Hepatitis induced by Kava (Piper methysticum rhizoma).
OBJECTIVE
Botanical drugs are widely used and often contain highly active compounds. Kava root (Piper methysticum rhizoma), used frequently in Europe as a remedy against anxiety, contains kavapyrones with sedative effects. Seven case reports suggested the development of hepatitis after the intake of Kava.


METHODS
We analyzed 29 novel cases of hepatitis along with Kava ingestion which occurred between 1990 and 2002 in addition to the seven already published case reports using a clinical diagnostic scale established for adverse hepatic drug reactions.


RESULTS
Hepatic necrosis or cholestatic hepatitis were noticed with both alcoholic and acetonic Kava extracts. The majority of the 29 patients and the additional seven published reports were women (27 females, nine males). Both the cumulative dose and the latency to when the hepatotoxic reaction emerged were highly variable. Nine patients developed fulminant liver failure, of which eight patients underwent liver transplantation. Three patients died, two following unsuccessful liver transplantation and one without. In all other patients, a complete recovery was noticed after the withdrawal of Kava. Pathophysiologically, both immunoallergic and idiosyncratic factors may be responsible.


CONCLUSIONS
The present report emphasizes the potentially severe hepatotoxicity of Kava which has recently led to the retraction of Kava-containing drugs by the pharmacovigilance authorities in Germany.
Stickel
Felix
F
Department of Medicine I, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany. felix.stickel@med1.imed.uni-erlangen.de
Baumüller
Hans-Martin
HM
Seitz
Karlheinz
K
Vasilakis
Dimitrios
D
Seitz
Gerhard
G
Seitz
Helmut K
HK
Schuppan
Detlef
D
D000208:Acute Disease; D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000473:pathology; D005260:Female; D005858:Germany; D006801:Humans; D020901:Kava / Q000009:adverse effects*; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000139:chemically induced / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011358:Product Surveillance, Postmarketing
D014151:Anti-Anxiety Agents