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2016; Lippincott Williams & Wilkins; Volume: 38; Linguagem: Inglês
10.1097/01.eem.0000480650.58366.f1
ISSN1552-3624
Autores ResumoFigure: Powdered kava is mixed with water to make tea.FigureKava bars are cropping up in many U.S. cities thanks to KavaSutra, a chain of bars across the country. Users drink a few cups of a dirty-tasting tea and achieve effects similar to an alcoholic drink. Users and bar owners don't need a valid ID or liquor license, respectively, and cost is considerably less than a cocktail. Kava, however, is not without controversy. Europe banned commercial marketing and kava sales for most of the early 2000s, but lifted the ban in February 2015. Canada has a similar history with kava, and its government lifted the ban in 2012. The major controversy around the plant-based drink stems from concerns for sedative-like effects and reports of hepatotoxicity. Kava (Piper methysticum) is traditionally brewed in a tea and consumed as part of ceremonial rituals in South Pacific island nations. One to two glasses cause mild throat and tongue numbness, followed by general relaxation and sedation. These effects are mediated by the lipophilic kavalactones, which cause sodium channel blockade, GABA agonism, and possible MAO-I like activity. (Aust N Z J Psychiatry 2011;45[1]:27.) Those who practice alternative medicine have used kava to treat depression, anxiety, and alcohol abuse. (Aust J Med Herbalism 2010;22[1]:12; Cochrane Database Syst Rev 2003[1]:CD003383.) Case reports surrounding the concern for hepatotoxicity have only occurred in western countries, and may be caused by ethanol-and-acetone-based extracts or consumption with alcohol. Traditional kava, however, is water-based and consumed alone. (World Health Organization. “Assessments of the Risk of Hepatotoxicity with Kava Products.” Geneva, Switzerland, 2007.) Traditional kava, however, is brewed from the kava rhizome, a continuously growing horizontal underground stem. At the time of the previous hepatotoxic case reports, extracts were including portions of the roots, stems, and leaves. (Br J Clin Pharmacol 2011;71[3]:445.) More and more patients may be using kava to achieve the relaxation of alcohol while avoiding the carbohydrates and calories. Kava tea is also widely available online. Isolated use does not necessarily warrant a workup for hepatotoxicity, but be aware of kava's clinical effects and increasing popularity. Find more information at http://www.kavasutra.com/about/.
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