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Published on: May 31, 2018
Kava hepatotoxicity: pathogenetic aspects and prospective considerations.
1Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Johann Wolfgang Goethe-University, Frankfurt/Main, Hanau, Germany. rolf.teschke@gmx.de
Summary
Kava hepatotoxicity, a liver injury from kava extracts, may be preventable. Improving kava quality and adherence to recommendations, while avoiding other medications, can reduce liver damage risks.
Area of Science:
- Pharmacology
- Hepatology
- Phytochemistry
Background:
- Kava (Piper methysticum) extracts are linked to herb-induced liver injury (HILI).
- Both commercial (ethanolic, acetonic) and traditional (aqueous) kava extracts can cause liver damage.
- Confounding factors like comedication and non-adherence complicate understanding kava's hepatotoxicity.
Purpose of the Study:
- To review and identify potential pathogenetic factors contributing to kava-induced liver injury.
- To analyze confounding variables influencing the development of kava hepatotoxicity.
Main Methods:
- Comprehensive literature review of studies on kava hepatotoxicity.
- Analysis of proposed mechanisms including metabolic interactions, genetic factors, and extract quality.
- Consideration of confounding variables such as comedication and usage patterns.
Main Results:
- Multiple pathogenetic factors are implicated: CYP450 interactions, genetic deficiencies, toxic constituents, impurities, COX inhibition, P-glycoprotein alterations, glutathione depletion, solvents, and poor raw material quality.
- Inappropriate kava plant parts or cultivars may contribute to toxicity.
- Hepatotoxicity appears independent of the extraction medium used.
Conclusions:
- Kava hepatotoxicity is primarily attributed to daily overdose, prolonged use, and poor-quality extract batches.
- Improving kava quality control and patient adherence to recommendations are crucial.
- Avoiding comedication can significantly mitigate the risk of kava-induced liver injury, making it largely preventable.
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