Kava

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use kava, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

Do not use different forms (tablets, liquid, tincture, teas, etc) of kava at the same time without medical advice. Using different formulations together increases the risk of an overdose.

You should have frequent blood tests to check your liver function if you choose to take kava.

If you need surgery, stop taking kava at least 2 weeks ahead of time.

Call your doctor if the condition you are treating with kava does not improve, or if it gets worse while using this product.

Store kava as directed on the package. In general, kava should be protected from light and moisture and stored in a sealed container.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Long-term use of kava can cause dry, flaking, discolored skin; reddened eyes; a scaly skin rash; puffy face; muscle weakness; blood abnormalities; and feelings of poor health.

Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra kava to make up the missed dose.

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use kava, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

Do not use different forms (tablets, liquid, tincture, teas, etc) of kava at the same time without medical advice. Using different formulations together increases the risk of an overdose.

You should have frequent blood tests to check your liver function if you choose to take kava.

If you need surgery, stop taking kava at least 2 weeks ahead of time.

Call your doctor if the condition you are treating with kava does not improve, or if it gets worse while using this product.

Store kava as directed on the package. In general, kava should be protected from light and moisture and stored in a sealed container.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using kava and call your healthcare provider at once if you have:

• liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Long-term use of kava may cause serious health problems, including:

• dry, scaly, flaky skin;

• yellowed skin, hair, fingernails, or toenails;

• red eyes, puffy face;

• decreased ability to absorb protein;

• weight loss;

• lung problems;

• blood in your urine; or

• blood cell disorders that can make it easier for you to bleed or get sick.

Common side effects may include:

• drowsiness.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Documented adverse effects. Avoid use. 2

Rare cases of severe liver toxicity have been reported.

An 1886 monograph on kava 14 stimulated research and isolation of the kavalactones (also known as kavapyrones), the primary bioactive constituents of kava root that are poorly water soluble. 15 A total of 18 kavalactones have been isolated in kava root extract. 16 The 6 major kavalactones are kawain, 7,8-dihydrokawain, methysticin, 7,8-dihydromethysticin, yangonin, and demethoxyyangonin, 15 , 16 , 17 which occur in varying proportions in different cultivars. The first 4 kavalactones listed are chiral enantiomers, and the last 2 are achiral enantiomers. 15 On a dry weight basis, the content of kavalactone ranges from 3% to 20%. 15 , 16 The structures of the kavalactones were first elucidated in the 1930s, 18 although many of the pure compounds were first isolated in the 19th century. They were later synthesized in racemic and optically pure forms. 19 , 20 , 21 Full nuclear magnetic resonance assignments have been made for the kavalactones. 22 While the kavalactones are characteristic of P. methysticum , individual kavalactones occur in other plant families (ie, Lauraceae, Gesneriaceae, Zingiberaceae). 23 A process for the commercial production of kava extract has been patented, 24 and the use of supercritical fluid extraction of kavalactones from the root has been demonstrated. 25 Many methods have been developed for the analysis of kavalactones. These include thin layer chromatography, 26 gas chromatography, 27 high-performance liquid chromatography (HPLC), 28 , 29 , 30 gas chromatography-mass spectrometry (GC-MS), 18 , 31 , 32 , 33 chiral HPLC, 34 HPLC-MS, 35 and micellar electrokinetic chromatography. 36 The metabolism of the kavalactones has been studied in humans. 37 The uptake of kavalactones into mouse brain also has been studied. 38 The latter study found elevated brain levels of kawain when the whole resin was administered, compared with kawain alone. This supported the observation that the total kava resin has greater pharmacologic effect than the sum of the individual kavalactones, presumably because of the saturation of common metabolic pathways utilized by these compounds.

Other constituents of kava include 2 chalcones, flavokawains A and B, 39 that were postulated to cause dermopathy in heavy kava users. 40 A patent claims production of an extract with very low chalcone content. 24 Several minor alkaloids also have been isolated from kava roots 41 and leaves. 42