Kew

kava-kava (Piper Methysticum)

(ka-va ka-va) ,

Ava pepper

(trade name),

intoxicating pepper

(trade name),

kao

(trade name),

kew

(trade name),

tonga

(trade name),

wurzelstock

(trade name),

yagona

(trade name) Anxiety, stress, restlessness, insomnia, benzodiazepine withdrawalMild muscle aches and painsMenstrual cramps and PMS

Action

Pharmacokinetics

Time/action profile

ROUTE	ONSET	PEAK	DURATION
PO	1.8 hr	unknown	8 hr

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• dizziness
• headache
• drowsiness
• sensory disturbances
• extrapyramidal effects

Ear, Eye, Nose, Throat

• Pupil dilation
• red eyes
• visual accommodation disorders

Gastrointestinal

• hepatotoxicity (life-threatening)
• gastrointestinal complaints

Dermatologic

• allergic skin reactions
• yellow discoloration of skin
• pellagroid dermopathy

Hematologic

• ↓ lymphocytes
• decreased platelets

Metabolic

• weight loss (long term, high dose)

Neurologic

• ataxia
• muscle weakness

Interactions

Additive effect when used with alprazolam.Potentiates effect of CNS depressants (ethanol, barbiturates, benzodiazepines, opioid analgesics ).Has ↓ effectiveness of levodopa in few cases.May have additive effects with antiplatelet agents.May ↑ risk of liver damage with other hepatotoxic agents.Concurrent use with other hepatotoxic products such as DHEA, coenzyme Q-10 (high doses), and niacin can ↑ risk of liver damage.May have additive sedative effects when used with other herbs with sedative properties.

Availability (generic available)

Nursing implications

Nursing assessment

• Assess muscle spasm, associated pain, and limitations of movement prior to and periodically during therapy.
• Assess degree of anxiety and level of sedation (visual disturbances and changes in motor reflexes are side effects) prior to and periodically during therapy.
• Assess sleep patterns and level of sedation upon arising.
• Prolonged use may lead to ↓ of platelet and lymphocyte counts and ↑ liver function tests.

Potential Nursing Diagnoses

Anxiety (Indications)
Impaired physical mobility (Adverse Reactions)
Risk for injury (Side Effects)

Implementation

• Prepared as a drink from pulverized roots, tablets, capsules, or extract.

Patient/Family Teaching

• Inform patient that significant, serious side effects may occur with prolonged use. Use for longer than 1 mo is not recommended without supervision of health care professional.
• Caution patient to avoid alcohol or other CNS depressants while taking this herb; may increase sedative effect.
• May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to herb is known.
• Warn patients to stop use of the herb immediately if shortness of breath or signs of liver disease (yellowing of the skin or whites of the eyes, brown urine, nausea, vomiting, light-colored stools, unusual tiredness, weakness, stomach or abdominal pain, loss of appetite) occur and contact health care professional.
• Advise patients who have liver disease or liver problems, or persons who are taking drug products that can affect the liver, to consult health care professional before using kava-containing supplements.
• Inform patient that although there is no evidence of physiological dependence, the risk of psychological dependence still exists.
• Advise female patients to use contraception during therapy and to notify health care professional immediately if pregnancy is planned or suspected or if breastfeeding.
• Instruct patient to consult health care professional before taking any Rx, OTC, or other herbal products concurrently with kava-kava.
• Kava has been banned in other countries due to hepatotoxicity.

Evaluation/Desired Outcomes

• Decrease in anxiety level.
• Decrease in muscle spasms.
• Relief of insomnia.