Kava Calm And Sleep

Kava is one of the herbs our naturopaths are most careful with, so these are the questions we'd ask you in store: what it's for, who it isn't for, and when to stop.

A good fit if

• You're an adult, and you're not pregnant or breastfeeding
• What you're dealing with is mild, and you'd see your doctor if it weren't
• You're planning a short stretch and then a break, rather than taking it every day for months
• You'll avoid alcohol for as long as you're taking it
• You'll check the kavalactones per dose on the label before you buy

Check with us first if

• You take a benzodiazepine or any other sedating or mood medicine. A possible interaction with benzodiazepines has been reported, and reviews advise caution with other medicines that act on the brain. Don't swap one for the other.
• You take HIV medicines. Kava is named among the herbs that need caution with antiretrovirals.
• You take a medicine where small changes matter, such as warfarin or ciclosporin. Herb and medicine interactions carry the most risk with these. For digoxin specifically, one trial in people found kava didn't change its levels.
• You take a medicine broken down by the liver enzyme CYP2E1. Kava cut that enzyme's activity by about 40% in a 28-day trial, and your pharmacist can tell you if your medicine is one of them.
• You've had liver problems before. Australian labels must say kava may harm the liver.
• You drive or operate machinery. Reviewers say high doses should be avoided before either, and kava foods must be labelled 'May cause drowsiness'.
• You've been taking it regularly and want to keep going. That's the point to get your liver function checked.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before starting.

• Water (aqueous) extract of kava root, tablet or capsule. Best known for: Symptoms of mild anxiety, short term. It's the only extract type an Australian kava medicine may use. Absorption: No human absorption data exists in our sources. The extract pulls out less total kavalactone than solvent methods. Typical use: Trials used 240 to 250 mg kavalactones a day. A 3-week trial in 60 adults was strongly positive; a 16-week trial in 171 adults found no difference from placebo.
• Dried kava root in a tea bag, up to 3 g per bag. Best known for: The closest medicine form to the traditional drink, with traditional calmative use behind it. Absorption: Not established. No trial we hold used a tea bag. Typical use: Traditional use only. There's no efficacy evidence for the tea-bag form at all.
• Acetone extract (WS 1490). Best known for: The most studied kava extract in the world, for anxiety, tension and restlessness. Absorption: Not established. It's a solvent extract with a different make-up from water extracts. Typical use: 150 to 200 mg of extract a day in European trials. Not permitted in an Australian listed medicine, so those results don't transfer to products sold here.
• Ethanol extract (LI 150). Best known for: Anxiety scores compared with two prescription medicines, in a trial with no placebo group. Absorption: Not established. Typical use: 400 mg of extract a day for 8 weeks. Not permitted in an Australian listed medicine.
• Dried or raw kava root, or a cold-water drink, sold as a food. Best known for: Traditional social and ceremonial drinking across the Pacific. Absorption: Kavalactones per serve aren't standardised, and the food standard doesn't require it. Typical use: A food, not a medicine. It must be labelled 'Use in moderation' and 'May cause drowsiness', and importing it needs a permit.
• Kava and kratom blended drinks. Best known for: Nothing we can support. Kratom is a separate plant with its own dependence risk. Absorption: Not established. Typical use: Avoid. Heavy use of a kava and kratom drink has been linked to withdrawal severe enough for hospital care. Not permitted as a listed medicine.

Reference values. There aren't any. Kava is a herb, not a nutrient, so there's no nutrient reference value, RDI or NHMRC upper level for kavalactones.

Typical supplemental range. The Australian rules set a limit rather than a recommended dose. A kava medicine taken by mouth can provide no more than 250 mg of kavalactones a day, no more than 125 mg in any one tablet or capsule, and no more than 3 g of dried root in a tea bag. The two trials of the water extract used 240 and 250 mg of kavalactones a day, so an Australian product can reach trial doses. A single 180 mg dose, tested on its own, didn't change anxiety at all.

Upper level. 250 mg of kavalactones a day is the legal limit for an Australian listed medicine. It's a regulatory limit, not a target to aim for.

Worth knowing. How long you take it matters as much as how much. The label must say 'Not for prolonged use', the longest controlled trial we know of ran for 16 weeks, and one review notes liver problems are especially possible after 8 weeks. If you use kava regularly, clinical reviewers advise regular liver function tests. Check the kavalactones per dose on the label, not just the root weight. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Traditional kava drink, made from kava root suspended in cold water only, with no organic solvent: not standardised. The food standard sets no kavalactone amount per serve, and studies of kava drinkers report widely varying doses
• Dried or raw kava root, sold as a food: no set amount. It must carry the warnings 'Use in moderation' and 'May cause drowsiness'

This list is the part of the page we will not shorten. If any of it applies to you, talk to one of our naturopaths or your doctor before starting.

• Pregnancy and breastfeeding. Mandatory label statement: 'Not recommended for pregnant or lactating women'. Avoid.
• Everyone, over time. Mandatory label statement: 'Not for prolonged use'. One review notes liver toxicity is especially possible beyond 8 weeks.
• Liver. Labels above 25 mg kavalactones a dose must say 'May harm the liver'. The largest Australian trial recorded more abnormal liver function tests on kava, though no participant met criteria for herb-induced liver injury.
• Liver, case level. Serious reactions including liver damage are rare but reported. Of 19 German suspected cases, a very probable causal link was established in one.
• Benzodiazepines. A possible interaction has been reported. Refer to the prescriber.
• Alcohol. Avoid together.
• Other psychotropic medicines. Caution advised. Refer to the prescriber.
• Antiretroviral medicines. Caution advised. Refer to the prescriber.
• Narrow-therapeutic-index drugs such as warfarin and ciclosporin. Refer to the prescriber or pharmacist.
• CYP2E1 substrates. Kava reduced CYP2E1 activity by about 40% over 28 days. Refer to the pharmacist.
• Driving and machinery. Avoid high doses. Kava foods must carry 'May cause drowsiness'.
• Heavy or escalating use. A withdrawal syndrome has been documented, including one case needing phenobarbital in hospital.
• Kava combined with kratom. Severe withdrawal requiring hospitalisation has been reported. Avoid.
• Memory and tremor. More reported in the kava group than placebo in the largest Australian trial.
• Skin. Kava dermopathy is described with heavy use.
• Children and teenagers. No permitted dose and no paediatric evidence. Not recommended.