What are the effects of kava

Kava - Better Health Channel

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Summary

Read the full fact sheet

Kava is a drug made from the ground roots of a plant found in the South Pacific.
It is taken as a drink, supplement or extract.
Long-term kava use may be associated with a range of problems including apathy, weight loss and liver damage.

Kava is a drug made from the ground roots of the plant Piper methysticum, a member of the pepper family that also includes black pepper. It is a native plant found in the South Pacific.

Kava can be taken as a drink or as a supplement or extract. Traditionally the root is crushed, ground or powdered and soaked in water to be drunk as a tea. This tea is often consumed socially and as part of traditional ceremonies and cultural practices throughout the South Pacific Islands.

In small doses, the effects of kava include muscle relaxation, sleepiness and feelings of wellbeing. However, long-term use of kava can lead to a range of health problems, including malnutrition, weight loss and apathy.

Australian laws and kava imports

From 1 December 2021 kava can be imported into Australia for commercial purposes with no limit on quantity.

People aged over 18 years entering Australia can bring in up to four kilograms of kava in their accompanied baggage (although local restrictions mean that kava cannot be brought into the Northern Territory).

The Commonwealth Government will monitor and evaluate the relaxing of laws for importing kava for two years, commencing 1 December 2021.

Read more about kava import restrictions.

Kava – effects on the body

The active chemicals in kava are known as kavalactones. Variations in growing conditions (such as soil type and the amount of sunlight and water available) and different varieties of plant mean that the strength of kavalactones can vary widely.

The strength of a dose of kava also depends on how the drink is prepared and how much powdered kava is added to the water.

Kava is a central nervous system depressant. Even though there is no alcohol in kava, it can produce similar symptoms to drunkenness, including difficulty with balance, and slurred speech.

The effects of kava on your body can depend on:

your body size
your general health
if you have taken kava before
the strength and amount taken
if you are taking other drugs at the same time.

Common effects include:

for small doses – relaxed muscles, sleepiness, feelings of wellbeing and relaxation, mild loss of feeling in the throat and mouth, appetite loss
for larger doses – dilated pupils, reddened eyes, nausea, drowsiness, reduced muscle control (ataxia).

Kava is dangerous for some people

It’s dangerous to take kava in combination with other psychoactive drugs or alcohol. There is little information on how kava interacts with other medication, so it's best to avoid kava if you are taking any prescription medicine.

Do not take kava if you:

are pregnant
are breastfeeding
are driving or operating heavy machinery
are currently taking pharmaceutical medicine
drink large quantities of alcohol
have a pre-existing heart, lung or liver condition.

Children should not take kava.

Problems from long-term use of kava

In the long term, kava use may cause a wide range of problems including:

breathing difficulties
visual changes, including sensitivity to light (photophobia)
slight alterations to blood cells, including white and red blood cells, and platelets
liver damage
compromised immune function
kidney damage
contact dermatitis – causing scaly, flaky rash on the skin
appetite loss, leading to malnutrition and weight loss
loss of drive and motivation
worsened symptoms of pre-existing mental illnesses such as schizophrenia.

Kava withdrawal risk is low

There is no evidence to suggest people who regularly drink large doses of kava become dependent. Because of this there doesn't seem to be a risk of withdrawal if a person suddenly stops taking kava. However, medical supervision is recommended.

Medicinal uses of kava

In 2003, products containing kava were banned in most European countries, because of concerns about its possible toxic effects on the liver. In Australia, all products containing kava were temporarily withdrawn, following the death of one person from liver failure.

This restriction was withdrawn after a review by the Therapeutic Goods Administration in 2005. As a result of that review, products with standardised amounts of kava, such as in supplements and teabags, became available in Australia.

Products with kava can be used for stress, anxiety and insomnia. If you are thinking about taking kava for medicinal purposes, be sure to contact a healthcare professional first.

Seek medical advice for kava symptoms

Immediately seek medical advice if you experience any symptoms while taking preparations containing kava. Symptoms may include:

appetite loss
extreme tiredness
raised body temperature
nausea and vomiting
abdominal pains
brown-coloured urine
unusual bruises or bleeding
yellowing of the eyes or skin (jaundice).

