⚠ Regulatory caution
📰Read the full Kava evidence review on GMJ News →Complete clinical article, references and updates on news.gmj.ge. This page is the structured safety summary.⚠ >100 hepatotoxicity cases including liver failure/death [1]
⚠ NEVER with alcohol or hepatotoxic drugs [1]
⚠ CYP pan-inhibitor (1A2, 2C9, 2C19, 2D6, 3A4) — major drug interaction potential [1]
⚠ New fatigue/dark urine/jaundice → STOP immediately, check LFTs [1]
⚠ Water extracts may be safer than ethanol-based [1]
ℹ️ Not obtained from food. Not applicable — this is not obtained from food in meaningful amounts; supplementation is the practical route.
🔬 Lab interpreter
Recommended test
ALT, AST, bilirubin
ALT, AST, bilirubin
Reference range / target
Normal
Normal
Mandatory liver monitoring during kava use [1].
Full lab monitoring ↓⚕ For professionals — confirm ranges against your local laboratory.
Clinical verdict
Kava IS effective for anxiety (Cochrane confirmed). BUT: >100 hepatotoxicity cases including DEATHS. Banned/restricted in several countries. Water extracts may be safer than ethanol/acetone. Limit to 1–3 months. Monitor liver. No dependence (advantage vs benzodiazepines). The benefit-risk is a genuine clinical dilemma [1] [2].
1 How much do I need?
👤 Adults: Specific dosage data under clinical review
👴 Elderly: Specific dosage data under clinical review
🤰 Pregnancy: See guidance
AVOID — hepatotoxicity + potential uterotonic [1].
👦 Pediatric: See guidance
AVOID — hepatotoxicity [1].
🏃 Athletes: Standard dose
⚖️ Obesity: Standard dose
Fat-soluble compounds may require dose adjustment in obesity.
🩺 Renal: Consult specialist
Dose adjustment may be needed in renal impairment.
🌱 Vegan: Standard dose
How to take
🍽 Timing: Divided BID-TID [2].
💊 With food: With or without food [1].
🚫 Avoid: Alcohol. Hepatotoxic drugs. >3 months. Pregnancy [1].
2 Which form?
| Form | Bioavailability | Vegan | Cost |
|---|---|---|---|
| ['Water extract (traditional)', 'preferred', 'Traditional Pacific Island preparation. May be safer (aqueous extraction) [1].'] | Standard | Check label | |
| ['Ethanolic/acetonic extract', '', 'Used in European supplements. May be linked to higher hepatotoxicity risk [1].'] | Standard | Check label | |
| ['WS 1490 extract', '', 'Standardized. Used in the Cochrane-reviewed trials [2].'] | Standard | Check label |
3 Common questions
Is kava safe? ▼
It IS effective for anxiety (Cochrane). But >100 hepatotoxicity cases (including deaths) are documented. The benefit-risk is debated. Water-based extracts may be safer. Limit to 1–3 months. Monitor liver symptoms. Avoid with alcohol or hepatotoxic drugs [1].
Why was kava banned in Germany? ▼
>30 hepatotoxicity cases in Germany led to a 2002 ban. The ban was partially lifted in 2014 after review concluded the overall benefit-risk was acceptable with appropriate warnings. Acetonic extracts may be riskier than traditional water preparations [1].
4 Clinical evidence
Strong
Cochrane review: kava is effective for anxiety (superior to placebo) [2]. >100 hepatotoxicity cases including deaths: well-documented pharmacovigilance data [1]. Kavalactone GABA-A modulation: confirmed pharmacology [1]. HIGH
Moderate
GAD: multiple positive RCTs at 120–240 mg kavalactones/day [2]. Sleep: some evidence for improved sleep quality [1]. Comparable to low-dose benzodiazepines for anxiety in some trials [2]. MODERATE
Insufficient
5 Safety, toxicity & adverse events
Absolute contraindications
✕ Liver disease — documented risk of severe hepatotoxicity
✕ Concurrent hepatotoxic drugs or significant alcohol use
✕ Pregnancy and lactation
Relative
⚠ Parkinson's disease — may worsen motor symptoms
⚠ Concurrent benzodiazepines/CNS depressants — additive sedation
⚠ Do not drive after use; discontinue before surgery
🚩 Red flags
● ANY liver symptoms (fatigue, dark urine, jaundice) in kava user — STOP, check LFTs [1]
● Alcohol + kava — additive hepatotoxicity [1]
● Patient on multiple CYP-metabolized drugs — kava is a pan-CYP inhibitor [1]
6 Interactions
Drug interactions
Hepatotoxic drugs (acetaminophen, statins, etc.) Major
Mechanism: Additive hepatotoxicity. [1]
Effect: Liver injury/failure. [1]
Action: AVOID [1].
7 Regulatory
Germany: Banned 2002, partially reinstated 2014 with restrictions [1].
France/UK: Restricted/banned at various points [1].
United States: Dietary supplement (no restrictions) [1].
Pacific Islands: Traditional ceremonial use for centuries [1].
8 US supplement products
3
on-market products containing Kava (NIH DSLD)
Brands carrying Kava (1)
Click a brand to see its Kava products.
9 Cite this page
Vancouver: Pkhakadze G. Kava — safety profile [Internet]. Tbilisi: PHIG; 2026 [cited 2026 Aug 31]. Available from: https://supplement.ge/ingredients/kava/
APA 7th: Pkhakadze, G. (2026). Kava — Safety profile. Public Health Institute of Georgia. https://supplement.ge/ingredients/kava/
📋 Editorial information
Author: Prof. G. Pkhakadze, MD, MPH, PhD
Institution: Public Health Institute of Georgia (PHIG)
Affiliation: David Tvildiani Medical University (DTMU)
First published: January 2026
Last reviewed: 2026-05-29
Next review: March 2027
References: 2 cited sources
COI: SupplementIndex receives no funding from supplement manufacturers. All content independently authored by PHIG.
Process: Systematic literature review
📄 License & reuse
Published under Creative Commons Attribution 4.0 International (CC BY 4.0). You may share and adapt for any purpose with attribution.
Pkhakadze G. "Kava — Safety Profile." SupplementIndex, PHIG, 2026. https://supplement.ge/ingredients/kava/ CC BY 4.0.
GP
Prof. G. Pkhakadze, MD, MPH, PhD
Professor of Public Health · Head of Department, DTMU
Editor-in-Chief, Georgian Medical Journal (ISSN 3088-4322)
Chair, Public Health Institute of Georgia · UEMS Public Health Section
Educational and public health purposes. CC BY 4.0. Consult your healthcare provider before starting any supplement. Corrections: info@accreditation.ge. Publisher: PHIG