Kava safety if taking prescription medication

[Senoz]

Hello all,

Many people in this forum, from what I can tell, have had psychological issues and I assume that there will be a relevant part of the users taking prescription medication, or trying to withdraw from it. All the quality sources of information about kava safety that I'Ve found advise that if you take prescription medication, kava may not be safe... and to ask your physician. However, my physician has no idea about kava. Nor has my pharmacist. I'm struggling to find good information about my specific concern regarding kava-venlafaxine (Effexor) interaction. Any ideas/suggestions?

Thanks in advance!
Kind regards,
S.

 

[verticity]

I take Effexor, and have not had any problems drinking kava as well. However, there are some risks. Kava is a very mild reversible MAOI (Monamine Oxidase Inhibitor) This means that kava can increase the presynaptic concentrations of the catecholamine neurotransmitters, namely serotonin, dopamine and norepinephrine. I don't know how strong this effect is, but it is certainly much much weaker than the effect of powerful irreversible MOAI antidepressants such as Nardil and Parnate (which are absolutely contraindicated with other antidepressants, and require a special diet). Kava is a reversible MAOI and not very potent one as far as I can tell. Reversible MAOIs are much less dangerous than the irreversible kind, and do not require the special diet. However, because kava can increase the same neurotransmitters that Effexor does, there is some risk of interactions. In particular, Effexor is a very potent serotonin reuptake inhibitor, so when it is combined with anything else that can increase serotonin levels, there is a risk of serotonin syndrome. I believe this risk is minimal enough in the case of kava+Effexor that I choose to use kava with Effexor myself. But I understand that I am taking a risk.
Note:
1) I am not a doctor
2) I am describing what I have done for the past 2+ years with no ill effect; that does not mean others might not react differently. What I'm saying here is strictly anecdotal based on my own experience. If you use kava with any antidepressant you are taking a risk. It's a small risk in my opinion, but a risk nonetheless.
3) I am not a doctor
4) I am not a pharmacist
5) I am not a doctor

I should also mention that I am not a doctor, I am some guy on the internet who you don't know.

 

[Abbas]

I take Effexor, and have not had any problems drinking kava as well. However, there are some risks. Kava is a very mild reversible MAOI (Monamine Oxidase Inhibitor) This means that kava can increase the presynaptic concentrations of the catecholamine neurotransmitters, namely serotonin, dopamine and norepinephrine. I don't know how strong this effect is, but it is certainly much much weaker than the effect of powerful irreversible MOAI antidepressants such as Nardil and Parnate (which are absolutely contraindicated with other antidepressants, and require a special diet). Kava is a reversible MAOI and not very potent one as far as I can tell. Reversible MAOIs are much less dangerous than the irreversible kind, and do not require the special diet. However, because kava can increase the same neurotransmitters that Effexor does, there is some risk of interactions. In particular, Effexor is a very potent serotonin reuptake inhibitor, so when it is combined with anything else that can increase serotonin levels, there is a risk of serotonin syndrome. I believe this risk is minimal enough in the case of kava+Effexor that I choose to use kava with Effexor myself. But I understand that I am taking a risk.
Note:
1) I am not a doctor
2) I am describing what I have done for the past 2+ years with no ill effect; that does not mean others might not react differently. What I'm saying here is strictly anecdotal based on my own experience. If you use kava with any antidepressant you are taking a risk. It's a small risk in my opinion, but a risk nonetheless.
3) I am not a doctor
4) I am not a pharmacist
5) I am not a doctor

I should also mention that I am not a doctor, I am some guy on the internet who you don't know.

Where did you go to med school?

 

[verticity]

Where did you go to med school?

I went to med school at the University of Educated Laymen. I graduated summa cum laude with an NMD degree (Non Medical Doctor).

 

[kasa_balavu]

@verticity Do you know if the potential issues you describe would show up in blood tests?
Say OP were to have a full blood test done, then drink kava daily for a week followed by another blood test. Would signs of undesirable/toxic effect show up in the blood test results? Or is this the sort of thing that is more subtle?

 

[verticity]

@verticity Do you know if the potential issues you describe would show up in blood tests?
Say OP were to have a full blood test done, then drink kava daily for a week followed by another blood test. Would signs of undesirable/toxic effect show up in the blood test results? Or is this the sort of thing that is more subtle?

