Kraft, M. Spahn, T. W. Menzel, J. Senninger, N. Dietl, K. H. Herbst, H. Domschke, W. Lerch, M. M.
Institution
Medizinische Klinik und Poliklinik B, Universitatsklinikum Munster,
Albert-Schweitzer-Strasse 33, 48129 Munster, Germany.
Title
Fulminant liver failure after administration of the herbal antidepressant
Kava-Kava. [German]
Original Title
Fulminantes Leberversagen nach Einnahme des pflanzlichen antidepressivums
Kava-Kava
Source
Deutsche Medizinische Wochenschrift. 2001. 126: 36, 970-972. 16 ref.
Abstract
History and clinical findings: A 60 year-old woman was admitted to hospital because of jaundice, fatigue, weight loss over several months and icteric skin. Because of progressive liver failure, concomitant renal failure and progressive encephalopathy, she was transferred to an intensive care unit. Investigations: Biochemical tests revealed acute liver failure with high levels of total and conjugated bilirubin (30 mg/dl) as well as aspartate aminotransferase (921 IU/litre) and alanine aminotransferase (1350 IU/litre) concentrations. Prothrombin time was less than 10%. Serological tests could rule out viral hepatitis, metabolic or autoimmune causes of liver failure. On abdominal computed tomography and ultrasonography no pathological changes were detected. Above all portal vein thrombosis, ascites, focal lesions of the liver and extrahepatic cholestasis could be excluded. Liver histology showed extensive hepatocellular necrosis with intrahepatic cholestasis. Treatment and clinical course: The patient's physical condition deteriorated. She had to be intubated because of respiratory insufficiency and encephalopathy stage IV. Because of progressive liver failure under conservative treatment, the patient received an orthotopic liver transplant 11 days after admission. Conclusions: The exclusion of other causes and the histological diagnosis made Kava-Kava (Piper methysticum root extract) the most likely cause of acute liver failure. This is the 18th case of Kava-Kava induced liver failure reported to the European regulatory authorities.
Perhaps a more reasonable approach is shown in this article
web page
A systematic review of the safety of kava extract in the treatment of anxiety.
………. Data from short-term post-marketing surveillance studies and clinical trials suggest that adverse events are, in general, rare, mild and reversible. However, published case reports indicate that serious adverse events are possible including dermatological reactions, neurological complications and, of greatest concern, liver damage.
……….It is concluded that when taken as a short-term monotherapy at recommended doses, kava extracts appear to be well tolerated by most users.
I’m surprised there are not more articles available. It certainly seems like a knee jerk reaction, but “overlooked” hepatotoxins do tend receive quick attention, especially if they are widely used. Still, can’t deny that for some people even non-chronic use could be detrimental. Personally, I’m not surprised its bad shit…certainly tastes like it.
What would be more sensible would be to investigate what levels of kava present a danger. It could well turn out that low dose preparations are OK, but unless someone does the research we will probably never know for sure. It’s all about dose and predisposition isn’t it? And there’s no mention of what dose of Kava was involved in any of the above cases.
As for panadol, it’s amazing its so freely available, with so little warning given. Perhaps we need an active “Liver Society” like the Heart groups. If something is bad for your heart you certainly hear about it. I guess a list for things bad for your liver would be long, including almost everything