Kava Kava rhizome (root) - Most Respected Herb in the South Pacific

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Kava Kava rhizome (root) - Most Respected Herb in the South Pacific

 

Latin Name: Piper methysticum

Pharmacopeial Name: Piperis methystici rhizoma

Other Names: kava, awa

http://herbalgram.org/ogdenpress/ExpandedCommissionE/he055.asp#Contraindications

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Overview

 

Kava (also known as kava kava) is the most respected herb in the islands of the

South Pacific. It is used as a ritual beverage for ceremonial purposes,

including the welcoming of important guests.

 

Pope John Paul II, Queen Elizabeth, President Lyndon B. Johnson, Lady Bird

Johnson, and Hillary Rodham Clinton are all known to have drunk kava upon being

welcomed to Fiji (the Pope) and Samoa (others) (Singh and Blumenthal, 1997).

 

Kava has been used in native medicine for its relaxing qualities, for urinary

tract infections, asthma (Hope et al., 1993), as a topical anesthetic, and other

applications.

 

The primary interest in the West has been its well documented anxiolytic

effects.

 

Numerous clinical studies, including laboratory testing, conducted in Germany

reveal the relative safety and efficacy of kava extracts for reduction of

symptoms in patients with anxiety disorders (Kinzler et al., 1991; Volz and

Kieser, 1997).

 

The results of the clinical studies and the experiences of German patients using

kava phytomedicines have shown that kava is an appropriate treatment compared to

tricyclic antidepressants and benzodiazepines in anxiety disorders.

 

Kava has also been shown effective for long-term use without the tolerance

problems associated with the use of tricyclics and benzodiazepines (Volz and

Kieser, 1997).

 

There is some documentation to support the increased popularity of kava with

menopausal women.

 

An eight-week study on a special kava extract (Laitan , W. Schwabe, Germany)

resulted in reduction of neurovegetative and psychosomatic dysfunctions (hot

flashes, depressive moods, irritability) after only one week of treatment

(Warnecke, 1991).

 

Although usually contraindicated with alcohol, a recent study designed to

determine any adverse synergies between the two substances concluded that no

negative " multiplicative " (i.e., synergistic) effects of a special proprietary

kava extract (WS 1490) were observed with persons ingesting alcohol (0.05% blood

alcohol concentration) (Herberg, 1993).

 

Other safety concerns with kava deal with the observed yellowing and scaling of

the skin in persons using kava beverages heavily for an extended period, a

condition known as " kava dermopathy. "

 

A study (Ruze, 1990) of male kava drinkers in the Tongan Islands concluded that

the observed pellagroid dermopathy was not due to niacin deficiency as had

previously been suggested.

 

The general safety of kava was assessed in an industry-sponsored review of the

historical and scientific literature, and it was concluded that, " When used in

normal therapeutic doses, kava appears to offer safe and effective anti-anxiety

and muscle relaxant actions without depressing centers of higher thought.

 

The safe use of kava as a dietary supplement in cultures that do not have

historical experience with its use depends on responsible manufacturing,

marketing, individual consumer patterns, and education (Dentali, 1997).

 

Due to concerns about the relative safety of kava, in September 1997 the

American Herbal Products Association recommended the following label warning to

all its members: " Caution: Not for use by persons under the age of 18. If

pregnant, nursing, or taking a prescription drug, consult healthcare

practitioner prior to use. Do not exceed recommended dosage. Excessive

consumption may impair ability to drive or operate heavy equipment " (Anon,

1999). This warning is consistent with cautions published by the Commission E.

 

German pharmacopeial grade kava kava consists of the peeled and cut dried

rhizome of Piper methysticum G. Forster, mostly removed from the root.

 

It must contain not less than 3.5% total kavalactones, calculated as kavain.

Botanical identification is confirmed by thin-layer chromatography (TLC),

macroscopic and microscopic examinations, as well as organoleptic evaluations

including taste, smell, and chewing the rhizome to stimulate salivation and a

long lasting anesthetic effect on the tongue (DAC, 1986–1989).

 

 

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Description

 

Kava kava rhizome consists of the dried rhizomes of P. methysticum G. Forster

[Fam. Piperaceae], as well as their preparations in effective dosage. The

rhizome contains kava pyrones (kawain).

 

 

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Chemistry and Pharmacology

 

Kava kava rhizome contains >3.5% kavalactones, a.k.a. kavapyrones, mainly

methysticin, dihydromethysticin, kavain, 7,8-dihydrokavain, 5,6-dehydrokavain,

5-6,dehydromethysticin, and yangonin; chalcones, including flavokavains A, B,

and C (He et al., 1997).

