Volgin A, Yang L, Amstislavskaya T, Demin K, Wang D, Yan D, et al. DARK classics in chemical neuroscience: kava. ACS Chem Neurosci. 2020. https://doi.org/10.1021/acschemneuro.9b00587.

Article  PubMed  Google Scholar 

Bian T, Corral P, Wang Y, Botello J, Kingston R, Daniels T, et al. Kava as a clinical nutrient: Promises and challenges. Nutrients. 2020;12. https://doi.org/10.3390/nu12103044.

WHO. Kava: a review of the safety of traditional and recreational beverage consumption. Food Agriculture Organ U Nation. 2016;1:1–35.

Google Scholar 

Aporosa AS, Atkins M, Brunton R. Kava drinking in traditional settings: Towards understanding effects on cognitive function. Hum Psychopharmacol. 2020;35:e2725. https://doi.org/10.1002/hup.2725.

Article  PubMed  Google Scholar 

Balick MJ, Lee R. Traditional use of sakau (kava) in Pohnpei: lessons for integrative medicine. Altern Ther Health Med. 2002;8:96–8.

PubMed  Google Scholar 

Clough AR, Bailie RS, Currie B. Liver function test abnormalities in users of aqueous kava extracts. J Toxicol Clin Toxicol. 2003;41:821–9. https://doi.org/10.1081/clt-120025347.

Article  PubMed  Google Scholar 

Mathews JD, Riley MD, Fejo L, Munoz E, Milns NR, Gardner ID, et al. Effects of the heavy usage of kava on physical health: summary of a pilot survey in an aboriginal community. Med J Aust. 1988;148:548–55. https://doi.org/10.5694/j.1326-5377.1988.tb93809.x.

Article  PubMed  CAS  Google Scholar 

Showman AF, Baker JD, Linares C, Naeole CK, Borris R, Johnston E, et al. Contemporary Pacific and Western perspectives on ‘awa (Piper methysticum) toxicology. Fitoterapia. 2015;100:56–67. https://doi.org/10.1016/j.fitote.2014.11.012.

Article  PubMed  Google Scholar 

Wheatley D. Kava and valerian in the treatment of stress-induced insomnia. Phytother Res. 2001;15:549–51. https://doi.org/10.1002/ptr.840.

Article  PubMed  CAS  Google Scholar 

Lehrl S. Clinical efficacy of kava extract WS 1490 in sleep disturbances associated with anxiety disorders. Results of a multicenter, randomized, placebo-controlled, double-blind clinical trial. J Affect Disord. 2004;78:101–10. https://doi.org/10.1016/s0165-0327(02)00238-0.

Article  PubMed  Google Scholar 

Kuchta K, Hladikova M, Thomsen M, Nahrstedt A, Schmidt M. Kava (Piper methysticum) extract for the treatment of nervous anxiety, tension and restlessness. Drug Res (Stuttg). 2021;71:83–93. https://doi.org/10.1055/a-1268-7135.

Article  PubMed  CAS  Google Scholar 

Finau SA, Stanhope JM, Prior IA. Kava, alcohol and tobacco consumption among Tongans with urbanization. Soc Sci Med. 1982;16:35–41. https://doi.org/10.1016/0277-9536(82)90421-x.

Article  PubMed  CAS  Google Scholar 

Munte TF, Heinze HJ, Matzke M, Steitz J. Effects of oxazepam and an extract of kava roots (Piper methysticum) on event-related potentials in a word recognition task. Neuropsychobiology. 1993;27:46–53. https://doi.org/10.1159/000118952.

Article  PubMed  CAS  Google Scholar 

Pollastri MP, Whitty A, Merrill JC, Tang X, Ashton TD, Amar S. Identification and characterization of kava-derived compounds mediating TNF-alpha suppression. Chem Biol Drug Des. 2009;74:121–8. https://doi.org/10.1111/j.1747-0285.2009.00838.x.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Pittler MH, Ernst E. Kava extract for treating anxiety. Cochrane Database Syst Rev. 2003;Cd003383. https://doi.org/10.1002/14651858.Cd003383.

Boerner RJ, Sommer H, Berger W, Kuhn U, Schmidt U, Mannel M. Kava-Kava extract LI 150 is as effective as Opipramol and Buspirone in Generalised Anxiety Disorder–an 8-week randomized, double-blind multi-centre clinical trial in 129 out-patients. Phytomedicine. 2003;10(Supp 4):38–49. https://doi.org/10.1078/1433-187x-00309.

Article  PubMed  Google Scholar 

Cagnacci A, Arangino S, Renzi A, Zanni AL, Malmusi S, Volpe A. Kava-Kava administration reduces anxiety in perimenopausal women. Maturitas. 2003;44:103–9. https://doi.org/10.1016/s0378-5122(02)00317-1.

