Dear Kava Guru,
What can and can’t I combine Kava with?
Dan, Reno, NV
This is a question I get asked so often, and it’s a wonder at how much literature there is on the topic. Well, if you think about it, ‘Kava combinations’ is quite a broad topic, since the combinations of interest can range from herbal to pharmaceutical and everything in between! So, there’s a lot of information here – and I’ve done my best to break it down and pick out the most important Kava combinations from the masses of research that there are on various combinations with Kava and their interactions. If you don’t see your combinations of interest here – go ahead and summon my guru wisdom. How can you summon my wisdom? By simply asking!
Naturally, many people instinctively combine other medicinal herbs with kava kava, thinking something along the lines of “Hey it’s all natural – why not throw it all together and reap multiple benefits!” But, it’s important to realize that- as with Kava – many medicinal herbs have biochemical interactions with the body that could alter the functioning of enzymes, hormones, or other biochemical components of the body. For example, Kava inhibits the CYP 450 enzymatic pathway, and as a result any herbal treatment that is metabolized by these enzymes cannot be properly metabolized and there may be resultant health risks . It’s possible then that certain chemical reactions or states might not mix well with each other. As a result – it’s always wise to err on the side of caution and do a bit of research before combining Kava with other herbs or plants. So, to help you out I’ve put together some of my own research with regard to combining Kava and other popular herbal remedies.
Sedatives: (lavender, passionflower, valerian, chamomile, hops)
The general consensus within the field of herbal interactions is that you will experience a heightened sedative effect when combining any other herbal sedative with Kava; this is an effect that may or may not be desirable [1, 3, 6]. Since Kava is in some way also a sedative and acts on the same enzymatic pathways – the two naturally coincide. In terms of safety there isn’t really any information with regard to Kava and herbal mixture health concerns or precautions. But, nonetheless you should always research your combination of interest or ask a health practitioner.
Passiflora (Passionflower): One study directly monitored the effect of passionflower and Kava alone and in combination. The results indicated that there was a doubling effect, meaning that the combination of the two increased the effect of each individually by 50%. The study demonstrated that in terms of sedative effects, there was a 91.6% prolongation of sleep duration when the combination of kava kava and passionflower was administered .
Valerian: There was an extensive study conducted on the effects of Kava and Valerian independently and combined with each other. The results indicated heightened levels of stress reduction and anxiety alleviation in three categories: social, personal and life events. Also, there was a significant improvement with subjects experiencing insomnia – ie. insomnia was decreased. One of the most common effects indicated by the subjects who took the combination of Kava and Valerian was vivid dreaming .
Stimulants: (coffee, kola nut, máte, guaraná)
Unfortunately, there isn’t too much information available with regard to the safety of combining Kava with herbal stimulants or their interactions. But, generally speaking, it’s unwise to combine kava kava with any herbal stimulant, and probably any synthetic stimulant as well. Quite generally – it’s unwise and counterproductive to combine stimulants and sedatives, because of their counteractions on the same or relatively similar biochemical compounds . If you’re looking for something to calm you down, you take a sedative — you don’t want to then take a stimulant and undo what you’re trying to accomplish.
For example, coffee and Kava probably interfere with each other and their relative performance. It’s quite possible that Kava aggravates dopamine or dopamine receptors, meaning that it interferes with its release . If this is the case, then something like coffee – a natural substance that stimulates the release of dopamine  – will naturally compete with Kava because each is trying to do a different thing to your biochemical system.
Combination with Alcohol:
Ahhh, now to discuss the single most commonly searched Kava combination – alcohol and Kava. I won’t go into too much detail here, as I’ve unloaded much of my wisdom on another post with regard to combining alcohol and Kava; I’ve posted the link below.
But, I will say very generally that although people often combine Kava and alcohol and have remained alive to tell the story – it isn’t necessarily very safe or wise to do so. There are several studies on the combination of Kava and alcohol and the general consensus of all of these studies is that you should never combine Kava and alcohol, as the combination of the two greatly increases your chance of hepatotoxicity (toxicity of the liver).
Besides, why not just drink Kava instead of alcohol altogether? Many people actually prefer to drink Kava over alcohol – given that it has very similar effects, and is generally considered to be a nonaddicting and healthy alternative to drinking alcohol.
Pharmaceutical Drug Interactions:
In the case of Kava combinations with pharmaceutical drugs – it is imperative that you seek medical advice from a practitioner or at least do some research on the interaction of the two substances. Yadhu N. Singh suggests that pharmaceutical interactions could be the most significant of the Kava combinations. Kavalactones – the beneficial compounds in Kava – inhibit cytochrome P 450 (CYP 450) . CYP 450 is an enzyme that acts as a catalyst in the process of oxidizing organic substances. However, most importantly, it is a major enzyme category used by the body for the metabolization of drugs . Given that these enzymes are inhibited by Kava, Kava may then prevent the body from properly metabolizing pharmaceutical drugs . As a result it is extremely important that you do your research before combining Kava with any pharmaceutical drug. I’ve put together some information on the most common Kava and pharmaceutical interactions – hopefully you’ll find your answers!
