Fatal fulminant hepatic failure induced by a natural therapy containing kava

Paul J Gow, Nathan J Connelly, Peter Crowley, Peter W Angus and Richard L Hill
Med J Aust 2003; 178 (9): 442-443.

We describe a case of acute liver failure and death associated with the use of a preparation containing the "natural" anxiolytic kava (Piper methysticum) and passionflower (Passiflora incarnata). The patient died after a report by the Therapeutic Goods Administration (TGA) warning of the potential for hepatotoxicity associated with the use of kava-containing products. The general public and alternative medicine practitioners need to be aware of the potential for non-prescription drugs to cause serious hepatic reactions.

Preparations containing kava (Piper methysticum) have become freely available in Australia and have gained widespread use as over-the-counter anxiolytics or sedatives. We report the first Australian case of fulminant hepatic failure associated with a kava-containing preparation.

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  • Paul J Gow1
  • Nathan J Connelly2
  • Peter Crowley3
  • Peter W Angus4
  • Richard L Hill5

  • 1 Austin and Repatriation Medical Centre, Melbourne, VIC.
  • 2 Adverse Drug Reactions Unit, Therapeutic Goods Administration, Canberra, ACT.


Competing interests:

None identified.

  • 1. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239-245.
  • 2. Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002; 177: 440-443. <MJA full text>
  • 3. Therapeutic Goods Administration. Kava practitioner alert. Available at: (accessed Dec 2002).
  • 4. O'Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989; 97: 439-445.


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