Kava: herbal panacea or liver poison?

Robert F W Moulds and Joji Malani
Med J Aust 2003; 178 (9): 451-453.


  • Following reports of liver toxicity, including liver failure, associated with extracts from the Pacific islands plant kava (Piper methysticum), these have been banned from sale as a herbal anxiolytic in many Western countries, to the detriment of Pacific island economies.

  • Pacific Islanders have used kava extensively for centuries, without recognised liver toxicity. However, the population is small, and there has been no systematic evaluation of possible liver damage.

  • For both economic and public health reasons, it is important to determine if kava is inherently hepatotoxic, and what the mechanisms of toxicity are.

  • Such research could lead to safer kava extracts for sale in Western countries, or identification of a subpopulation who should not consume kava.

Please login with your free MJA account to view this article in full

  • Robert F W Moulds1
  • Joji Malani2

  • The Fiji School of Medicine, Suva, Fiji.


Competing interests:

None identified.

  • 1. Yadhu N, Singh Y. Kava: an overview. J Ethnopharmacol 1992; 37: 13-45.
  • 2. Lebot.V, Merlin M, Lindstrom L. Kava. New Haven: Yale University Press, 1992.
  • 3. Cawte J. Parameters of kava used as a challenge to alcohol. Aust N Z J Psychiatry 1986; 20: 70-76.
  • 4. Campo J, McNabb J, Perel J. Kava-induced fulminant hepatic failure. J Am Acad Child Adolesc Psychiatry 2002; 41: 631-632.
  • 5. Escher M, Desmeulus J, Giostra E, Mentha G. Hepatitis associated with kava, a herbal remedy for anxiety. BMJ 2001; 322: 139.
  • 6. Strahl S, Ehret V, Dahm H, et al. Necrotising hepatitis after taking herbal remedies. Dtsch Med Wochenschr 1998; 123: 1410-1414.
  • 7. Stevinson C, Huntley A, Ernst E. A systemic review of the safety of kava extract in the treatment of anxiety. Drug Safety 2002; 25: 251-261.
  • 8. Kraft M, Spahn T, Menzel J, et al. Fulminant liver failure after administration of the herbal antidepressant kava-kava. Dtsch Med Wochenschr 2001; 126: 970-972.
  • 9. Russmann S, Lauterburg BH, Helbling A. Kava hepatotoxicity [letter]. Ann Intern Med 2001; 135: 68-69.
  • 10. McCutchan T. Fiji loses millions in kava export ban. The Daily Post [Fiji] 2003; 22 Jan: 1.
  • 11. Murray W. Neoliberal globalisation, "exotic" agro-exports, and local change in the Pacific islands: a study of the Fijian kava sector. Singap J Trop Geogr 2000; 21: 355-373.
  • 12. Mathews JD, Riley MD, Fejo L, et al. Effects of heavy usage of kava on physical health: summary of a pilot survey in an Aboriginal community. Med J Aust 1988; 148: 548-555.
  • 13. Denham A, McIntyre M, Whitehouse J. Kava — the unfolding story: report on a work-in-progress. J Altern Complement Med 2002; 8: 237-263.
  • 14. Whitfield JB. Gamma glutamyl transferase. Crit Rev Clin Lab Sci 2001; 38: 263-355.
  • 15. Wanwimolruk S, Bhagwan S, Coffield PF, Chalcroft SC. Genetic polymorphism of debrisoquine (CYP2D6) and proguanil (CYP2C19) in South Pacific Polynesian populations. Eur J Clin Pharmacol 1998; 54: 431-435.
  • 16. Buckley JP, Furgiulel AR, O'Hara MJ. Pharmacology of kava. In: Efron DH, Holmstedt B, Kilne NS, editors. Ethnopharmacological search for psychoactive drugs. New York: Raven Press, 1979; 141-145.
  • 17. Klohs MW, Keller F, Williams RE, et al. A chemical and pharmacological investigation of Piper methysticum. J Med Pharm Chem 1959; 1: 95-99.
  • 18. Singh YN, Blumenthal M. Kava — an overview. HerbalGram 1997; 39: 33-56.
  • 19. Duve RN, Prasad J. Efficacy of extraction of constituents in the preparation of the Yaqona beverage. Fiji Agric J 1984; 45: 1-6.
  • 20. Duve RN, Prasad J. Quality evaluation of Yaqona (Piper methysticum) in Fiji. Fiji Agric J 1981; 43: 1-8.
  • 21. Pittler MH, Ernst E. Kava extract for treating anxiety (Cochrane Review). In: The Cochrane Library 2003; Issue 1. Oxford: Update Software.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.