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of the catastrophic liver damage associated with its use in the cases noted by the FDA. Four
sources still recommend careful use of kava. Lake and Spiegel, Mischoulon and Rosenbaum, the
Natural Standard, and Weil counsel that kava should be avoided in individuals with a history of
liver disease or alcohol use, and in those who are taking concurrent medications with potential
liver toxicity. Mischoulon and Rosenbaum conclude: “Kava should be prescribed and used with
great caution.” Use of kava is not recommended to exceed three months.
More research pinpointing risk factors could modify these recommendations, since liver toxicity
appears to be extremely rare, and bad experience with other anxiolytics could prompt a trial of
kava if the risk factors appear to be low, with proper medical supervision. Pregnancy, lactation
or child use would appear not to impose a separate challenge.
CONCLUSION
Caution. The risk of liver damage is substantial and may be irreversible, even though it appears
to be rare.