kava and Acute-Disease

Topics: Acute Disease; Aftercare; Anti-Inflammatory Agents; Biopsy; Diagnosis, Differential; Erythema; Exanthema; Female; Humans; Kava; Plants, Medicinal; Prednisolone; Pruritus; Skin Diseases; Systemic Inflammatory Response Syndrome; Treatment Outcome; Urticaria; Young Adult

Botanical drugs are widely used and often contain highly active compounds. Kava root (Piper methysticum rhizoma), used frequently in Europe as a remedy against anxiety, contains kavapyrones with sedative effects. Seven case reports suggested the development of hepatitis after the intake of Kava.. We analyzed 29 novel cases of hepatitis along with Kava ingestion which occurred between 1990 and 2002 in addition to the seven already published case reports using a clinical diagnostic scale established for adverse hepatic drug reactions.. Hepatic necrosis or cholestatic hepatitis were noticed with both alcoholic and acetonic Kava extracts. The majority of the 29 patients and the additional seven published reports were women (27 females, nine males). Both the cumulative dose and the latency to when the hepatotoxic reaction emerged were highly variable. Nine patients developed fulminant liver failure, of which eight patients underwent liver transplantation. Three patients died, two following unsuccessful liver transplantation and one without. In all other patients, a complete recovery was noticed after the withdrawal of Kava. Pathophysiologically, both immunoallergic and idiosyncratic factors may be responsible.. The present report emphasizes the potentially severe hepatotoxicity of Kava which has recently led to the retraction of Kava-containing drugs by the pharmacovigilance authorities in Germany.

Topics: Acute Disease; Adult; Aged; Anti-Anxiety Agents; Chemical and Drug Induced Liver Injury; Female; Germany; Humans; Kava; Liver; Liver Failure; Male; Middle Aged; Product Surveillance, Postmarketing

Two unrelated women, aged 39 and 42 years, had been admitted (at different times) to hospital because of "recurrence of an aetiologically uncertain acute hepatitis". Both patients had a history of acute hepatitis with GPT concentration of 796 and 755 U/l, respectively. Each of them had experienced recurrences of hepatitis, each of them preceded by taking herbal remedies as alternative medication, containing kava or common (or lesser) celandine, respectively. In each patient physical examination had been unremarkable.. Maximal values of GPT in the two patients were 422 and 350 U/l, respectively. Viral, autoimmune and metabolic causes of the hepatitis were excluded. In each of them liver biopsy revealed the picture of acute necrotizing hepatitis.. As it was suspected that the hepatitis was medication-induced, the intake of the mentioned herbal preparations was stopped. The liver function tests quickly became normal.. In view of the rapid response to their withdrawal, a causal connection between intake of the herbal preparations and the recurrences of acute hepatitis is the most likely explanation in both cases.

Topics: Acute Disease; Adult; Alanine Transaminase; Anti-Anxiety Agents; Chemical and Drug Induced Liver Injury; Female; Humans; Kava; Necrosis; Papaver; Plant Extracts; Plants, Medicinal; Recurrence