What is the dermatologic preoperative evaluation and management of kava?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Kava has gained widespread popularity as an anxiolytic and a sedative. [21] The results from clinical trials suggest that kava has a therapeutic potential in the symptomatic treatment of anxiety. The kavalactones appear to be the source of the pharmacologic activity of kava.

Due to its psychomotor effects, kava was one of the first herbal medications expected to interact with anesthetics. The kavalactones have dose-dependent effects on the CNS, including antiepileptic, neuroprotective, and local anesthetic properties. Kava may act as a sedative-hypnotic by potentiating gamma-aminobutyric acid (GABA) inhibitory neurotransmission. This effect may explain the mechanism underlying the report of a case of coma attributed to an alprazolam-kava interaction. With heavy use, kava produces a condition called kava dermopathy, which is characterized by reversible, scaly, cutaneous eruptions.

Research findings show that kava is potentially associated with cardiovascular complications. Kava may inhibit sodium and calcium channels, thereby decreasing systemic vascular resistance and secondarily decreasing blood pressure. Kava also inhibits cyclooxygenase, which may interfere with platelet aggregation and renal blood flow.

Peak kava plasma levels occur 1.8 hours after an oral dose, and the elimination half-life of kavalactones is 9 hours. Unchanged kavalactones and their metabolites are eliminated through urine and feces. The pharmacokinetic data and the possibility for the potentiation of the sedative effects of anesthetics suggest that patients taking kava should discontinue its use at least 24 hours prior to surgery.


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