Kava Risks and Benefits for Anxiety and Insomnia

Efficacy and Safety Concerns

The U.S. Food and Drug Administration recommends against using kava for anxiety or insomnia due to its lack of proven efficacy and significant risk of acute fatal liver toxicity 1, 2, 3
Studies show no benefit of using kava to treat chronic insomnia disorder compared with placebo 1, 2, 3

The American College of Surgeons and anesthesiologists should be aware that kava should be held for at least 2 weeks before surgery due to its potential for central nervous system depression and inhibition of cyclooxygenase 4, 5
The National Kidney Foundation notes that kava can cause decreased blood flow to the kidneys potentially via inhibition of cyclooxygenase and significant inhibition of multiple cytochrome P450 enzymes (CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP4A9/11) leading to drug interactions 6

The American Psychological Association recommends first-line treatments for anxiety should include evidence-based psychotherapy (such as cognitive behavioral therapy) and/or FDA-approved medications with established safety profiles 1
The American Academy of Sleep Medicine strongly recommends Cognitive Behavioral Therapy for Insomnia (CBT-I) as first-line treatment for insomnia 1, 2, 3
The U.S. Food and Drug Administration warns that kava has a "strong against" recommendation for insomnia treatment in clinical practice guidelines 1, 2, 3

Patients taking medications metabolized by cytochrome P450 enzymes should be warned about potential interactions by their healthcare provider 6
The American Society of Anesthesiologists recommends that patients undergoing surgery should discontinue kava at least 2 weeks prior to the procedure 4, 5