Remedy · herb

Kava

Also: Piper methysticum, kava kava

A genuinely anxiolytic herb whose use is overshadowed by a real risk of severe liver injury.

Active compounds Kavalactones

Evidence by condition

Each grade reflects the research for Kava and that condition specifically.

C
Anxiety & stress
A Cochrane meta-analysis shows a real reduction in anxiety versus placebo (~5 points on the Hamilton scale), but the grade is capped by a documented risk of serious, sometimes fatal, liver injury.
1 citation
- Kava extract for treating anxiety
  Systematic review 2003 · n=645 · Cochrane Database of Systematic Reviews · PMID 12535473 · DOI 10.1002/14651858.CD003383

Kava really does reduce anxiety in trials — but it is a well-documented cause of idiosyncratic, sometimes fatal liver injury, which led to bans or restrictions in several countries and a 2002 FDA advisory. It should never be combined with alcohol or other liver-stressing drugs, and anyone with liver disease must avoid it. This is the clearest case where efficacy and safety pull in opposite directions.

What researchers studied

These describe how the remedy was used in studies — not a dose or a recommendation.

Form studied: standardized kavalactone extract
Amounts in trials: ~70–250 mg kavalactones/day in trials

Safety

Avoid in pregnancy

Interactions: alcohol and other hepatotoxic drugs
sedatives / CNS depressants (additive sedation)
Contraindications: any liver disease
combining with alcohol or other liver-stressing drugs
pregnancy or breastfeeding
Side effects: idiosyncratic liver injury — including hepatitis, liver failure, and death (LiverTox category A)
drowsiness

Safety data is not exhaustive. Always check with a clinician or pharmacist before combining remedies or medications.

Tradition vs. evidence

Traditional use is context, not proof. Here is what older systems claim, and how modern research treats it.

Traditional useEvidence aligns
A traditional Pacific Islander ceremonial and calming drink.