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Kava & Drug Interaction Kava safe pain killer for headaches?

Sam Handwich

Kava Enthusiast
Hi all, I am wondering if anyone is aware of a painkiller that can be taken for headaches the same day as kava consumption? I know that Advil would be a bad idea but I thought I once read that aspirin might be ok? I get frequent tension headaches in my neck and kava does not help them, in fact I think it might make them worse :(
 

Zaphod

Kava Lover
Hi all, I am wondering if anyone is aware of a painkiller that can be taken for headaches the same day as kava consumption? I know that Advil would be a bad idea but I thought I once read that aspirin might be ok? I get frequent tension headaches in my neck and kava does not help them, in fact I think it might make them worse :(
The basic recommendation is to not take acetaminophen (aka Paracetamol, tylenol, panadol) because it is metabolized by the liver and can be toxic. It is one of the leading causes of liver toxicity in the US. Kava is also metabolized by the liver - and as such it is recommended not to take both at the same time. Both Ibuprofen (advil) and Naproxen have a much lower level of liver toxicity and adverse liver events. All that said for one time use your probably okay taking any of these, but better to stay on the safer side with advil. I have taken both advil and naproxen on rare occasions after drinking kava.
 

SelfBiasResistor

Persist for Resistance!
Hi all, I am wondering if anyone is aware of a painkiller that can be taken for headaches the same day as kava consumption? I know that Advil would be a bad idea but I thought I once read that aspirin might be ok? I get frequent tension headaches in my neck and kava does not help them, in fact I think it might make them worse :(
Unless you have a health condition increasing your risk in consuming OTC pain relievers you shouldn't have any issues occasionally taking them the same day as kava. I've taken many pain relievers (NSAIDs, acetaminophen, pharmaceutical opioids) many times while daily drinking kava and have had no adverse reactions. Acetaminophen is a terrible drug on it's own so I limit my use of it whenever possible. I don't take them much anymore though since between kratom and cannabis I'm pretty well set on pain control.

I can understand healthy caution but the constant warnings of potential catastrophic liver damage from consuming anything with kava that is metabolized through the liver doesn't portray a lot of confidence in the safety of kava. Liver killing substances like alcohol and tylenol don't kill people because they interact with the liver, they kill because of their toxic metabolites building up too quickly. To this point, that isn't what's been observed in water extracted kava drinks. In the case of kava and tylenol, kava inhibits the the enzyme that converts acetaminophen into it's toxic metabolite so that is a potential action of protection from liver damage as the big danger is that metabolite converting too quickly and the body not having enough time to detoxify it before it causes damage which is what can happen with tylenol and alcohol. Alcohol causes that enzyme to convert the drug more quickly which can overwhelm the livers ability to metabolize it into a less toxic chemical before damage ensues.
 

kasa_balavu

Yaqona Dina
Taking painkillers with kava isn't normally a concern.
However, if you're taking painkillers regularly, then you're not normal and your liver or kidneys (depending on which painkiller you take) are possibly in poor health. It's probably best to consult your medical professional about interactions if you fall in this category.
 

Sam Handwich

Kava Enthusiast
Thanks for the replies, I'm long over the usual kava health scare, I've just never mixed any otc painkillers with kava. I also try and avoid them with alcohol, just seems like a bad idea. Any thoughts on if aspirin would be a better choice than Advil?
 

kavakarma

Kava Enthusiast
My first impression was you asking if Kava is safe / efficient to use for headache treatment. I would say yes. No need to mix, Kava is good medicine

Edit: I realize you're looking for a safe mix, try things that help you feel hydrated and warm, like ginger tea, green tea, coconut water [or other sources of Omega 3 such as broccoli and fish], maybe CBD oil
 

fait

Position 5 Hard Support
I too have had days where I have a headache or a neckache and I've wondered if I had kava if taking some ibuprofen would be OK. I usually take...is it 200mg? However much one pill of ibuprofen is.