Article  PubMed  Google Scholar 

Gastpar M, Klimm HD. Treatment of anxiety, tension and restlessness states with kava special extract WS 1490 in general practice: a randomized placebo-controlled double-blind multicenter trial. Phytomedicine. 2003;10:631–9. https://doi.org/10.1078/0944-7113-00369.

Article  PubMed  CAS  Google Scholar 

Sarris J, Kavanagh DJ, Byrne G, Bone KM, Adams J, Deed G. The Kava Anxiety Depression Spectrum Study (KADSS): a randomized, placebo-controlled crossover trial using an aqueous extract of Piper methysticum. Psychopharmacology (Berl). 2009;205:399–407. https://doi.org/10.1007/s00213-009-1549-9.

Article  PubMed  CAS  Google Scholar 

Jacobs BP, Bent S, Tice JA, Blackwell T, Cummings SR. An internet-based randomized, placebo-controlled trial of kava and valerian for anxiety and insomnia. Medicine. 2005;84:197–207. https://doi.org/10.1097/01.md.0000172299.72364.95.

Article  PubMed  Google Scholar 

Wheatley D. Stress-induced insomnia treated with kava and valerian: singly and in combination. Hum Psychopharmacol. 2001;16:353–6. https://doi.org/10.1002/hup.299.

Article  PubMed  Google Scholar 

Xing C, Malaty J, Malham MB, Nehme AMA, Freeman B, Huo Z, et al. Reducing tobacco-associated lung cancer risk: a study protocol for a randomized clinical trial of AB-free kava. Trials. 2023;24:36. https://doi.org/10.1186/s13063-023-07081-x.

Article  PubMed  PubMed Central  Google Scholar 

Hu Q, Tang Z, Lynch A, Freeman B, Fujioka N, Salloum RG, et al. One-week kava dietary supplementation increases both urinary N- and O-Glucuronides of NNAL, a lung carcinogen major metabolite, among smokers. Chem Res Toxicol. 2024;37:1515–23. https://doi.org/10.1021/acs.chemrestox.4c00109.

Article  PubMed  CAS  Google Scholar 

Freeman B, Mamallapalli J, Bian T, Ballas K, Lynch A, Scala A, et al. Opportunities and challenges of kava in lung cancer prevention. Int J Mol Sci. 2023;24. https://doi.org/10.3390/ijms24119539.

Wang Y, Narayanapillai S, Tessier K, Strayer L, Upadhyaya P, Hu Q, et al. The impact of one-week dietary supplementation with kava on biomarkers of tobacco use and nitrosamine-based carcinogenesis risk among active smokers. Cancer Prev Res. 2020;13:483–92. https://doi.org/10.1158/1940-6207.CAPR-19-0501.

Article  CAS  Google Scholar 

Xing C, Malaty J, Malham MB, Orlando FA, Lynch A, Huo Z, et al. The potential of AB-free kava in enabling tobacco cessation via management of abstinence-related stress and insomnia: study protocol for a randomized clinical trial. BMC Complement Med Ther. 2024;24:422. https://doi.org/10.1186/s12906-024-04722-9.

Article  PubMed  PubMed Central  Google Scholar 

Teschke R, Gaus W, Loew D. Kava extracts: safety and risks including rare hepatotoxicity. Phytomedicine. 2003;10:440–6. https://doi.org/10.1078/0944-7113-00314.

Article  PubMed  CAS  Google Scholar 

WHO Assessments of the risk of hepatotoxicity with kava products. WHO Document Production Service; 2007.

Google Scholar 

Teschke R, Schwarzenboeck A, Hennermann KH. Kava hepatotoxicity: a clinical survey and critical analysis of 26 suspected cases. Eur J Gastroenterol Hepatol. 2008;20:1182–93. https://doi.org/10.1097/MEG.0b013e3283036768.

Article  PubMed  Google Scholar 

Teschke R, Schulze J. Risk of kava hepatotoxicity and the FDA consumer advisory. JAMA. 2010;304:2174–5. https://doi.org/10.1001/jama.2010.1689.

Article  PubMed  CAS  Google Scholar 

Teschke R, Sarris J, Lebot V. Kava hepatotoxicity solution: A six-point plan for new kava standardization. Phytomedicine. 2011;18:96–103. https://doi.org/10.1016/j.phymed.2010.10.002.

Article  PubMed  CAS  Google Scholar 

Teschke R. Kava hepatotoxicity. A clinical review. Ann Hepatol. 2010;9:251–65. https://doi.org/10.1016/S1665-2681(19)31634-5.

Article  PubMed  Google Scholar 

Teschke R. Kava hepatotoxicity: pathogenetic aspects and prospective considerations. Liver Int. 2010;30:1270–9. https://doi.org/10.1111/j.1478-3231.2010.02308.x.

Article  PubMed