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Don't take APAP (Acetaminophen/Tylenol/Paracetamol) if you take kava on a regular basis.

Kapmcrunk

The Kaptain (40g)
KavaForums Founder
Abstract:

"Anxiolytic kava products have been associated with rare but severe hepatotoxicity in humans. This adverse potential has never been captured in animal models, and the responsible compound(s) remains to be determined. The lack of such knowledge greatly hinders the preparation of a safer kava product and limits its beneficial applications. In this study we evaluated the toxicity of kava as a single entity or in combination with acetaminophen (APAP) in C57BL/6 mice. Kava alone revealed no adverse effects for long-term usage even at a dose of 500 mg/kg bodyweight. On the contrary a three-day kava pretreatment potentiated APAP-induced hepatotoxicity, resulted in an increase in serum ALT and AST, and increased severity of liver lesions. Chalcone-based flavokawains A (FKA) and B (FKB) in kava recapitulated its hepatotoxic synergism with APAP while dihydromethysticin (DHM, a representative kavalactone and a potential lung cancer chemopreventive agent) had no such effect. These results, for the first time, demonstrate the hepatotoxic risk of kava and its chalcone-based FKA and FKB in vivo and suggest that herb–drug interaction may account for the rare hepatotoxicity associated with anxiolytic kava usage in humans."

Full Paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203398/

Kava used: "Wild Crafted Kava Root" from Gaia Herbs. Ethanolic extract.

ELI5: FKB and FKA, seen more prevalently in extracts and non-noble kavas but still present in small amounts in all kavas, slow the breakdown of acetaminophen (APAP/Tylenol). When Tylenol breaks down in the body some of the chemicals it breaks down into are toxic. Generally the body can eliminate these chemicals quickly. The FKB/FKA in kava slows this process through reducing specific enzymes that Tylenol needs to be broken down with. This caused those toxic chemicals to build up which resulted in physical liver damage in the mice they tested, and one mouse death.

TL/DR: Don't mix kava with Tylenol (Acetaminophen, APAP, Paracetamol). In fact, don't use Tylenol at all. If you consume kava in any form, go for ibuprofen or naproxen. The consumption of only kava caused no issues in this study.

Likelihood of harm if combined:

If using powdered noble kavas, low.

Extracts of an unknown source should be considered a high risk as solvents are likely to pull out more from the kava than what is traditionally found in your standard brew.

Kavas with high levels of FKB/FKA will also fall into the high risk category when combined with APAP.

Note: Risks only in regards to mixing with APAP, not on it's own.
 

hightides42

Kava Curious
very disturbing info, considering I take a goodies powder daily (it's aspirin, acetaminophen and caffeine). Already liver concerned as I was quite a heavy alcohol user/abuser for decades leading up to finding kava late last year and ending my alcohol dependence and nearly all use this past new year.
will have to watch this closely for more focused studies and conclusions, will shift to b&c powders for now since it doesn't have the acetaminophen included.
 

Kapmcrunk

The Kaptain (40g)
KavaForums Founder
very disturbing info, considering I take a goodies powder daily (it's aspirin, acetaminophen and caffeine). Already liver concerned as I was quite a heavy alcohol user/abuser for decades leading up to finding kava late last year and ending my alcohol dependence and nearly all use this past new year.
will have to watch this closely for more focused studies and conclusions, will shift to b&c powders for now since it doesn't have the acetaminophen included.
If using powdered noble kavas traditionally I'd say your risk is nearly zero. Since I can't really tell if someone is eating acetonic/ethanolic extracts or making kava traditionally I simply suggest the removal of APAP if at all possible.
 

hightides42

Kava Curious
yah, noble and traditional prep sound safest way to avoid such an issue. Apap already has a bad rep regarding liver, time for me to just eliminate it from my medicine cabinet completely~
 

Kapmcrunk

The Kaptain (40g)
KavaForums Founder
noble and traditional prep sound safest way to avoid such an issue.
I'm honestly not sure that kava consumed in this fashion could ever hurt you, or if it did it would take the wildest set of circumstances coalescing all at once while also being struck by lightning. I'm seeing a common theme, and that being traditional kava (kava powder mixed with water and strained) is safe. The codex got it right.
 