 

The major kavalactones can be classified into enolides (e.g.,

5,6-dihydro-a-pyrones with an asymmetric carbon atom) and dienolides (e.g.,

achiral a-pyrones) (H‰berlein et al., 1997); approximately 3.2% minerals,

including potassium (approximately 2.2%), calcium, magnesium, sodium, aluminum,

iron; approximately 3.5% amino acids (Leung and Foster, 1996; Mack, 1994).

 

The Commission E reported anti-anxiety activity for kava kava.

 

In animal experiments a potentiation of narcosis (sedation), as well as

anticonvulsive, antispasmodic, and central muscular relaxant effects were

described.

 

The neuropharmacologic effects of kava include analgesia, anesthesia, sedation,

and hyporeflexia (Holm et al., 1991; Jamieson et al., 1989; Singh, 1983). Kava

affects motor and muscular function (Holm et al., 1991; Jamieson et al., 1989;

Meyer, 1962; Singh, 1983), while mental function appears to remain clear

(Pfeiffer et al., 1967).

 

Kava pyrones have been shown to protect mice from strychnine-induced convulsions

(Klohs et al., 1959). Kava has also been shown to improve seizure control in

epileptic patients but with unacceptable skin-yellowing side effects (Pfeiffer

et al., 1967).

 

The mechanism of action by kava on the central nervous system is not clear. In

vitro and in vivo studies have produced differing conclusions regarding whether

kava binds at GABA receptors. A possible noradrenaline uptake effect has been

shown in 3 kavalactones.

 

Anticonvulsant activity may be a result of mediation of Na+ channel receptor

sites, common targets of anti-epileptic drugs (Anon, 1998). One of the more

interesting features about kava is its ability to relax skeletal muscles, yet it

does not act as a central nervous system depressant.

 

Studies show that kava actually helps to retain or increase mental processes

(Emser, 1993; Heinze et al., 1994; M nte et al., 1993; Pfeiffer et al., 1967;

Saletu et al., 1989).

 

 

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Uses

 

Commission E approved kava for use in conditions of nervous anxiety, stress, and

restlessness.

 

Clinical trials have also studied the use of kava for cognitive enhancement

(Emser, 1993; Heinze et al., 1994; M nte et al., 1993; Saletu et al., 1989) and

climacteric symptom reduction (Warnecke, 1991).

 

 

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Contraindications

 

Endogenous depression.

 

 

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Side Effects

 

None known.

 

Note: Extended continuous intake can cause a temporary yellow discoloration of

skin, hair, and nails. In this case, application of this preparation must be

discontinued. In rare cases, allergic skin reactions can occur. Also,

accommodative disturbances, such as enlargement of the pupils have been

described.

 

 

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Use During Pregnancy and Lactation

 

Not recommended.

 

 

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Interactions with Other Drugs

 

Potentiation of effectiveness is possible for substances acting on the central

nervous system, such as alcohol, barbiturates, and psychopharmacological agents.

 

 

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Dosage and Administration

 

Unless otherwise prescribed: 1.7–3.4 g per day of cut rhizome and other

galenical preparations for oral use, equivalent to 60–120 mg kava pyrones. Do

not exceed recommended dose.

 

Note: The equivalency of 1.7–3.4 g dry rhizome to 60–120 mg kava pyrones is

based on the drug codex requirement of minimum 3.5% (35 mg/g) kava pyrones

content in the raw material.

 

Cold macerate: Soak 1.7–3.4 g of ground rhizome in 150 ml cold water for several

hours, then strain.

 

Dried rhizome: 1.5–3 g, in divided doses throughout the day (Bone, 1993–1994;

Burgess, 1998); 2–4 g (Karnick, 1994).

 

Note: The rhizome needs to be chewed well and suffiently mixed with saliva while

ingesting (Alschuler, 1998).

 

Fluidextract 1:2 (g/ml): 3–6 ml, in divided doses (Alschuler, 1998; Bone,

1993–1994; Burgess, 1998).

 

Dry normalized extract containing 30% (300 mg/g) kava pyrones: 0.2–0.4 g

(200–400 mg).

 

Soft native extract containing approximately 55% (550 mg/g) kava pyrones:

0.1–0.2 g (100–200 mg).

 

Note: The traditional kava preparation in a single dose is reported to deliver

approximately 250–300 mg of active a-pyrones (Dentali, 1997).

 

Duration of administration: Not more than 3 months without medical advice.

 

Note: Even when administered within its prescribed dosages, this herb may

adversely affect motor reflexes and judgment for driving and/or operating heavy

machinery.

 

 

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References

 

Alschuler, L. 1998. Kava: an herb for our hectic times. Nature's Impactô by

Impact Communications, Inc.

 

Anon. 1999. AHPA's Recommended Label Language for Kava Products. HerbalGram 45.

 

Anon. 1998. Monograph: Piper methysticum (kava kava). Alt Med Rev 3(6):458–460.

