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Kava hepatotoxicity: pathogenetic aspects and prospective considerations.
Liver Int. 2010 Oct; 30(9):1270-9.LI

Abstract

Kava hepatotoxicity is a well-defined herb-induced liver injury, caused by the use of commercial anxyolytic ethanolic and acetonic kava extracts, and of traditional recreational aqueous kava extracts. The aim of this review is to elucidate possible pathogenetic factors for the development of kava-induced liver injury, considering also confounding variables. In patients with liver disease in a causal relation to kava ± comedication, confounding factors include non-adherence to therapy recommendations and comedication consisting of synthetic and herbal drugs and dietary supplements including herbal ones and herbs-kava mixtures. Various possible pathogenetic factors have to be discussed and comprise metabolic interactions with exogenous compounds at the hepatic microsomal cytochrome P450 level; genetic enzyme deficiencies; toxic constituents and metabolites derived from the kava extract including impurities and adulterations; cyclooxygenase inhibition; P-glycoprotein alterations; hepatic glutathione depletion; solvents and solubilizers of the extracts; and kava raw material of poor quality. In particular, inappropriate kava plant parts and unsuitable kava cultivars may have been used sometimes for manufacturing the kava extracts instead of the rhizome of a noble cultivar of the kava plant (Piper methysticum G. Forster). In conclusion, kava hepatotoxicity occurred independently of the extraction medium used for the kava extracts and may primarily be attributed to daily overdose, prolonged treatment and to a few kava extract batches of poor quality; by improving kava quality and adherence to therapy recommendation under avoidance of comedication, liver injury by kava should be a preventable disease, at least to a major extent.

Authors+Show Affiliations

Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Johann Wolfgang Goethe-University, Frankfurt/Main, Hanau, Germany. rolf.teschke@gmx.de

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20630022

Citation

Teschke, Rolf. "Kava Hepatotoxicity: Pathogenetic Aspects and Prospective Considerations." Liver International : Official Journal of the International Association for the Study of the Liver, vol. 30, no. 9, 2010, pp. 1270-9.
Teschke R. Kava hepatotoxicity: pathogenetic aspects and prospective considerations. Liver Int. 2010;30(9):1270-9.
Teschke, R. (2010). Kava hepatotoxicity: pathogenetic aspects and prospective considerations. Liver International : Official Journal of the International Association for the Study of the Liver, 30(9), 1270-9. https://doi.org/10.1111/j.1478-3231.2010.02308.x
Teschke R. Kava Hepatotoxicity: Pathogenetic Aspects and Prospective Considerations. Liver Int. 2010;30(9):1270-9. PubMed PMID: 20630022.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Kava hepatotoxicity: pathogenetic aspects and prospective considerations. A1 - Teschke,Rolf, PY - 2010/7/16/entrez PY - 2010/7/16/pubmed PY - 2011/2/18/medline SP - 1270 EP - 9 JF - Liver international : official journal of the International Association for the Study of the Liver JO - Liver Int VL - 30 IS - 9 N2 - Kava hepatotoxicity is a well-defined herb-induced liver injury, caused by the use of commercial anxyolytic ethanolic and acetonic kava extracts, and of traditional recreational aqueous kava extracts. The aim of this review is to elucidate possible pathogenetic factors for the development of kava-induced liver injury, considering also confounding variables. In patients with liver disease in a causal relation to kava ± comedication, confounding factors include non-adherence to therapy recommendations and comedication consisting of synthetic and herbal drugs and dietary supplements including herbal ones and herbs-kava mixtures. Various possible pathogenetic factors have to be discussed and comprise metabolic interactions with exogenous compounds at the hepatic microsomal cytochrome P450 level; genetic enzyme deficiencies; toxic constituents and metabolites derived from the kava extract including impurities and adulterations; cyclooxygenase inhibition; P-glycoprotein alterations; hepatic glutathione depletion; solvents and solubilizers of the extracts; and kava raw material of poor quality. In particular, inappropriate kava plant parts and unsuitable kava cultivars may have been used sometimes for manufacturing the kava extracts instead of the rhizome of a noble cultivar of the kava plant (Piper methysticum G. Forster). In conclusion, kava hepatotoxicity occurred independently of the extraction medium used for the kava extracts and may primarily be attributed to daily overdose, prolonged treatment and to a few kava extract batches of poor quality; by improving kava quality and adherence to therapy recommendation under avoidance of comedication, liver injury by kava should be a preventable disease, at least to a major extent. SN - 1478-3231 UR - https://www.unboundmedicine.com/medline/citation/20630022/Kava_hepatotoxicity:_pathogenetic_aspects_and_prospective_considerations_ L2 - https://doi.org/10.1111/j.1478-3231.2010.02308.x DB - PRIME DP - Unbound Medicine ER -