James LaValle, R.Ph., D.H.M., D.H.Ph., is a registered pharmacist with mote than 10 years of clinical experience in the natural medicine industry. He is an adjunct instructor for Natural Medicine at the University of Cincinnat College of Pharmacy.
Kava kava root preparations are quickly becoming one of the best-selling botanical agents on the market; sales of kava preparations have risen 116 percent in the past few years. Pharmacists can expect a sharp rise in questions from customers and patients regarding this botanical supplement, similar to what happened with St. Johns Wort in the past year. Anyone with stress and anxiety in their life is a potential customer. Supplement companies are boosting manufacturing and advertising of various kava supplements, predicting the "wave" of success.
In recommended doses, kava produces relaxation and a tranquil state of being without the unwanted side effects most pharmaceutical anti-anxiety agents, such as benzodiazepines, have.
Historical perspective
Imagine sitting around a campfire on one of the exotic Polynesian islands. Native people surround a large bowl containing a strange liquid. The chants become louder and louder as a religious ceremony unfolds. After chewing and grinding a knotted root, the pulp is spit into a traditional vessel where coconut milk is added, and the mixture strained. Each male member of the tribe now drinks the soapy, pungent liquid from the bowl, becoming relaxed and sociable as the calming effects of the mixture begin to take effect.
The mixture is made from the root of the sacred Kava or Awa plant kava (piper methysticum), a member of the pepper family. Kava became known to the New World in 1768, when Captain James Cook wrote of a strange ceremony in which the natives routinely participated. The use of kava on the South Pacific islands, including Fiji and Vanuatu, is as common as drinking coffee in our society.
Kava is used religiously by natives of these islands as an intoxicating beverage, causing visions and hallucinations in high doses and bringing individuals closer to their God.
Constituents
Kava root and rhizome contain a group of resinous compounds termed kavalactones (kava alpha-pyrones). A good quality rootstock contains between 5.5 percent and 8.3 percent [kavalactones.sup.1]. These lactones exhibit sedative, analgesic, anticonvulsant and muscle-relaxing [properties.sup.2]. The root causes a numbing sensation to the oral mucosa comparable to that of cocaine, with a longer duration of action than [benzocaine.sup.3]
Pharmacology and clinical studies
Kava preparations are approved medicines in several European countries for the treatment of nervous anxiety and [restlessness.sup.(4)(5)] Studies have reported that kava preparations compare favorably to benzodiazepines in controlling symptoms of anxiety and minor depression, while increasing vigilance, sociability, memory and reaction time.
Using the Hamilton-Anxiety Scale, a double-blind study reported that a standardized kava preparation had a statistically significant reduction in symptoms of anxiety, including feelings of nervousness and somatic complaints, such as heart palpitations, chest pains, headache, dizziness and feelings of gastric [irritation.sup.6] No side effects were reported.
Several other studies have reported positive effects of kava when anxiety is present, including in PMS and menopausal complaints and drug addiction and [withdrawal.sup.(7)(8)].
Reports are conflicting as to whether kava's anti-anxiety actions are GABA [mediated.sup.(9)(10)]. Kavalactones appear to act on the limbic system, in particular the amygdala complex-the primitive part of the brain that is the center of the emotional being and basic survival [functions.sup.11]. It is thought that kava may promote relaxation, sleep and rest by altering the way in which the limbic system modulates emotional processes.
Kava preparations have also been reported to produce skeletal muscle relaxation (comparable to [mephenesin.sup.12]), have anticonvulsant [activity.sup.13], produce local anesthetic action on mucous membranes along with [analgesia.sup.14], be antifungal (not for [Candida.sup.15]). and have beneficial effects in relieving temporary, transient [insomnia.sup.16] Kava is commonly used in a proprietary formula in Europe for treating cystitis and dysuria.
Dosage
The recommended dose of kava kava in reducing anxiety and tension is 100 mg to 200mg bid-tid, standardized to contain 30 percent kavalactones. Also, the powdered root in its whole form may also be beneficial in relieving stress; use 1.5 gm to 3 gin daily in divided doses as needed. Do not exceed recommended dosages or use for more than three months without a drug holiday.
Contraindications and side effects
Kava is reported to be a safe treatment for anxiety and at normal doses does not dampen alertness or cause drowsiness in most individuals. Although kava preparations have been reported to be safe in recommended doses, overdosage can cause ataxia, nausea, vomiting, visual disturbances and other GI symptoms. Large, prolonged doses (more than 10 times the recommended dosage) of kava may cause a dermatitis termed "kava dermopathy," characterized by a dry, flaking, scaly skin rash on the [body.sup.17]. The dermatitis was believed to be caused by a deficiency of niacin, but further research has reported that the problem is more likely an alteration in cholesterol metabolism, causing a reversible acquired [ichthyosis.sup.18]
There have been mixed reports of kava interacting with [alcohol.sup.(19)(20)(21)] It is best to recommend caution if an individual is taking a preparation of kava and drinking alcoholic beverages in moderation, individuals should be cautioned when driving a car or operating dangerous machinery while taking kava preparations. Recently a study reported a drug interaction in an individual taking a kava preparation and [alprazolam.sup.22]. Use with caution if currently taking prescribed antidepressant or anti-anxiety medications. Kava does not produce tolerance or physical [dependence.sup.23].
Kava is not recommended in pregnancy or lactation, and should not be used in individuals with Parkinson's disease. Do not use kava in chronic liver disease or if endogenous depression is [present.sup.24]. Kava has not been reported to produce physical dependence, but caution should be observed in individuals with addictive behavior due to the potential for mental [dependence.sup.25].
Conclusion
Kava is an excellent agent in anxiety, tension, restlessness and nervousness in most all situations. Kava may also help in transient insomnia. Next time an individual comes into the pharmacy seeking relief from minor anxiety and would rather not take the pharmaceutical agents, kava root may be recommended as a safe, natural agent.
COPYRIGHT 1998 Lebhar-Friedman, Inc.
COPYRIGHT 2000 Gale Group
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