Continue to warn patients about kava’s liver toxicity

The supplement kava, pulled from European markets and the subject of a Food and Drug Administration MedWatch alert after reports of liver injury, should not be used until more information is available about potential hepatotoxicity, as reported at a seminar on treating mood and anxiety disorders. If the patient insists on using kava, document your discussion about the warnings and monitor liver function tests said by a director of psychopharmacology, McLean Hospital, Blemont, Mass., and Harvard Medical School, Boston. Case reports have tied kava to at least instances of liver failure requiring transplantation and one death. Nonetheless, it now appears unlikely that the supplement will be completely removed from US markets said at the meeting sponsored by Harvard Medical School.

Swiss researchers have linked the toxicity with an acetone-extraction manufacturing process widely used in the German and Swiss products. The European cases also involved consumption of high doses of this acetone extract, according to a report prepared by the British Herbal Medicine Association and submitted to the UK Committee for the Safety of Medicines in March 2002. The association report recommends that daily doses not exceed 2g of the fried rhizome, which is half the dose used in the suspect German preparations. Expect that there will be a rapid response by the supplement industry to come out with safer formulations. Kava can also be extracted with ethanol or water. Before the hepatotoxicity warnings, kava ranked ninth in popularity among supplements taken by Americans, totaling $15 million in