Where to get help

Your GP (doctor)
Alcohol and Drug Foundation – list of help and support services in Australia, Tel. 1300 858 584
DirectLine – for 24-hour confidential drug and alcohol telephone counselling, information and referral, Tel. 1800 888 236

Rychetnik L, Madronio CM, 2010, 'The health and social effects of drinking water-based infusions of kava: a review of the evidence', Drug and Alcohol Review, vol. 30, no. 1, pp. 74–83
Clouatre, DL 2004, Kava kava: examining new reports of toxicity, Toxicology Letters, vol. 150, no. 1, pp. 85–96
Lucie, R & Christine M., M 2011, The health and social effects of drinking water-based infusions of kava: a review of the evidence, Drug and Alcohol Review, no. 1, p. 74
Krueger GP, Leaman HM, Bergoffen, G, et al. 2011 ‘Effects of psychoactive chemicals on commercial driver health and performance: stimulants, hypnotics, nutritional, and other supplements’, Transportation Research Board, USA.

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Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 12-08-2022

Kava - Alcohol and Drug Foundation

What is Kava?

Kava is a depressant drug, which means it slows down the messages travelling between the brain and the body. Kava is made from the root or stump of the kava (Piper methysticum) shrub.¹

Kava comes in different forms including:

brownish-coloured drink
brown powder
capsules
extracts
drops.

Other names

Kava kava, kawa, waka, lewena, yaqona, grog (Fiji), sakau (Pohnpei), ‘awa (Hawaii), ‘ava (Samoa) and wati (New Guinea). ²

How is it used?

Pacific Islands

Traditionally, Pacific Islanders crushed, chewed and ground the root and stump of the shrub, then soaked it in cold water to produce a drink for ceremonies and cultural practices. These rituals were said to strengthen ties among groups, reaffirm status and help people communicate with spirits.¹

Many Pacific Islanders who have settled in Australia have continued drinking kava or using kava extracts.³

Aboriginal and Torres Strait Islander peoples

Kava was introduced to the communities in the north of Australia in the 1980s as a substitute for alcohol, to reduce alcohol-related harms in the community. The kava drink is often used for sedative, hypnotic and muscle-relaxant effects, in much the same way that alcohol is used.¹¹

Herbal preparations

Kava extract is used in some herbal preparations. They are sold as over-the-counter tablets and preparations to be used in the treatment of insomnia, stress and anxiety. ⁴

Effects of kava

There is no safe level of drug use. Use of any drug always carries some risk. Even medications can produce unwanted side effects. It’s important to be careful when taking any type of drug.

Kava affects everyone differently, based on:

size, weight and health
whether the person is used to taking it
whether other drugs are taken around the same time
the amount taken
the strength of the drug
the environment (where the drug is taken).

The following effects may be experienced:

feeling happy and relaxed
mild sleepiness
numb mouth and throat
reduced or loss of appetite.⁵

If a large amount of kava is taken the following effects may also be experienced:

drowsiness
nausea
loss of muscle control
mild fever
pupil dilation and red eyes.⁵

Long-term effects

Regular use of large amounts of kava may eventually cause:

mood swings
apathy
dry, scaly skin
malnutrition and severe weight loss
getting infections more easily
shortness of breath.

Manufactured products such as herbal remedies that contain kava extract have been linked to irreversible liver damage. Kava has been shown to cause liver damage when taken in an alcoholic or acetonic extract. For this reason water based extracts of Kava ( as a drink or tablet) should not be consumed with alcohol, especially if there is a history of liver damage or disease.^5,6

Impact of mood and environment

Drugs that affect a person’s mental state (psychoactive drugs) can also have varied effects depending on a person’s mood (often called the ‘set’) or the environment they are in (the ‘setting’):

Set: a person’s state of mind, previous encounters with psychedelic drugs, and expectations of what’s going to happen. For example, feelings of stress or anxiety before using kava may result in an unpleasant experience.⁷
Setting: the environment in which someone consumes kava – whether it’s known and familiar, who they’re with, if they’re indoors or outdoors, the type of music and light. For example, using kava in a calm, quiet and relaxed environment can lead to, or contribute to, a pleasant experience but being in a noisy, crowded place may result in a negative experience.⁷
Being in a good state of mind, with trusted friends and a safe environment before taking kava reduces the risk of having a negative experience.

