Kava hepatotoxicity with Western herbal products: does it occur with traditional kava use?

Bart J Currie and Alan R Clough
Med J Aust 2003; 178 (9): . || doi: 10.5694/j.1326-5377.2003.tb05279.x
Published online: 5 May 2003

Differences in kava extraction methods may affect hepatotoxicity

In this issue of the Journal, Gow and colleagues (page 442) report the first Australian case of fulminant hepatic failure attributed to a herbal product containing kava,1 while Moulds and Malani (page 451) note the cultural and economic importance of kava for Pacific island nations, and provide a balanced overview on kava safety and availability.2 For centuries kava has been widely consumed in Pacific island countries as a ceremonial beverage and for its mood-altering and stress-relieving properties. It is prepared as an aqueous emulsion of the crushed fresh or dried roots or lower stems of the kava shrub Piper methysticum ("intoxicating pepper").3 Pharmacological properties, such as anxiolytic activity, are attributed to a poorly characterised group of compounds termed kavalactones.3,4

  • Menzies School of Health, Darwin, NT.


  • 1. Gow PJ, Connelly NJ, Hill RL, et al. Fatal fulminant hepatic failure induced by natural therapy containing kava. Med J Aust 2003; 178: 442-443.<eMJA full text>
  • 2. Moulds RFW, Malani J. Kava: herbal panacea or liver poison? Med J Aust 2003; 178: 451-453.<eMJA full text>
  • 3. Clough AR, Burns CB, Mununggurr N. Kava in Arnhem Land: a review of consumption and its social correlates. Drug Alcohol Rev 2000; 19: 319-328.
  • 4. Pittler MH, Ernst E. Kava extract for treating anxiety (Cochrane Review). The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
  • 5. Mathews J, Riley M, Fejo L, et al. Effects of the heavy usage of kava on physical health: summary of a pilot survey in an Aboriginal community. Med J Aust 1988; 148: 548-555.
  • 6. Centers for Disease Control and Prevention. Hepatic toxicity possibly associated with kava-containing products — United States, Germany, and Switzerland, 1999-2002. MMWR Morb Mortal Wkly Rep 2002; 51: 1065-1067.
  • 7. Escher M, Desmeules J, Giostra E, Mentha G. Hepatitis associated with Kava, a herbal remedy for anxiety. BMJ 2001; 322: 139.
  • 8. Commonwealth Department of Health and Ageing. TGA recalls over the counter medicines containing kava [media release]. 15 Aug 2002. Available at: (accessed Mar 2003).
  • 9. Russmann S, Lauterburg BH, Helbling A. Kava hepatotoxicity. Ann Intern Med 2001; 135: 68-69.
  • 10. Clough AR, Jacups SP, Wang Z, et al. Health effects of kava use in an eastern Arnhem Land community. Intern Med J 2003. In press.


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