Just to confirm with whoever's active here, the occasional ibuprofen with kava on the same day shouldn't have any ill effects?
 

verticity

I'm interested in things
I looked up research about specific interactions of kava with aspirin, acetaminophen and ibuprofen. Here's what I found.

Acetaminophen
It should be noted that there a couple studies about the specific interaction between kava and acetaminophen.

1. One study in-vivo suggested that kava might exacerbate the damage to liver cells caused by acetaminophen. The study has some issues and is not definitive: it used an unknown type of kava extract, not traditionally prepared kava, and involved exposing non-human liver cells in a test tube, probably to much higher doses of both acetaminophen and kava extract than anyone would normally consume.
Kava extract, an herbal alternative for anxiety relief, potentiates acetaminophen-induced cytotoxicity in rat hepatic cells

2. There was another in-vivo study in mice that showed that kava extract (and also the FKA and FKB alone) potentiated liver damage caused by acetaminophen (although kava extract by itself showed no toxicity). Some of the same caveats as above apply: the kava was an ethanol extract, not traditional water extract; the subjects were not human; the doses were much higher than people would normally consume (500 mg of extract per kg of body weight):
Flavokawains A and B in Kava, Not Dihydromethysticin, Potentiate Acetaminophen-Induced Hepatotoxicity in C57BL/6 Mice

So both of these studies do have some obvious things about them that could be criticized, as noted above. Nonetheless, they are specific results about a specific interaction, not a generic warning about anything that is metabolized by the same liver enzymes as kava. Since they are the only solid information we do have, in my opinion the usual advice to avoid combining kava and acetaminophen is probably wise.

Aspirin
Googling for aspirin + kava interactions, I found this PhD thesis from Fiji. It doesn't quite address the OPs question about safety, but it is very interesting because it suggests that there actually can be a sort of interaction between aspirin and traditionally consumed kava. Specifically it examines whether regular kava use inhibits the blood thinning effect of aspirin. And the author actually found that for regular kava drinkers, a low dose of aspirin (100mg) seemed to be less effective as an anti-platelet (blood thinning) drug than for non- or occasional kava drinkers. This possible interaction could be important for people who take aspirin for heart disease prevention: regular kava drinkers might need higher doses of aspirin for it to be effective. (But it doesn't suggest that combining aspirin with kava is dangerous, and in fact doesn't say anything about what the acute effect of consuming aspirin and kava at the same time might or might not be..).

KHATRI, V. (2011). EFFECT OF ASPIRIN INTERVENTION ON PLATELET AGGREGATION IN NON-KAVA DRINKING AND KAVA DRINKING FIJIAN AND INDO-FIJIAN HEALTHY VOLUNTEERS AND DETERMINATION OF ASPIRIN RESISTANCE (Doctoral dissertation, The University of South Pacific Fiji).

Ibuprofen
I can't find any specific studies about ibuprofen + kava (in a Google Scholar search..)

TL/DR
So to summarize what we know from studies of the specific interactions (as opposed to speculation about potential interactions based on metabolic mechanisms):
  • Acetaminophen + kava: Two studies (one in vitro, and one in live mice) of kava extract suggest it could potentiate the liver toxicity of acetaminophen. IMO wise to avoid.
  • Aspirin + kava: One human study suggests regular kava drinking could reduce the effectiveness of low-dose aspirin as a blood thinner.
  • Ibuprofen + kava: We know nothing.
 
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SelfBiasResistor

Persist for Resistance!
I looked up research about specific interactions of kava with aspirin, acetaminophen and ibuprofen. Here's what I found.

Acetaminophen
It should be noted that there a couple studies about the specific interaction between kava and acetaminophen.