Using kava with other drugs

Kava changes the way that the liver processes some types of medications and drugs, therefore you should consult with your healthcare provider before taking kava.⁵

Kava + alcohol: increased drowsiness, impaired reflexes and risk of liver damage.
Kava + benzodiazepines: sedation.³

Reducing harm

Avoid taking kava if you plan to drive or use machinery
Avoid using kava and alcohol together
children, pregnant and breastfeeding women should not use kava
do not use kava if you have liver disease
have regular breaks from kava use
Drink kava in moderation as drinking large quantities may produce dry, itchy, and scaly skin
Kava has the potential to interact with several drugs and medications. Talk with a health professional before use

Kava in Australia

The import, advertising and sale of kava in Australia are strictly controlled.

Personal use

Passengers coming into Australia, who are over the age of 18 years, are allowed to bring 4kg of kava without a license or permit, provided it is in their accompanied baggage.⁸

For use as food

The importation of kava, for food use, is prohibited unless the importer holds a permit issued by the office of Drug Control. A number of regulations must be followed to comply with Imported Food Control Act 1992.⁸

A permit is required for each shipment. If kava is imported without a permit, it can be seized by Australian Border Force.

Media outlets have reported that a permit has been granted to sell kava drink in selected supermarkets as part of the Australian Government’s Kava pilot.⁹

Medical and scientific use

The importation of kava for medical and/or scientific purposes is prohibited unless the importer holds a licence and permit issued by the Office of Drug Control. ⁸

Further information

Withdrawal

There is no evidence that people who regularly use kava become dependent on the drug, so if you stop taking it, you are unlikely to experience withdrawal symptoms. However, if you have health problems seek medical advice.⁵

Getting help

If your use of Kava is affecting your health, family, relationships, work, school, financial or other life situations, you should seek help and support.

Call our DrugInfo line on 1300 85 85 84 for confidential and non-judgmental information and advice.

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Kava Kava - a natural herb with promising sedative properties

The information in this blog has not been verified by your country's public health authority and is not intended to constitute a diagnosis, treatment, or medical advice. More

What is kava?

Kava (kava kava or intoxicating pepper) is a plant with a long history of use in a wide variety of ceremonies among the peoples of Oceania. The traditional drink was made from kava roots by soaking in cold water. Consumption of kava usually has a pronounced relaxing effect, not accompanied by intoxication or hallucinations, although vomiting or headache may occur if consumed in excess. Traditional ways of consuming this plant remain popular in Oceania to this day.

Healing properties of kava

Calming effect

Kava contains substances known as kavalactones. Although we do not currently have a complete understanding of the nature of this effect, kava appears to perform a specific set of actions that explain the plant's relaxing effect.

Like other traditional sedatives such as valerian, passion flower, lavender and lemon balm, kava also acts on gamma-aminobutyric acid (GABA), a well-known neurotransmitter. GABA is the main inhibitory neurotransmitter in the central nervous system, slowing down brain activity. Although kavalactones bind very poorly to GABA receptors, they appear to be very good at enhancing the binding capabilities of other molecules. Through increased binding of these molecules, kavalactones likely enhance GABA activity.

However, unlike other common sedatives, kava can also affect voltage-gated sodium channels (PVCs). PZNA are channels found in cell membranes and play an important role in the functioning of the nervous system. Electrical signals travel through the nerves when the sodium channels are open, producing a nerve impulse. Kavalactones can block sodium channels, reducing the overall activity of the brain and nervous system. This effect, combined with increased binding to GABA receptors, likely explains the calming effect of kava drinks.

Anti-inflammatory and anti-clotting effect

Early studies in the 1960s initially showed a pronounced anti-inflammatory effect of this plant. The study showed a reduction in inflammation when consuming kava when exposed to various substances and ultraviolet radiation.

