Assessment Of The Risk Of Hepatotoxicity With Kava Products

There has been international concern over the association of kava products and serious hepatotoxicity. Regulatory action banning these products in Europe has been controversial. The objective of this report is to investigate the possibility of hepatotoxicity with kava. It contains a description of kava and provides safety information as well as information on regulatory issues, conclusions and recommendations by the Committee appointed to handle this enquiry.

This review critically analyzes the clinical data of patients with suspected kava hepatotoxicity and suggests recommendations for minimizing risk. Kava is a plant (Piper methysticum) of the pepper family Piperaceae, and its rhizome is used for traditional aqueous extracts in the South Pacific Islands and for commercial ethanolic and acetonic medicinal products as anxiolytic herbs in Western countries. A regulatory ban for ethanolic and acetonic kava extracts was issued in 2002 for Germany on the basis of reports connecting liver disease with the use of kava, but the regulatory causality assessment was a matter of international discussions. Based on one positive reexposure test with the kava drug, it was indeed confirmed that kava is potentially hepatotoxic. In subsequent studies using a structured, quantitative and hepatotoxicity specific causality assessment method in 14 patients with liver disease described worldwide, causality for kava ± co-medicated drugs and dietary supplements including herbal ones was highly probable (n = 1), probable (n = 4) or possible (n = 9) regarding aqueous extracts (n = 3), ethanolic extracts (n = 5), acetonic extracts (n = 4), and mixtures containing kava (n = 2). Risk factors included overdose, prolonged treatment, and comedication with synthetic drugs and dietary supplements comprizing herbal ones in most of the 14 patients. Hepatotoxicity occurred independently of the used solvent, suggesting poor kava raw material quality as additional causative factor. In conclusion, in a few individuals kava may be hepatotoxic due to overdose, prolonged treatment, comedication, and probably triggered by an unacceptable quality of the kava raw material; standardization is now required, minimizing thereby hepatotoxic risks.

Drug-Induced Liver Injury, Volume 85, the newest volume in the Advances in Pharmacology series, presents a variety of chapters from the best authors in the field. Chapters in this new release include Cell death mechanisms in DILI, Mitochondria in DILI, Primary hepatocytes and their cultures for the testing of drug-induced liver injury, MetaHeps an alternate approach to identify IDILI, Autophagy and DILI, Biomarkers and DILI, Regeneration and DILI, Drug-induced liver injury in obesity and nonalcoholic fatty liver disease, Mechanisms of Idiosyncratic Drug-Induced Liver Injury, the Evaluation and Treatment of Acetaminophen Toxicity, and much more. Includes the authority and expertise of leading contributors in pharmacology Presents the latest release in the Advances in Pharmacology series

Featuring more than 4100 references, Drug-Induced Liver Disease will be an invaluable reference for gastroenterologists, hepatologists, family physicians, internists, pathologists, pharmacists, pharmacologists, and clinical toxicologists, and graduate and medical school students in these disciplines.

Written by the foremost authority in the field, this volume is a comprehensive review of the multifaceted phenomenon of hepatotoxicity. Dr. Zimmerman examines the interface between chemicals and the liver; the latest research in experimental hepatotoxicology; the hepatotoxic risks of household, industrial, and environmental chemicals; and the adverse effects of drugs on the liver. This thoroughly revised, updated Second Edition features a greatly expanded section on the wide variety of drugs that can cause liver injury. For quick reference, an appendix lists these medications and their associated hepatic injuries. Also included are in-depth discussions of drug metabolism and factors affecting susceptibility to liver injury.

This book presents the current clinical evidence on the efficacy of herbal and nutritional treatments for anxiety that is experienced in association with psychiatric disorders, and explains how health professionals can apply this knowledge to the benefit of patients presenting with a wide range of symptoms, including comorbid mood disorders. All chapters are written by world-leading researchers who draw on the findings of human clinical trials to provide uncompromising assessments of individual treatments, including herbal anxiolytics with sedative actions, adaptogens, cognitive anxiolytics, and nutraceuticals. Traditional treatments requiring further study – including the plant-based psychotropic Ayahuasca and other phytotherapies of potential value in the treatment of anxiety – are also reviewed. In the closing chapters, a series of helpful case studies are provided by mental health clinicians in order to illustrate how herbal and nutritional treatments can best be integrated into an overall treatment plan for individuals with a range of comorbid diagnoses. Mental health professionals, researchers, and general readers will find that the book provides an excellent review of current scientific knowledge gained from the study of herbal and nutritional treatments, together with important clinical recommendations for their use in patients experiencing clinically significant levels of anxiety.

