Primary Name: Kava Kava (Piper methysticum)
Other Names: Ava, Ava pepper shrub, awa, kawa, intoxicating pepper, sakau, tonga, and yagona.
Dosage: Anxiety disorders: 100 mg three times daily; nervousness or stress: 60 to 120 mg three times daily.
Indications/Homeopathic Use
- Analgesic
- Anticonvulsant
- Anxiety
- Benzodiazepine withdrawal
- Epilepsy
- Insomnia
- Nervousness
- Psychosis
- Sedative
Perioperative Concerns
Kava can disrupt dopamine's action and should therefore not be combined with levodopa (L-dopa, Sinemet) or other medications used to treat Parkinson’s disease. Additionally, kava should not be used alongside certain anesthetic medications, like metoclopramide, due to its interference with dopamine. It is also contraindicated during pregnancy because it can reduce uterine tone. The use of kava with intraoperative drugs such as barbiturates, sedatives like midazolam and diazepam, narcotics, anti-nausea medications, and inhalation anesthetic agents may lead to prolonged CNS depression after surgery.
Patients are advised to discontinue kava usage at least two weeks prior to surgery to mitigate risks of prolonged CNS depression and the anticoagulant effects of kava.
Additional Information
Kava Kava is most renowned for its calming effect, believed to be due to its action on the brain's limbic system, a critical area involved in emotional regulation and overseeing essential bodily functions. Furthermore, kava possesses an array of therapeutic properties, including anxiolytic, anticonvulsant, antispasmodic, anticoagulant, and analgesic effects, the latter through non-opiate pathways.
Sedation is the most frequently reported side effect of kava. Long-term use can result in decreased serum albumin and protein levels in the urine, as well as reduced bilirubin levels. Although rare, there have been instances where liver failure necessitated a transplant. Chronic heavy use can also produce kava dermopathy, a reversible scaly (ichthyosiform) skin eruption that resolves when kava is stopped.
| Herbal | Mechanism | Perioperative implication |
|---|---|---|
| Garlic | Inhibits platelet aggregation | Enhances warfarin, pentoxifylline, indomethacin, dipyridamole, aspirin and ibuprofen; bleeding and hypotension |
| Ginkgo | Reduces clot formation, erythrocyte aggregation and blood viscosity | Prolonged preoperative use significantly raises bleeding risk, especially when platelet inhibitors are given intraoperatively |
| Ginseng | In animal studies, inhibits platelet aggregation and may elevate PT or PTT; ginsenosides increase fibrinolytic activity | Increased bleeding risk and diminished anticoagulation efficacy of warfarin |
| Kava kava | Anticoagulant activity among its therapeutic effects | Contributes, with prolonged CNS depression, to the two-week preoperative hold |