Tumor necrosis factor-alpha (TNF-alpha) is a major inflammatory signaling molecule. In several autoimmune diseases, standard medical treatment involves suppression of TNF-alpha activity. Some kavalactones in kava can suppress TNF-alpha. Endotoxins are substances found in the outer membrane of Gram-negative bacteria that greatly increase inflammation. In a mouse given a lethal dose of endotoxin, kava helped with a normally fatal inflammatory response.

This anti-inflammatory effect is also manifested in the ability to reduce the likelihood of blood clotting due to inflammation. This appears to be due to the suppression of inflammatory mechanisms provided by arachidonic acid, an inflammation-promoting fat.

Sleep improvement

Anxiety treatment often helps with insomnia and vice versa. While there are exceptions, such as melatonin, which should only be used for sleep problems, most natural remedies for anxiety and insomnia problems are interchangeable. Standard medications are used to treat sleep problems that are often prescribed for people with anxiety disorders.

Thus, it is not surprising that a number of clinical studies on the effects of kava on improving sleep have proven the effectiveness of this plant. A preliminary study of kava and valerian for the treatment of stress-induced insomnia showed positive effects when both plants were taken. Stress levels and insomnia decreased as a result of taking kava and valerian.

The effect of kava on sleep disturbances in anxiety disorder was evaluated in a double-blind, placebo-controlled clinical trial. Scientists found that taking kava over a 4-week period improved sleep and reduced anxiety. A large web-based study found that kava was marginally better than placebo in treating insomnia, although this may be due to the very high efficacy of placebo treatment. Both kava and placebo were able to nearly halve the severity of insomnia during the study.

Further research is needed to fully evaluate the effect of kava on insomnia. However, while recognizing that kava has strong anti-anxiety abilities, the published study suggests that kava may improve some of the symptoms in at least a subset of patients with sleep disorders.

‌‌‌‌Studies on the effects of kava on anxiety levels in humans

Studies on the benefits of kava for anxiety in humans seem to show fairly consistent results. The first recommendations for the therapeutic use of this plant for the treatment of anxiety appeared more than 100 years ago and were based on examples of traditional use.

One of the first double-blind studies was conducted in Germany in 1991. The study authors found a marked reduction in anxiety levels as early as one week after starting treatment, and symptoms continued to improve within one month. The agent was very well tolerated by the participants and did not cause adverse reactions. A larger study from 1997 lasted a full 25 weeks and found a large number of benefits along with a minimum number of side effects.

A separate, double-blind, placebo-controlled study evaluated the transition from the standard medication, benzodiazepines used to treat anxiety disorder, to kava as an alternative. They concluded that kava was more effective, well tolerated, and better at managing anxiety.

Although one small study on the use of kava for the treatment of general anxiety disorder showed no significant improvement, the placebo response was very marked. Participants with an anxiety disorder responded well to kava, as did people who received a placebo. A separate small study in post-menopausal women found that taking kava for one month improved anxiety symptoms, with even better results after three months. One of the most interesting was the results of a study using web resources, according to which the effect of taking this plant was minimal.

A large study using a lower dosage of half the standard amount of kavalactones also showed some results in the treatment of neurotic anxiety. However, when using a lower dosage, the effect was less pronounced than in previous studies. The authors of a slightly more recent study attempted to evaluate the possibility of using small doses of kava for the treatment of various anxiety conditions. Even at low doses, the treatment was still effective in reducing anxiety and did not cause side effects.

Although there are a number of studies with negative results, reviews generally confirm that kava can reduce anxiety, and one of the authors noted that kava has an "uncompromising calming effect." According to recent assessments, while further research is needed, kava has promising anti-anxiety potential and may be used as a convenient option for short-term anxiety treatment of 4-8 weeks.

‌‌‌‌Safety and Toxicity

Any discussion of the medical use of kava must include a discussion of its safety. Although the traditional use of kava has not been associated with possible harm to the liver, rare cases of liver damage, liver failure, and even death have been reported as a result of certain kava extracts. While these data are troubling, it must be understood that these events are rare, much less common than liver toxicity from standard medications such as antibiotics, anticonvulsants, and anti-inflammatory drugs (NSAIDs).

The World Health Organization evaluated data on cases of hepatotoxicity in 2008. There are reports of 93 cases of hepatoxicity, and only 8 of them could be caused by kava with a high probability, and in another 53 cases, kava was recognized as a possible, but not the only cause.