1. One study in-vivo suggested that kava might exacerbate the damage to liver cells caused by acetaminophen. The study has some issues and is not definitive: it used an unknown type of kava extract, not traditionally prepared kava, and involved exposing non-human liver cells in a test tube, probably to much higher doses of both acetaminophen and kava extract than anyone would normally consume.
Kava extract, an herbal alternative for anxiety relief, potentiates acetaminophen-induced cytotoxicity in rat hepatic cells

2. There was another in-vivo study in mice that showed that kava extract (and also the FKA and FKB alone) potentiated liver damage caused by acetaminophen (although kava extract by itself showed no toxicity). Some of the same caveats as above apply: the kava was an ethanol extract, not traditional water extract; the subjects were not human; the doses were much higher than people would normally consume (500 mg of extract per kg of body weight):
Flavokawains A and B in Kava, Not Dihydromethysticin, Potentiate Acetaminophen-Induced Hepatotoxicity in C57BL/6 Mice

So both of these studies do have some obvious things about them that could be criticized, as noted above. Nonetheless, they are specific results about a specific interaction, not a generic warning about anything that is metabolized by the same liver enzymes as kava. Since they are the only solid information we do have, in my opinion the usual advice to avoid combining kava and acetaminophen is probably wise.
Both studies make a good case for not combining acetaminophen with kava extracts for sure. It would have been really interesting to see the results with a water extraction since it would include the glutathione which detoxifies the toxic chemicals in kava (FKs) and the acetaminophen metabolite.

Also, to be clear, I wasn't recommending kava drinkers take acetaminophen. It's a terrible drug that has been marketed for years as being among the safest and gentlest OTC options available while that is the furthest from the truth.
 

Sam Handwich

Kava Enthusiast
I never take acetaminophen, usually just a few Advil once or twice a week. If I've already had kava I just tough it out with the headache. If I feel like I might be getting a headache I won't have any kava. Advil must be one of the most common otc medications in the world, surprising that there have been no studies done on the interactions. I wonder if they use any common painkillers in countries like Fiji or Vanuatu?
 

verticity

I'm interested in things
The big picture is that we in the US, etc. take a lot more pills of all kinds than people in Fiji and other countries where kava drinking is traditional. IMO concern about drug interactions with kava is legitimate, and likely to be a bigger issue here than there because of the sheer quantity of medications we consume.

Some data on total spending on pharmaceuticals in countries of interest. USD per capita in 2014 except as noted. Of course medication prices vary, so dollars spent isn't exactly proportional to number of pills taken, but it gives a rough idea of the different orders of magnitude.

Fiji: $47
Australia: $619
Canada: $794
UK: $478
US: $1114
NZ: $254 (in 2007, latest available)
Solomon Islands: $26
(no data for Vanuatu, but I would guess it would be similar to the Solomon Islands, less than Fiji)

Sources:
https://data.oecd.org/healthres/pharmaceutical-spending.htm
https://www.oecd-ilibrary.org/sites...content/component/health_glance_ap-2018-40-en
 
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fait

Position 5 Hard Support
Not that I plan on having any headaches any time soon, but I may take some ibuprofen on the same day I drink kava just to see how it goes. I definitely plan to give the two a berth of about 3-4 hours, depending on how bad the headache is. I'll report back here if I think to when I conduct this experiment.

If someone does this sooner than I, please post here. Like I said, I don't plan to have a headache. When it happens, it happens.
 

SelfBiasResistor

Persist for Resistance!
Not that I plan on having any headaches any time soon, but I may take some ibuprofen on the same day I drink kava just to see how it goes. I definitely plan to give the two a berth of about 3-4 hours, depending on how bad the headache is. I'll report back here if I think to when I conduct this experiment.

If someone does this sooner than I, please post here. Like I said, I don't plan to have a headache. When it happens, it happens.
I've taken the two many times. I highly doubt you'll have any side effects that you wouldn't have with ibuprofen alone.
 

SelfBiasResistor

Persist for Resistance!
How much time in-between each? Is timing important even?
Sometimes 10 hours before, several hours later and sometimes while shelling. I only drink late afternoon/night so it just depends on the pain/inflammation I'm dealing with at the time. At this point I take NSAIDs very rarely due to their health/stomach destroying capabilities but I haven't noticed any more side effects taking them close to kava compared to separate.
 
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