Hepatitis, kava-associated

Escher, M., Desmeules, J., Giostra, E., and Mentha, G. (2001) Hepatitis associated with kava, a herbal remedy for anxiety. BMJ 322 139. 

Kava Piper methysticum) 03/26/2002 Kava is associated with liver-related injury including hepatitis, cirrhosis, and liver failure... 

Recent reports from European health authorities have linked kava to at least 25 cases of liver toxicity, including hepatitis, cirrhosis, and liver failure. The FDA is currently (2002) investigating the health risks of the herbal supplement. Under review are 38 Americans, including a liver transplant recipient, with medical problems associated with kava use. As of February 2002, sales have been halted in Switzerland and are suspended in Britain, Germany is acting to make kava a prescription product and the FDA recommends avoiding kava until safety questions are answered. 

Other reported dangers are the kava-containing supplements. Supplements containing the herbal ingredient kava are promoted for relaxation. For instance, kava is known to relieve stress, anxiety, and tension for sleeplessness, and menopausal symptoms. There has not yet been a determination from FDA that kava-containing products have the ability to perform such benefits. Kava-containing products have been associated with liver-related injuries, including hepatitis, cirrhosis, and liver failure. 

The packaging of the kava products was unavailable for identification purposes. Liver biopsy revealed active fulminant hepatitis with extensive necrosis and tests for viral hepatitis were negative. She underwent a successful liver transplantation and was able to return to normal activity upon recovery (34). Unfortunately, no information was provided indicating that acetaminophen toxicity had been ruled out, and the observed toxic effect could also have been associated with a large, undiagnosed acetaminophen ingestion. 

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(47) 1065-1067. 

Escher M, Desmeules J. Hepatitis associated with kava, a herbal remedy. BMJ 2001 322 139. 

In the past few years, about 30 cases of possible hepatotoxicity associated with kava use have been reported from Europe, mostly in Germany and Switzerland, with about 10 additional cases from North America (Hagemann, 2001 Waller, 2002), Australia, and New Zealand. The adverse event reports in these cases included cholestatic hepatitis. 

A number of case reports of hepatotoxicity in association with kava use have been reported in the medical literature and to pharmacovigilance centers. Reports include cases of fulminant liver failure, severe liver damage, necrotizing hepatitis, cholestatic hepatitis, liver cell impairment, and an increase in liver enzymes (Brauer et al. 2001,2003 Bujanda et al. 2002 Campo et al. 2002 Gow et al. 2003 Humberston... 

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