During case evaluation, it was noted that drinking alcohol while taking kava can cause liver damage. Anyone who takes kava is advised to refrain from drinking alcoholic beverages at the same time.

It is also possible that the drugs causing the problems were produced in a different way from the traditional way and using plant species not intended for human consumption. The traditional way to consume this plant is to steep the roots of the "noble" kava in cold water.

Noble Kava and Two Day Kava

Cases of hepatotoxicity may also be associated with a change in the type of kava grown and exported. The noble kava has been used in traditional ceremonies and takes four years to grow until it is harvested. Unfortunately, due to high demand, one of the main exporters of kava extract began to look into other types of kava growing on the commercial kava island of Vanuatu.

After chemical analysis, the exporter's experts concluded that the "two-day" kava grows much faster and contains more kavalactones. This type of kava has been banned from export as a product for human consumption and has never been used in traditional ceremonies. However, this prohibition was ignored and the plant began to be used for the production of kava extracts. Shortly thereafter, the first cases of hepatotoxicity appeared.

Clinical studies of kava, which proved the safety and effectiveness of this plant, in almost all cases used alcoholic extracts of noble kava. All 14,114 clinical study participants who received kava products did not experience any signs of hepatotoxicity. Studies have generally confirmed the safety and good tolerability of kava. Despite all of the above, for added safety, people with known liver problems should avoid taking kava products. Also, under no circumstances should the recommended dosage be exceeded.

Conclusions

Kava is an amazing herb with a long history of safe traditional use. Studies show marked efficacy in reducing anxiety levels, although only short-term use is recommended. With the right plant species and proper processing, kava is effective.

Although cases of hepatotoxicity are quite rare, information in the medical literature has associated such cases with the use of 2-day-old kava species in the form of acetone extracts, which are prohibited for export and human use. As with other herbal products, purchasing herbal products from reliable manufacturers is important to minimize risk.

Sources:

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Singh YN, Singh NN. Therapeutic potential of kava in the treatment of disorders of anxiety. CNS Drugs. 2002;16(11):731-743. doi:10.2165/00023210-200216110-00002
Bruni O, Ferini-Strambi L, Giacomoni E, Pellegrino P. Herbal Remedies and Their Possible Effect on the GABAergic System and Sleep. Nutrients. 2021;13(2):530. Published 2021 Feb 6. doi:10.3390/nu13020530
MEYER HJ. ANTAGONISTISCHE WIRKUNGEN GENUINER KAWA-PYRONE BEI EXPERIMENTELLEN ENTZUENDUNGEN UND FIEBER [ANTAGONISTIC EFFECTS OF GEUNINE KAWA PYRONES IN EXPERIMENTAL INFLAMMATIONS AND FEVER]. Klin Wochenschr. 1965;43:469-470. doi:10.1007/BF01483859
Pollastri MP, Whitty A, Merrill JC, Tang X, Ashton TD, Amar S. Identification and characterization of kava-derived compounds mediating TNF-alpha suppression. Chem Biol Drug Des. 2009;74(2):121-128. doi:10.1111/j.1747-0285.2009.00838.x
Bian T, Corral P, Wang Y, et al. Kava as a Clinical Nutrient: Promises and Challenges. Nutrients. 2020;12(10):3044. Published 2020 Oct 5. doi:10.3390/nu12103044
Gleitz J, Beile A, Wilkens P, Ameri A, Peters T. Antithrombotic action of the kava pyrone (+)-kavain prepared from Piper methysticum on human platelets. Planta Med. 1997;63(1):27-30. doi:10.1055/s-2006-957597
Kinzler E, Krömer J, Lehmann E. Wirksamkeit eines Kava-Spezial-Extraktes bei Patienten mit Angst-, Spannungs-, und Erregungszuständen nicht-psychotischer Genese. Doppelblind-Studie gegen Plazebo über 4 weeks [Effect of a special kava extract in patients with anxiety-, tension-, and excitation states of non-psychotic genesis. Double blind study with placebos over 4 weeks]. Arzneimittelforschung. 1991;41(6):584-588.
Volz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety disorders--a randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry. 1997;30(1):1-5. doi:10.1055/s-2007-979474
Malsch U, Kieser M. Efficacy of kava-kava in the treatment of non-psychotic anxiety, following pretreatment with benzodiazepines. Psychopharmacology (Berl). 2001;157(3):277-283. doi:10.1007/s002130100792
Connor KM, Davidson JR. A placebo-controlled study of Kava kava in generalized anxiety disorder. Int Clin Psychopharmacol. 2002;17(4):185-188. doi:10.1097/00004850-200207000-00005
Cagnacci A, Arangino S, Renzi A, Zanni AL, Malmusi S, Volpe A. Kava-Kava administration reduces anxiety in perimenopausal women. Maturitas. 2003;44(2):103-109. doi:10.1016/s0378-5122(02)00317-1
Gastpar M, Klimm HD. Treatment of anxiety, tension and restlessness states with Kava special extract WS 1490 in general practice: a randomized placebo-controlled double-blind multicenter trial. Phytomedicine. 2003;10(8):631-639. doi:10.1078/0944-7113-00369
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Kava Kava Extract: Benefits, Side Effects & Dosage

