ava how the drink is made. In the

ava Kava is a plant typically found in the western pacific. Kava is made into a drink by cutting the root, chewing it and spitting it into a bowl – where then water and milk of coconuts is poured on it. This mixture is the strained – and that is how the drink is made. In the western pacific, kava has a great religious significance.
Kava is clinically used to treat anxiety and insomnia. The active ingredient kavalactone is said to have a similar effect as alcohol – providing relaxation, euphoria, and talkativeness – while still maintaining mental clarity, which are the effects they take advantage of for its anxiolytic effects. 
Kava seems to have some level of abuse potential, but is rare with normal doses. 
The biggest concern about Kava, is the chance of liver injury. It seems that the frequency of clinically apparent livery injury due to kava is less than 1:1,000,000. However, there are spontaneous cases that need to be taken into consideration. Even with the low number of liver injury cases, there seem to be some cases of severe hepatitis leading to hepatic failure that requires liver transplant – and some even leading to death.  Patients typically present with fatigue, nausea, elevations in serum aminotransferase levels, and jaundice – and this occurs about 2 to 24 weeks after starting use. Due to the hepatotoxic potential, kava has been banned or restricted in many countries of the world such as Germany, Switzerland, France, Canada, and Great Britain.

This was a very interesting herb to research – because it is so unclear how prominent the cases of liver toxicity are. It is really easy to dismiss a herb like this – but I think it will always come down to, what else the patient has tried, what seems to have failed. I think this would be a last-line option for sure – and only for people that really are struggling with their anxiety with no other way to control it. There are also a variety of patient factors that need to be considered – like allergies, pre-existing liver conditions, drug/alcohol abuse, and the prescription medications a patient is on. I feel that these are all things to take into consideration before rrecommending to a patient. I think it is also important to be clear with the patient about the issue of heptatotoxicity – just so they are aware of all the experiences that may rise from using this herb – whether it be positive of negative, the patient needs to understand all the implications of using this herb. 

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