Central Nervous System Agents (Benzodiazepines): Given that Kava and Benzodiazepines act on the same CNS receptors, it is likely that the combination adds to the effects caused individually by each and/or has at least a synergistic pairing with each other (ie. increases the effects of each substance). Also, Kava will add to the drowsiness that is stereotypically experienced by those who use benzodiazepines .
Anesthetic Agents: Kava is actually considered to be an anesthetic itself and has been reported to have muscle relaxant effects as well as inducing numbness. Since anesthetics are intended to essentially do exactly the same thing – relax and numb muscles/tissues – there will inevitably be synergistic effects and Kava will prolong and intensify the effects of the anesthetic . It’s actually recommended to not ingest Kava before going in for surgery for precisely the reason mentioned above – that there will be an interference with the functioning of the pharmaceutical anesthetics that you will be given .
Analgesics or Painkillers (Acetaminophen, ibuprofen, aspirin, Percocet): There is an increased chance of liver damage or hepatotoxicity and kidney damage when Kava and pharmaceutical painkillers are taken simultaneously. As a result it is simply wise to avoid this combination .
Diuretics (acetazolamide, amiloride, furosemide and ACE inhibitors such as benazepril, captopril, lisinopril, quinapril and ramipril): Kava is a diuretic itself and also does cause dehydration, so if Kava is combined with pharmaceutical or herbal diuretics it will likely add to the effects and increase dehydration [10, 1].
Psychoactive Drugs (Xanax): While there is one reported case of coma induction, which is possibly linked to the combination of Kava with Xanax , it is nonetheless unclear what the exact biochemical interaction is like.
Dopamine agonists/antagonists (Xanax, prozac, droperidol, haloperidol, risperidol, metoclopramide, and other antidepressants or anti-anxiety medications): As was mentioned above in relation to coffee – Kava is reported to be an antagonist of dopamine; meaning, Kava inhibits dopamine receptors and transmitters. As a result Kava can either act as an additive to the effects of pharmaceutical dopamine antagonists or an inhibitor in the case of the combination with dopamine agonists .
As you can see there are a TON of possible interactions that Kava may have with herbal and plant-based remedies or pharmaceutical medications. If your health is as important to you as it is to us – then hopefully you have read this article and are doing further research on the particular Kava combination you have in mind. If you don’t see information on the Kava combination you seek to gain knowledge about, please do ask me! My guru wisdom is pretty much endless when it comes to many topics and I would love to share as much as possible with my readers – but of course sometimes it’s not possible to cover everything. That’s where you come in! I love to get some direction from my readers telling me what it is exactly they want to know about. In the meantime, I hope that this has helped!
A few quick tips to remember:
– It is unwise to combine Kava with alcohol – rather, use Kava as a healthy alternative!
– Always consult a physician when wanting to combine Kava with a pharmaceutical drug.
– Kava acts on CYP 450 enzymes, as do many herbal and pharmaceutical remedies – so, be careful when combining them! These enzymes metabolize some herbs and medicines, so Kava could interfere with the metabolization process or have other undesirable biochemical interactions.
1. Basch, Bent, Boon, Ernst, Hammerness, Sollars, Tsourounis, Ulbricht, Jen Woods. “Safety review of kava (Piper methysticum) by the Natural Standard Research Collaboration”. Natural Standard Research Collaboration, 2005. Vol. 4 (4), p. 779-794.
2. Bressler, Rubin. “Herb-drug interactions: interactions between Kava and prescription medications”. Advanstar Communications, INC, September 2005. Vol. 60 (9), p. 24.
3. Capasso, A and Sorrentio, L. “Pharmacological studies on the sedative and hypnotic effect of Kava kava and Passiflora extracts combination”. Phytomedicine, 2005. Vol 12, p. 39-45.
4. Graedon, Joe and Graedon Teresa. “Herb Interaction Could Lead to Coma”. Tribune Publishing Company LLC, February 21, 1999.
5. Singh, N. Yadhu. “Potential for interaction of kava and St. John’s wort with drugs”. Journal of Ethnopharmacology, May 18, 2005. Vol. 100, p. 108-113.
6. Stuart, Armando Ph. D. “Kava Kava”. 2005. Online: http://www.herbalsafety.utep.edu/herbs-pdfs/kava.pdf
7. Wenk, Gary Ph. D. “Why Does Coffee Make us Feel so Good?” Psychology Today – Your Brain on Food, October 28, 2011. Online: http://www.psychologytoday.com/blog/your-brain-food/201110/why-does-coffee-make-us-feel-so-good
8. Wheatley, David. “Stress-induced insomnia treated with kava and valerian: singly and in combination”. Human Psychopharmacology, 2001. Vol. 16, p. 353-356.
9. Wikipedia. “Cytochrome p450”. Last updated, April 28, 2014. http://en.wikipedia.org/wiki/Cytochrome_P450
10. Wong, Cathy ND. “Kava Kava”. About.com – Alternative Medicine. Last Updated, April 08, 2014. Online: http://altmedicine.about.com/od/kava/p/kava.htm