Kava Kava, also simply called Kava , is a plant native to the South Pacific that has been used for generations. Today, many still use it for stress relief and relaxation.

Despite the benefits of kava kava extract, there are some warnings about side effects. Kava, also known as Piper methysticum, is a shrub that grows in the tropical South Pacific. The indigenous people of the islands would grind the root into a paste that they would add to drinks they would consume during traditional events or for medicinal purposes.

The active ingredient in the root of the plant are kavalactones, which are a class of lactone compounds. Studies show that kavalactones are beneficial in reducing stress, relieving pain, protecting neurons from damage, and may also reduce the risk of certain types of cancer.

How kava reduces pain and stress is not well understood. This may be due to its effect on brain neurotransmitters.

Benefits of Kava Extract

Reduces Anxiety

Anxiety is one of the most common mental health disorders in the world. Although there are a number of medications that can treat anxiety, these medications often come with unpleasant side effects and can also be addictive.

With more and more people turning to natural substances, there has been a recent focus on how kava can help those suffering from anxiety disorders.

Kava Leaves

Pain Relief

Due to the natural pain-relieving properties of dihydrokavain and dihydromethostocin, kava can also be a good alternative to traditional pain medications. One method of using the plant for pain relief is to add kava powder or a decoction of the plant's root to tea to your favorite drink.

Additional benefits of Kava

When you don't get enough sleep, you may experience certain health problems, including high blood pressure, obesity, cancer, depression and diabetes. While there are over-the-counter medications that can help with sleep problems, they can be addictive. Also, some people may have bad reactions to sleep medications.

Kava in supplements

Kava is one of the best alternatives to sleeping pills due to its anti-stress properties. In one study, a group of people took kava and a placebo. Those who took kava reported falling asleep faster.

Additional research has been done suggesting that one of its benefits is improvement in insomnia associated with anxiety disorders. More research is needed to determine if kava can help with insomnia in those who do not suffer from anxiety.

Kava Side Effects

Several studies support the effectiveness of kava in relieving anxiety. However, there are concerns about side effects. There have been several cases of liver toxicity associated with the use of kava, which has led to problems of liver damage by the US Federal Drug Administration.

Kava was eventually restricted or outright banned in a number of countries, including France, Germany, Switzerland, Canada and even the UK. Its sale is still limited in each of these countries, with the exception of Germany. The restriction was lifted in Germany due to lack of evidence of risk.

Effects of kava on the liver

Researchers believe that kava can harm the liver in several ways. One of the reasons it can cause liver damage is because manufacturers use toxic parts of the plant. Some growers use the leaves and stems as opposed to the root to cut costs.

Although some studies have shown that kava is safe for people with healthy livers when consumed short-term.

Please note that if you are taking medications that pass through the liver, it is best not to use kava extract.

The fact that the people of the South Pacific have used kava for hundreds of years without suffering from liver damage is proof of unscrupulous brewers.

A small study by Jerome Sarris at the Australian University of Queensland included 37 patients with anxiety symptoms.

Learn more