Kava

Treatment of anxiety, stress, nervousness

Treatment of insomnia

Treatment of muscular aches and pains

Traditionally used in the South Pacific during religious and cultural ceremonies to achieve relaxation and for medicinal purposes

No data exist to quantify risk of adverse effects

ASA recommends stopping herbal supplements as long as 2 wk prior to elective procedures.

Risk of hepatotoxicity, especially when combined with other hepatotoxic drugs

Oversedation when combined with ethanol or other sedative drugs

Potential to affect hemodynamic stability and coagulation

Oral administration: Peak effect 1.8 h, elimination half-life 9 h, metabolized in liver by cytochrome P450.

Effects on various ion channels leading to decreased excitability of CNS.

Enhanced binding and regulation of GABA receptors, leading to anxiolysis, sedation, muscle relaxation, and anticonvulsive effects

Inhibition of limbic system, leading to decreased emotional excitability and mood enhancement

Weak Na channel antagonism, leading to potential anticonvulsant effects

Inhibition of calcium channels, leading to inhibition of vascular smooth muscle

Reduced reuptake of dopamine and norepinephrine

Inhibition of COX, leading to antithrombotic, analgesic, and anti-inflammatory effects