 

Bone, K. 1993–1994. Kava—a safe herbal treatment for anxiety. Brit J Phytother

3(4):147–153.

 

Burgess, N. 1998. Regulatory issues on Piper methysticum (kava). Aust J Med

Herbalism 10(1):2–3.

 

Dentali, S.J. 1997. Herb Safety Review: Kava, Piper methysticum Forster f.

(Piperaceae). Bethesda, MD: American Herbal Products Association.

 

Deutscher Arzneimittel-Codex, 1st suppl. (DAC). 1986–1989. Stuttgart: Deutscher

Apotheker Verlag. K-155:1–6.

 

Emser, W. 1993. Phytotherapy of insomnia—a critical overview. Pharmacopsychiatry

26:150.

 

H‰berlein, H., G. Boonen, M.A. Beck. 1997. Piper methysticum: enantiomeric

separation of kavapyrones by high performance liquid chromatography. Planta Med

63:63–65.

 

He, X., L. Lin, L. Lian. 1997. Electrospray high performance liquid

chromatography-mass spectrometry in phytochemical analysis of kava (Piper

methysticum) extract. Planta Med 63:70–74.

 

Heinze, H.J., T.F. Munthe, J. Steitz, M. Matzke. 1994. Pharmacopsychological

effects of oxazepam and kava-extract in a visual search paradigm assessed with

event-related potentials. Pharmacopsychiatry 27(6):224–230.

 

Herberg, K.W. 1993. [Effect of kava-special extract WS 1490 combined with ethyl

alcohol on safety-relevant performance parameters] [in German]. Blutalkohol

30(2):96–105.

 

Holm, E. et al. 1991. Untersuchungen zum Wirkungsprofil von D, L-Kavain.

Arzneimforsch/Drug Res 41(7):673–683.

 

Hope, B.E., D.B. Massey, G. Fournier-Massey. 1993. Hawaiian materia medica for

asthma. Hawaii Med J 52(6):160–166.

 

Jamieson, D.D., P.H. Duffield, D. Cheng, A.M. Duffield. 1989. Comparison of the

central nervous system activity of the aqueous and lipid extract of kava (Piper

methysticum). Arch Int Pharmacodyn Ther 301:66–80.

 

Karnick, C.R. 1994. Pharmacopoeial Standards of Herbal Plants, Vol. 2. Delhi:

Sri Satguru Publications. 79.

 

Kinzler, E., J. Kromer, E. Lehmann. 1991. [Effect of a special kava extract in

patients with anxiety-, tension-, and excitation states of non-psychotic

genesis. Double blind study with placebos over four weeks] [in German].

Arzneimforsch 41(6):584–588.

 

Klohs, M.W.F. et al. 1959. A chemical and pharmacological investigation of Piper

methysticum Forst. J Med Pharm Chem 1:95–99.

 

Leung, A.Y. and S. Foster. 1996. Encyclopedia of Common Natural Ingredients Used

in Food, Drugs, and Cosmetics, 2nd ed. New York: John Wiley & Sons, Inc.

330–331.

 

Mack, R. 1994. Kava kava. Piper methysticum—a unique economic plant of the

Pacific Islands. J Health Sci 1(1):43–48.

 

Meyer, H.J. 1962. Pharmakologie der Wirksamen Prinzipien de Kawa-rhizoms (Piper

methysticum Forst.) Arch Int Pharmacodyn Ther 138:505–536.

 

M nte, T.F. et al. 1993. Effects of oxazepam and an extract of kava roots (Piper

methysticum) on event-related potentials in a word recognition task.

Neuropsychobiology 27(1):46–53.

 

Pfeiffer, C.C., H.G. Murphree, L. Goldstein. 1967. Effects of kava in normal

subjects and patients. Ethnopharmacologic search for psychoactive drugs:

Proceedings of a symposium held in San Francisco, California. January 28–30.

Public Health Service Publication No. 1645:155–161.

 

Ruze, P. 1990. Kava-induced dermopathy: a niacin deficiency? Lancet

335(8703):1442–1445.

 

Saletu, B. et al. 1989. EEG-brain mapping, psychometric and psychophysiological

studies on central effects of kavain—a kava plant derivative. Hum

Psychopharmacol 4:169–190.

 

Singh, Y.N. 1983. Effects of kava on neuromuscular transmission and muscle

contractility. J Ethnopharmacol 7(3):267–276.

 

Singh, Y.N. and M. Blumenthal. 1997. Kava—An Overview. HerbalGram 39:33–56.

 

Volz, H.P. and M. Kieser. 1997. Kava-kava extract WS 1490 versus placebo in

anxiety disorders—A randomized placebo controlled 25-week outpatient trial.

Pharmacopsychiatry 30(1):1–5.

