内容
简洁明了
Kava can interact with medicines and other central nervous system depressants. Laboratory findings show several possible CYP inhibitions, but small human studies do not confirm one uniform pattern across all enzymes. Alcohol and sedatives in particular should not be self-combined; regular medication warrants individual review.
- ●酒精 – Additive drowsiness and impaired coordination are possible; concurrent use is not recommended
- ●苯二氮䓬类药物 – Possible additive CNS depression; combine only after professional review
- ●抗精神病药物 – Sedation and pharmacokinetic interactions are possible; direct clinical data are limited
- ●抗凝血药物 – Controlled interaction data are lacking; the narrow therapeutic window requires medical review
细胞色素P450系统
细胞色素P450系统（CYP450）是一组在肝脏中负责大多数药物代谢的酶。如果某种物质抑制这些酶，其他物质的代谢速度会减慢——其作用和副作用可能因此增强。
这为什么重要？
Many medicines are metabolised by CYP enzymes. An in-vitro finding does not automatically mean clinically relevant inhibition in humans. Preparation, dose, duration and the medicine's therapeutic window determine practical relevance.
哪些酶被抑制？
Mathews et al. (2002) tested kava extract and individual kavalactones in human liver microsomes and found inhibition of several CYP enzymes. These are in-vitro findings, not clinical inhibition ratings in humans:
| 酶 | 抑制强度 | 重要底物（示例） |
|---|---|---|
| CYP1A2 | In-vitro finding | 咖啡因，茶碱，氯氮平，奥氮平 |
| CYP2C9 | In-vitro finding | 华法林，苯妥英，非甾体抗炎药（布洛芬） |
| CYP2C19 | In-vitro finding | 奥美拉唑，地西泮，氯吡格雷 |
| CYP2D6 | In-vitro finding | 可待因，曲马多，许多抗抑郁药 |
| CYP3A4 | In-vitro finding | 苯二氮䓬类药物，他汀类药物，许多抗生素 |
临床意义
Russmann et al. (2005) reported reduced CYP1A2 activity in chronic users of traditional aqueous kava. Gurley et al. (2005; 12 healthy volunteers, 28 days, 138 mg kavalactones/day), by contrast, found reduced CYP2E1 but no significant change in CYP1A2, CYP2D6 or CYP3A4/5. The human findings are small and preparation- and consumption-dependent, so they cannot predict every medicine interaction.
高风险组合
The following combinations should be avoided or medically reviewed in advance. Reasons differ: some involve additive CNS effects or case reports, while others have only mechanistic signals and no controlled combination trials.
⚠ 酒精
Risiko: AVOID
Concurrent use of kava and alcohol is not recommended:
- 1.Additive CNS effects: Drowsiness, slower reactions and impaired coordination may increase.
- 2.Liver risk not quantified: A combined liver risk has not been quantified reliably; the combination is avoided because of this uncertainty.
- 3.Unpredictable intensity: Product, amount, drinking pattern and individual sensitivity make effects difficult to predict.
Do not use kava and alcohol together. The main practical reason is possible additive impairment of attention, reaction and coordination; the size of any additional liver risk is not reliably established.
⚠ 苯二氮䓬类药物和安眠药
Risiko: PROFESSIONAL REVIEW
Do not combine benzodiazepines or Z-drugs with kava without medical review:
- •Additive sedation: Drowsiness and psychomotor impairment may increase.
- •CNS depression: Clinically relevant potentiation is possible; controlled combination trials are lacking.
- •Interpret CYP findings: CYP3A4 inhibition was observed in vitro but not consistently confirmed in small human studies.
病例报告： Almeida & Grimsley (1996) described a semicomatose state in a 54-year-old man after reported kava and alprazolam use. A single case report is a warning signal but does not establish mechanism or frequency.
⚠ 抗精神病药物
Risiko: PROFESSIONAL REVIEW
Individual medical review is appropriate before kava use with antipsychotics:
- •Sedation: Additive drowsiness or psychomotor impairment is possible.
- •Case reports: Individual reports describe movement disorders; frequency and causality are unclear.
- •CYP findings: Laboratory inhibition does not reliably predict the level of a specific medicine.
⚠ 抗凝血药物（血液稀释剂）
Risiko: PROFESSIONAL REVIEW
Warfarin, phenprocoumon and other anticoagulants require professional review because of their narrow therapeutic window:
- •Mechanistic signal: CYP2C9 inhibition was observed in vitro; a clinical kava-warfarin interaction has not been established in controlled studies.
- •Monitor INR: Changes in co-used products should be coordinated with the treating clinician.
- •Bleeding risk: The baseline risk of anticoagulation makes self-testing inappropriate.
Use kava with anticoagulation only after individual medical review.