Liver disease in children is increasing in prevalence, placing a huge burden on healthcare systems and often requiring long-term management. Offering an integrative approach to the science and clinical practice of pediatric hepatology, this is the definitive reference text for improved diagnosis and treatment strategies. In the new edition of this authoritative text, chapters have been thoroughly revised in line with major advances in the field, such as recognizing the increased frequency of fatty liver disease, and how genetic testing has the potential to establish earlier diagnoses for a variety of diseases. Disorders covered include cholestasis, metabolic disorders and hepatitis, with their presentation across the spectrum of infancy, childhood and adolescence discussed. The indications and surgical aspects of liver transplant are explained and post-transplant care is described in detail. This is a valuable resource for pediatricians, hepatologists, gastroenterologists and all clinicians involved in the care of children with liver diseases.

This volume provides reviews and details of the quality, safety and efficacy for some of the top-selling botanicals worldwide, including black cohosh, chamomile, comfrey, echinacea, garlic, ginkgo, ginseng, kava, milk thistle, St John's wort and valerian. The work was written based on a systematic review of the scientific literature from 1975-2000.;Each review includes a brief introduction, a section on quality including a definition of the crude drug, geographical distribution, and a listing of the major chemical constituents. The safety and efficacy sections summarize the medical uses, pharmacology, contraindications, warnings, precautions, adverse reactions, dose and dosage forms. The safety and efficacy sections were written for a busy health-care professional, and should enable one to ascertain which clinical uses are supported by clinical data, without having to read through all the pharmacology. Each chapter is fully referenced, enabling the reader to access further information when necessary.

This volume assists practicing mental health professionals in expanding their knowledge about nutritional and herbal interventions that can be attempted as alternatives to prescription medications. Designed to provide guidance for non-medical caregivers treating children and adolescents who present with emotional and/or behavioral difficulties such as such as depression, anxiety, ADHD, sleep difficulties, impulsivity, distractibility, and other psychological and psychiatric disorders, the volume provides a comprehensive discussion of naturopathic solutions based on existing research. In areas where research is not extensive, conclusions are provided about potentially beneficial effects based on the specific pharmacologic action of the compounds. Dosage for specific age groups, schedules of administration, dietary considerations (i.e., whether or not to take the supplement with food), monitoring for response and adverse effects, signs of dangerous reactions, and the need to control interactions with other compounds (i.e., prescription medications) are thoroughly reviewed with regard to each supplement discussed in the book. Reviews specific psychological disorders (i.e. ADHD, depression, mania, anxiety, sleep difficulties, tic behaviors and autism) and the available data about their treatment with the use of nutritional and herbal supplements Provides rationale for the use of every specific compound with detailed recommendations tailored for each age group with regard to the dosage, frequency of administration, possible dangers and monitoring for side effects Discusses claims of efficacy used to market various products and ground those claims within fully vetted scientific research Discusses neurobiology, pharmacodynamics and pharmokinetics in detailed but accessible language *Non-medical clinicians with limited knowledge of medicine and pharmacology come away with understanding of key issues involved in Fully covers assessment, diagnosis & treatment of children and adolescents, focusing on evidence-based practices *Consolidates broadly distributed literature into single source and specifically relates evidence-based tools to practical treatment, saving clinicians time in obtaining and translating information and improving the level of care they can provide Detailed how-to explanation of practical evidence-based treatment techniques *Gives reader firm grasp of how to more effectively treat patients Material related to diversity (including race, ethnicity, gender and social class) integrated into each chapter *Prepares readers for treating the wide range of youth they will encounter in practice

Winner of American Botanical Council's 2005 James A. Duke Botanical Literature Award, the Essential Guide to Herbal Safety offers a balanced and objective perspective on the principles of herbal medicine safety as well as the complex challenges relating to self-prescribed or professionally prescribed herbal medications and supplements. With contributions from leading international practitioners and authorities, it contains comprehensive reviews, in monograph format, of the published safety data for 125 common herbs. You'll also find coverage of issues of quality, interactions, adverse reactions, toxicity, allergy, contact sensitivity, and idiosyncratic reactions. Provides the most current information on safety issues in herbal medicine. Presents authoritative and credible safety information from two experienced herbal practitioners. Combines theoretical chapters with 125 well-researched monographs, making it the most thorough and comprehensive text on the market for herbal safety in practice. Provides clear information using the most current evidence-based reviews, covering factors that influence herb safety, including the negative placebo effects (nocebo), various types of unpredictable effects, the basis for interactions between herbs and drugs, and quality issues. Uses an established grading system for assessing safety in pregnancy and lactation that is realistic and appropriate to herb use. Thoroughly critiques the dominant misinformation in the media and medical journals on herb safety issues. Contains 83 documented case studies on hepatoxicity and the effects in relation to kava. Kava safety is a hot topic. Includes two useful appendices detailing herbal references for pregnancy and lactation considerations.