cook on his celebrated voyages through the South Seas. Cook reported that on occasions when village elders and chieftains gathered together for significant meetings, they would hold an elaborate kava ceremony at the beginning to break the ice.

High doses of kava extracts are thought to cause muscle relaxation and even paralysis at very high doses.  Kava also has local anesthetic properties, producing peculiar numbing sensations when held in the mouth.

Recent studies have found an interaction with tranquilizers in the Valium family.

An accumulation of case reports suggests that kava products may rarely cause severe liver injury

Today, Kava is used for relieving "states of nervous anxiety, tension, and agitation," based on evidence from several studies.  However, case reports of liver damage later led to ban the use of kava. Like other anxiety-reducing drugs, kava could be useful for insomnia, but most of the supporting evidence for this use remains highly preliminary.  One study found that daily use of kava reduced sleep disturbances linked to anxiety.  However, another study failed to find benefits in people with both insomnia and anxiety.

Kava has been additionally proposed as a treatment for tension headaches, but it has not been evaluated for this purpose.

Dosage
A typical dosage of kava when used for treatment of anxiety is 300 mg/day of a product standardized to contain 70% kavalactones. A lower dose of 150 mg/day has also been tested, but may be less effective.  The typical dosage for insomnia is 210 mg of kavalactones 1 hour before bedtime.

Safety Issues
A study of people who took a rather low dose of kava found side effects in 1.5% of cases. However, a growing number of case reports have raised serious concerns about kava’s safety. These reports suggest that, occasionally, even normal doses of kava can cause severe liver injury.  At present, if you wish to use this herb, it is recommended that you seek physician supervision to monitor for liver inflammation. People with liver problems, who drink alcohol excessively, or who take medications that can harm the liver, are probably at increased risk of harm by kava.

There are other safety concerns as well. For example, kava should not be used by individuals who have had "acute dystonic reactions."

At ordinary doses, kava does not appear to produce mental cloudiness. However, high doses cause inebriation, and can lead to charges of driving under the influence of drugs. 
One study suggests that kava does not amplify the effects of alcohol.  However, there is a case report indicating that kava can increase the effects of certain sedative drugs.  For this reason, kava probably should not be combined with any drugs that depress mental function. Kava should also not be combined with antipsychotic drugs or drugs used for Parkinson's disease, due to the potential for increased problems with movement.
There have been warnings against the use of kava during pregnancy and nursing.

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