Kava can intensify benzodiazepines, barbiturates, alcohol, and other sedatives. It may also increase acetaminophen liver toxicity and alter CYP1A2 or CYP2E1 drug handling, although enzyme findings vary by preparation.

Contraindicated / High risk. Use only under qualified healthcare supervision.

Contraindications

Current or prior liver disease
Pregnancy or breastfeeding
Use with alcohol, benzodiazepines, barbiturates, or other sedatives
Use before driving, surgery, or other alertness-dependent activity

Cautions

Kava products have been linked to rare cases of severe or fatal liver injury.
Risk may vary with cultivar, plant part, extraction method, contamination, dose, duration, and individual susceptibility.
Long-term high-dose use can cause dry scaly skin, neurologic effects, and other toxicity.

Drug Interactions

Drug Class / Substrate	Mechanism	Severity	Source
Benzodiazepines, barbiturates, and other sedatives	Additive GABA-related sedation and muscle relaxation can impair breathing, alertness, and coordination.	Major	Memorial Sloan Kettering About Herbs
Acetaminophen and other liver-toxic medicines	Kava enhanced acetaminophen-related liver cell toxicity in laboratory research, adding concern to its independent liver risk.	Major	Memorial Sloan Kettering About Herbs
CYP1A2 and CYP2E1 substrate medicines	Human and preclinical findings suggest altered enzyme activity, but results vary by product and clinical relevance is not fully defined.	Uncertain	Memorial Sloan Kettering About Herbs

Pregnancy

Not recommended during pregnancy. Consult a qualified healthcare provider before any use.

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before using herbal medicines, especially if you take prescription medications.