Kava

Results from controlled clinical trials support the use of kava ( Piper methysticum ) for the symptomatic treatment of mild cases of anxiety and insomnia due to menopause, nervousness, stress or tension. A wide variety of products are available on the mar- ket, including standardized extracts containing 15 to 70% kava pyrones, the active chemical constituents. The recommended daily dose is a total of 60 to 210 mg of kava pyrones per day in two or three divided doses. One controlled clinical trial has shown that the anxiolytic activity of 210 mg of kava pyrones per day is similar to that of oxazepam (15 mg/day). Kava preparations should not be taken for more than three months at a time, unless under medical supervision. Adverse reactions to kava range from minor gastrointestinal disturbances, headaches, and dizziness to allergic skin reactions. Chronic excessive ingestion (abuse) of kava may lead to the development of a scaly, eruptive dermopathy, and a transient yellow discoloration of the skin and nails. These conditions are reversible upon discontinuation of the drug. A single case report has suggested a possible interaction has been reported between kava and alpra- zolam, but the clinical significance of this interaction has not been established. While kava administration does not appear to impair vigilance, patients should be cautioned that motor reflexes, driving ability and the operation of heavy machinery may be adversely affected. Due to a lack of safety data, kava should not be administered to patients with an allergy to the plants in the Piperaceae (black pepper family), during pregnancy or nursing, or to children under the age of twelve.