Contraindications

Brief & Concise

Although Kava is considered safe when used properly, there are certain situations in which its use is not recommended or contraindicated:

Important Overview

Although Kava is considered safe when used properly, there are certain situations in which its use is not recommended or contraindicated:

Absolutely contraindicated:

●Liver diseases
●Pregnancy & lactation
●Children under 18 years

Relative Contraindications:

●Parkinson's disease
●Severe depression
●Before planned surgeries

Absolute Contraindications

Kava should under no circumstances be used in the following conditions. The risks clearly outweigh any potential benefits.

Liver Diseases

Strictly contraindicated

Individuals with existing liver diseases should completely avoid Kava:

•Hepatitis (A, B, C): Active or chronic liver inflammation
•Liver cirrhosis: Regardless of the stage
•Fatty liver: Alcoholic and non-alcoholic fatty liver disease
•Elevated liver values: Unexplained increase in ALT, AST, GGT
•Previous liver damage: Even if currently normalized

Reason: With liver disease, kavalactone metabolism may be altered. Direct clinical safety data in affected people are lacking; certain metabolite accumulation cannot be assumed.

Pregnancy & Lactation

Avoid as a precaution

Kava should not be used during pregnancy and lactation:

•No safety data: There are no controlled studies on safety during pregnancy
•Placental permeability: No transfer studies have established whether or to what extent kavalactones reach the placenta.
•Breast milk: No transfer studies have established whether or to what extent kavalactones enter breast milk.
•Experimental evidence: Experimental observations do not establish a clinically relevant effect on the uterus during pregnancy.

Precaution: Because safety and transfer data are lacking, kava should be avoided during pregnancy and breastfeeding.

Children & Adolescents

Not recommended under 18 years

Kava should not be used by children and adolescents:

•Development: Effects on brain development not studied
•Metabolism: Children metabolize substances differently than adults
•No studies: No clinical data for this age group

Relative Contraindications

In the following conditions, particular caution is advised. Use may be possible under certain circumstances but should only be done after careful consideration and ideally after consulting a physician.

Parkinson's Disease

Not recommended

Because of individual case reports, people with Parkinson's disease or levodopa therapy should not use kava without medical review:

•Evidence base: The evidence is limited mainly to individual case reports, not controlled studies.
•Levodopa therapy: A 1995 report described more frequent and longer off periods during levodopa/benserazide treatment.
•Precaution: The temporal association does not establish frequency or mechanism, but it warrants medical review before use.

Case report: Schelosky et al. (1995) described a 76-year-old patient taking levodopa/benserazide who developed more frequent and longer off periods; her baseline pattern returned after kava was stopped. Meseguer et al. (2002) reported new severe parkinsonism in a 45-year-old woman; this was a different case. Case reports do not establish frequency or causality.

Severe Depression

Caution advised

Caution is warranted in cases of severe depression:

•CNS depression: Kava may enhance lethargy
•Medication interaction: Interactions with antidepressants possible
•Self-medication: May delay professional treatment

Note: In cases of mild to moderate anxiety, Kava may be helpful, but in severe depression, professional treatment should take precedence.

Before Planned Surgeries

Discontinue 2 weeks prior

Kava should be discontinued before planned surgeries:

•Anesthesia interaction: May enhance the effects of anesthetics
•Bleeding risk: Possible interaction with anticoagulant medications
•Liver function: Important for the metabolism of anesthetics

Recommendation: Discontinue Kava at least 2 weeks before a planned surgery and inform the anesthetist about prior use.

Driving & Operating Machinery

Impaired driving ability

Kava may impair reaction ability:

•Sedation: Fatigue and slowed reactions possible
•Dose-dependent: Higher doses impair more significantly
•Individual differences: Sensitivity varies widely

Note: After kava, do not drive, operate machinery or perform safety-critical activities until the effects have fully worn off. Familiarity with your own response does not establish fitness to drive.

Particular Caution

In certain groups of people, increased attention is required, even if there is no strict contraindication.

Genetic factors and idiosyncratic reactions

Possible individual susceptibility

Multiple hepatic enzymes and metabolic pathways are involved in kavalactone metabolism; the available evidence does not support reducing this process to a single enzyme.

•Multiple metabolic pathways: The contribution of individual hepatic enzymes may vary with the compound, dose and individual characteristics.
•Possible individual susceptibility: Genetic polymorphisms are only a possible, unconfirmed explanation for some idiosyncratic cases; no reliable quantitative risk attribution can be made.

Recommendation: Genetic polymorphisms are only a possible, unconfirmed explanation for some idiosyncratic cases; no reliable quantitative risk attribution can be made.

Older Adults

Special caution

Particular caution is advised in older adults:

•Reduced liver function: Slower metabolism with age
•Polypharmacy: Higher risk of interactions
•Fall risk: Sedation may increase the risk of falls

Recommendation: Data in older adults are limited; a blanket half-dose rule is not supported. The product, medicines, liver function and fall risk should be reviewed by a doctor or pharmacist before use.

Decision Aid: Is Kava Suitable for Me?

Self-Check Before Kava Consumption

❌ Kava is NOT suitable if you:

• Have or had a liver disease
• Are pregnant or breastfeeding
• Are under 18 years old
• Drink alcohol regularly
• Take benzodiazepines or antipsychotics
• Take anticoagulants (blood thinners)

⚠️ Talk to your doctor if you:

• Have Parkinson's disease
• Suffer from severe depression
• Take medications regularly
• Have a surgery planned
• Are over 65 years old

✓ Kava may be suitable if you:

• Are healthy and have no liver problems
• Do not take any of the medications listed above
• Drink little or only occasionally
• Are an adult (over 18 years)
• Are not pregnant or breastfeeding

General Recommendation

In case of doubt, consult a doctor or pharmacist before consuming Kava, especially if you regularly take medications or have health limitations.

Warning Signs: When You Should Stop Immediately

Stop consumption immediately and consult a doctor if you experience:

•Yellowing of skin or eyes (jaundice)
•Dark urine (beer-colored)
•Pale stool (discolored)

•Unusual fatigue or weakness
•Nausea or loss of appetite
•Pain in the upper right abdomen

These symptoms may indicate liver problems and require immediate medical evaluation.

Continue in the Safety Chapter

Overview

Back to the safety overview

Liver Safety

Hepatotoxicity & the ban of 2002

Interactions

Medications & CYP450 interactions

Based on studies by

Prof. Oliver Grundmann

ORCID

University of Florida College of Pharmacy

View profile →

With contributions from

Jerome Sarris

This wiki is a curated resource that synthesizes research from peer-reviewed studies and expert researchers. It is not written by the researchers listed above, but rather based on their published work.

Scientific Sources

The information on this page is based on the following scientific studies and publications:

Kava: From Ethnology to Pharmacology

Yadhu N. Singh (Editor) (2004) – CRC Press

View study

In Vitro Toxicity of Kava Alkaloid, Pipermethystine, in HepG2 Cells Compared to Kavalactones

Nerurkar P.V., Dragull K., Tang C.S. (2004) – Toxicological Sciences