 

Warnecke, G. 1991. [Psychosomatic dysfunction in the female climacteric.

Clinical effectiveness and tolerance of Kava Extract WS 1490] [in German].

Fortschr Med 109(4):119–122.

 

 

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Additional Resources

 

Frater, A.S. 1976. Medical aspects of yaqona. Fiji Med J 4:526–530.

 

Lebot, V., M. Merlin, L. Lindstrom. 1992. Kava: the Pacific Drug. New Haven:

Yale University Press.

 

Lebot, V. and P. Cabalion. 1988. Kavas of Vanuatu: Cultivars of Piper

Methysticum Forst. Technical Paper No. 1955. Noumea, New Caledonia: South

Pacific Commission. 3–53.

 

Lebot, V. and J. Levesque. 1989. The origin and distribution of kava (Piper

methysticum Forst. f., Piperaceae): a phytochemical approach. Allertonia

5:223–281.

 

Lehmann, E. et al. 1996. [Effects of a special Kava extract (Piper methysticum)

in patients with states of anxiety, tension and excitedness of non-mental

origin—A double blind placebo controlled study of four weeks treatment] [in

German]. Phytomedicine 3(2):113–119.

 

Lindenberg, Von D. and H. Pitule-Schodel. 1990. D,L-Kavain in comparison with

oxazepam in anxiety states. Double-blind clinical trial. Forschr Med

108(2):49–50; 53–54.

 

McGuffin, M., C. Hobbs, R. Upton, A. Goldberg. 1997. American Herbal Product

Association's Botanical Safety Handbook. Boca Raton: CRC Press.

 

Russell, P.N., D. Bakker, N.N. Singh. 1987. The effects of kava on alerting and

speed of access of information from long-term memory. Bull Psychonomic Society

25:236–237.

 

Shulgin, A.T. 1973. The narcotic pepper: the chemistry and pharmacology of Piper

methysticum and related species. Bulletin on Narcotics 25:59–74.

 

Singh, Y.N. 1992. Kava—An Overview. J Ethnopharmacol 37(1):13–45.

 

Smith, RM. 1979. Pipermethystine: a novel pyridone alkaloid from Piper

methysticum. Tetrahedron Lett 35:437–439.

 

Titcomb, M. 1948. Kava in Hawaii. J Polynesian Society 57:105–171.

 

 

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Note

 

This material was adapted from The Complete German Commission E

Monographs—Therapeutic Guide to Herbal Medicines. M. Blumenthal, W.R. Busse, A.

Goldberg, J. Gruenwald, T. Hall, C.W. Riggins, R.S. Rister (eds.) S. Klein and

R.S. Rister (trans.). 1998. Austin: American Botanical Council; Boston:

Integrative Medicine Communications.

 

1) The Overview section is new information.

 

2) Description, Chemistry and Pharmacology, Uses, Contraindications, Side

Effects, Interactions with Other Drugs, and Dosage sections have been drawn from

the original work. Additional information has been added in some or all of these

sections, as noted with references.

 

3) The dosage for equivalent preparations (tea infusion, fluidextract, and

tincture) have been provided based on the following example:

 

Unless otherwise prescribed: 2 g per day of [powdered, crushed, cut or whole]

[plant part]

 

Infusion: 2 g in 150 ml of water

 

Fluidextract 1:1 (g/ml): 2 ml

 

Tincture 1:5 (g/ml): 10 ml

 

4) The References and Additional Resources sections are new sections. Additional

Resources are not cited in the monograph but are included for research purposes.

 

 

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Excerpt from Herbal Medicine: Expanded Commission E Monographs

Copyright 2000 American Botanical Council

Published by Integrative Medicine Communications

Available from the American Botanical Council.

 

This material is not intended as a guide to self medication by consumers. The

lay reader is advised to discuss the information contained herein with a doctor,

pharmacist, nurse or other authorized health care practitioner. Neither the

editors nor the publisher accepts any responsibility for the accuracy of the

information itself or the consequences from the use or misuse of the information

contained herein.

_________________

JoAnn Guest

mrsjoguest

DietaryTipsForHBP

www.geocities.com/mrsjoguest/Gene

 

 

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Excerpt from Herbal Medicine: Expanded Commission E Monographs

Copyright 2000 American Botanical Council

Published by Integrative Medicine Communications

Available from the American Botanical Council.

 

This material is not intended as a guide to self medication by consumers. The

lay reader is advised to discuss the information contained herein with a doctor,

pharmacist, nurse or other authorized health care practitioner. Neither the

editors nor the publisher accepts any responsibility for the accuracy of the

information itself or the consequences from the use or misuse of the information

contained herein.

_________________

JoAnn Guest

mrsjoguest

DietaryTipsForHBP

www.geocities.com/mrsjoguest/Genes

 

 

 

 

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