中等风险组合
以下组合需要谨慎，且仅在医生咨询后进行。可能需要调整剂量。
抗抑郁药
Risiko: PROFESSIONAL REVIEW
- • Pharmacokinetic interactions may occur depending on the product but are not clinically established as a class
- • Serotonin syndrome from kava is not established as a typical clinical effect
- • Additive drowsiness or dizziness are possible
- • Direct clinical combination data are limited
- • Review co-medication individually rather than inferring from in-vitro CYP data
- • MAO-B effects of individual kavalactones have been studied preclinically
- • Pawa et al. (2026) found MAO-A inhibition by flavokawain A in an in-vitro enzyme assay; humans and combination with MAO inhibitors were not studied
- • Do not self-combine with MAO inhibitors because medicine interactions can be serious
- • Obtain medical review before use
抗癫痫药
Risiko: PROFESSIONAL REVIEW
苯妥英，卡马西平，丙戊酸和其他抗癫痫药：
- •Pharmacokinetics: Altered levels are possible but cannot be predicted reliably for individual combinations.
- •CNS effects: Additive drowsiness or coordination problems are possible.
- •Seizure control: Changes in co-used products belong under professional supervision.
在癫痫患者中，Kava仅应在医生监督下使用。
帕金森药物
Risiko: PROFESSIONAL REVIEW
左旋多巴和多巴胺激动剂：
- •Mechanism unclear: Blanket clinical dopamine antagonism by kava has not been established.
- •Case reports: Individual reports describe worsening Parkinson symptoms; medical review is therefore needed.
With Parkinson's disease or related medication, use kava only after medical review.
肝毒性药物
Risiko: 中等
已知具有肝毒性潜力的药物：
- •对乙酰氨基酚: 在较高剂量时特别有问题
- •他汀类药物: 阿托伐他汀，辛伐他汀等（CYP3A4底物）
- •甲氨蝶呤: 具有肝毒性的免疫抑制剂
- •异烟肼: 抗结核药物
Additional liver risk is plausible but not quantified for every combination. Potentially hepatotoxic medication requires individual medical review.
相互作用概览表
| 物质类别 | 示例 | 风险 | 机制 |
|---|---|---|---|
| 酒精 | 乙醇 | AVOID | Possible additive sedation and impaired coordination; liver risk not quantified |
| 苯二氮䓬类药物 | 地西泮，劳拉西泮，阿普唑仑 | PROFESSIONAL REVIEW | Possible additive CNS depression; one case report, no controlled combination trials |
| 抗精神病药物 | 氟哌啶醇，奥氮平，氯氮平 | PROFESSIONAL REVIEW | Sedation or interactions possible; direct clinical data limited |
| 抗凝血药物 | 华法林，苯基丙酮 | PROFESSIONAL REVIEW | No controlled kava interaction established; narrow therapeutic window |
| SSRIs | 氟西汀，舍曲林，帕罗西汀 | PROFESSIONAL REVIEW | Possible sedation or pharmacokinetics; no established kava serotonin syndrome |
| 抗癫痫药 | 苯妥英，卡马西平 | PROFESSIONAL REVIEW | Possible additive CNS effects and unpredictable pharmacokinetics |
| 帕金森药物 | 左旋多巴，多巴胺激动剂 | PROFESSIONAL REVIEW | Case reports of symptom worsening; no blanket dopamine antagonism established |
| 他汀类药物 | 阿托伐他汀，辛伐他汀 | PROFESSIONAL REVIEW | Direct clinical interaction data are lacking; review liver and medication context |
| 阿片类药物 | 可待因，曲马多，吗啡 | AVOID / REVIEW | Possible additive CNS depression |
| 咖啡因 | 咖啡，能量饮料 | CAUTION | Human CYP1A2 findings are small and inconsistent |
实用建议
Kava消费前检查清单
- 1.检查药物清单
检查所有当前药物的相互作用
- 2.咨询医生
在定期服用药物的情况下，Kava消费前咨询医生
- 3.避免饮酒
Do not use kava and alcohol together. The main practical reason is possible additive impairment of attention, reaction and coordination; the size of any additional liver risk is not reliably established.
- 4.低剂量使用
Do not experiment with a self-selected lower kava dose while taking medicines; obtain professional review of the combination.
- 5.观察症状
注意异常疲劳，头晕或其他症状
继续阅读安全性章节
基于研究
包含来自
此wiki是一个精选资源，综合了同行评审研究和专家研究人员的研究。它不是由上面列出的研究人员撰写的，而是基于他们发表的工作。
科学来源
本页面的信息基于以下科学研究和出版物：
Cytochrome P450 2E1 (CYP2E1) Is the Principal Enzyme Responsible for Urethane Metabolism
Hoffler U., El-Masri H.A., Ghanayem B.I. (2003) – Journal of Pharmacology and Experimental Therapeutics
查看研究