Zaphod

Kava Lover
very disturbing info, considering I take a goodies powder daily (it's aspirin, acetaminophen and caffeine). Already liver concerned as I was quite a heavy alcohol user/abuser for decades leading up to finding kava late last year and ending my alcohol dependence and nearly all use this past new year.
will have to watch this closely for more focused studies and conclusions, will shift to b&c powders for now since it doesn't have the acetaminophen included.
I am not a doctor (nor do I play one on the internet) but if one is concerned about their liver and specifically acetaminophen toxicity you should look at NAC. In the US it is available as a supplement and is literally what they would give you in the hospital for an acetaminophen overdose. Of course that would likely be an IV but it is still pretty bioavailable. It also has several other benefits, but you can google that on your own.

There was a paper that showed a water extracted kava had more glutathione and might be why water based kava beverages had less associated liver issues. NAC will boost glutathione.

I use it for more of a nootropic effect along with some other things but if you had a long history of alcohol abuse it might be something trying for a few weeks to see how you feel. It is pretty well tolerated by most.
 

hightides42

Kava Curious
Have not heard of NAC before, quick search tells me it's something I'm going to add to the daily regimen, thanks for mentioning it!
 

avahZ

YAHWEH Shalom
I wonder how this applies to the micronized kavas? I know the true instant kava would be akin the traditional prep.

The two types of micronized kava’s, one with Makas and ones without it...

The more these studies come out the more I am leaning back to only traditional prep. Though I love my Kava Candies...
 

Zaphod

Kava Lover
Have not heard of NAC before, quick search tells me it's something I'm going to add to the daily regimen, thanks for mentioning it!
I find aleve (naproxen) works better for me for headaches/pain when I need it anyways - so I have removed tylenol from my cabinet. Except for cough medicines that still have it mixed in.

NAC along with Alpha GPC in the morning with my coffee (sometimes l-theanine if anxious) gives me a nice focused boost of energy. However, it really is dependent on your brain chemistry if a particular nootropic will work for you and for how long. This one can also kick start me if I go to heavy or to much with the kava the night before and feel "brain fog". This combo works nice for me, but might not work well for you. Good luck!
 

Variyen

Kava Curious
Interesting. Is there a reason why ibuprofen doesn't have this risk? It's also a little frustrating to see an extract used, when from what I've seen the cases of hepatotoxicity in the past were likely exacerbated by extract use and not traditional preparation.
 

Kapmcrunk

The Kaptain (40g)
KavaForums Founder
Interesting. Is there a reason why ibuprofen doesn't have this risk? It's also a little frustrating to see an extract used, when from what I've seen the cases of hepatotoxicity in the past were likely exacerbated by extract use and not traditional preparation.
While ibuprofen does use the pathway inhibited by kava, the metabolites are not as toxic as those found in the breakdown of acetaminophen. Again, extracts of not-so-noble kavas are the main risk here, not traditional kava preparations. I, and many others feel that if that were an issue for normal kava drinking that we would be seeing countless issues arising from the south pacific population. At this point I would expect to see issues all over the place even in the US if this were an intrinsic issue with kava. Time, experience, and many studies are showing that kava mixed with water and strained is safe.
 

Orz[EST]

Kava Curious
Milk Thistle can be an excellent supplement for people and animals (dogs/cats) to help protect the liver.
...and Dandelion root (Taraxacum officinale) is one of the rare things that helps the liver. It's coffee's taste is not similar but comparable to kava in its tastiness.
 

Orz[EST]

Kava Curious
One more thing. Note that N-acetylcysteine is a major antidote to paracetamol poisoning and a partial but not full antidote in an animal study to the high dose kava toxicity.

A few noble strains have unusually high Flavokawain B, too.
 
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