I don't think elevated catecholamine levels would show up in a blood test, because they are endogenous neurotransmitters. If their levels could be measured, they would not indicate the reason for them being elevated: whether from an antidepressant, or something else. Moreover AFAIK, the levels of these neurotransmitters would not be elevated outside of the brain, and so could not be measured without a brain biopsy, which is not commonly done (LOL)

 

[Plantacious]

I take Effexor, and have not had any problems drinking kava as well. However, there are some risks. Kava is a very mild reversible MAOI (Monamine Oxidase Inhibitor) This means that kava can increase the presynaptic concentrations of the catecholamine neurotransmitters, namely serotonin, dopamine and norepinephrine. I don't know how strong this effect is, but it is certainly much much weaker than the effect of powerful irreversible MOAI antidepressants such as Nardil and Parnate (which are absolutely contraindicated with other antidepressants, and require a special diet). Kava is a reversible MAOI and not very potent one as far as I can tell. Reversible MAOIs are much less dangerous than the irreversible kind, and do not require the special diet. However, because kava can increase the same neurotransmitters that Effexor does, there is some risk of interactions. In particular, Effexor is a very potent serotonin reuptake inhibitor, so when it is combined with anything else that can increase serotonin levels, there is a risk of serotonin syndrome. I believe this risk is minimal enough in the case of kava+Effexor that I choose to use kava with Effexor myself. But I understand that I am taking a risk.
Note:
1) I am not a doctor
2) I am describing what I have done for the past 2+ years with no ill effect; that does not mean others might not react differently. What I'm saying here is strictly anecdotal based on my own experience. If you use kava with any antidepressant you are taking a risk. It's a small risk in my opinion, but a risk nonetheless.
3) I am not a doctor
4) I am not a pharmacist
5) I am not a doctor

I should also mention that I am not a doctor, I am some guy on the internet who you don't know.

I hope it's okay to revive an old thread.
I wanted to point out that it is very relevant, and perhaps critical, of the dosage you're taking, of each substance a person is combining.
Would you mind sharing the Effexor dosage you used while on kava, and approximately how much kava you consumed, as well ?
Would

 

[verticity]

I hope it's okay to revive an old thread.
I wanted to point out that it is very relevant, and perhaps critical, of the dosage you're taking, of each substance a person is combining.
Would you mind sharing the Effexor dosage you used while on kava, and approximately how much kava you consumed, as well ?
Would

Sure. Note that I don't take any psychiatric medications currently.

Effexor I think was 150 mg per day. The amount of kava I was consuming was known, in scientific terminology, as a "metric fucktonne". (But seriously, 1/4 - 1/2 cup traditionally prepared powder, most days)

I should point out some things I said in the above post that I later learned are not true. Kava has an effect on subtype MAO-B, not MAO-A. That is important because it means it does not have any effect on serotonin levels like I said, incorrectly, above. It does have an effect on norepinephrine, so there is still a potential for interaction. (There is also a possibility of metabolic interaction)

So, I should also point out that, yes I did that--I combined that medication with kava. It didn't cause any problems for me, but I don't do it anymore; and I don't recommend that anyone else do it--or at least if you do be aware that it is not without risk--because everyone is different. My experience is just one anecdote. The fact that the combination did not adversely effect me does not mean that someone with a different genetic makeup, health history, etc would also be unaffected.

 

[sɥɐʞɐs]

Sure. Note that I don't take any psychiatric medications currently.

Effexor I think was 150 mg per day. The amount of kava I was consuming was known, in scientific terminology, as a "metric fucktonne". (But seriously, 1/4 - 1/2 cup traditionally prepared powder, most days)

I should point out some things I said in the above post that I later learned are not true. Kava has an effect on subtype MAO-B, not MAO-A. That is important because it means it does not have any effect on serotonin levels like I said, incorrectly, above. It does have an effect on norepinephrine, so there is still a potential for interaction. (There is also a possibility of metabolic interaction)

So, I should also point out that, yes I did that--I combined that medication with kava. It didn't cause any problems for me, but I don't do it anymore; and I don't recommend that anyone else do it--or at least if you do be aware that it is not without risk--because everyone is different. My experience is just one anecdote. The fact that the combination did not adversely effect me does not mean that someone with a different genetic makeup, health history, etc would also be unaffected.

Vert, do you have any info regarding possible interactions between St. Johns Wort and Kava and to what degree prescribed SSRI's & St. John's Wort would have similar possible interactions with kava. For example, would St John's wort be significantly less risky to take in the same day as kava or an equal risk to prescribed SSRIs(plus kava)? ...and would taking would only taking St John's Wort in the morning and having kava at night reduce interaction risk?

 

[verticity]

Vert, do you have any info regarding possible interactions between St. Johns Wort and Kava and to what degree prescribed SSRI's & St. John's Wort would have similar possible interactions with kava. For example, would St John's wort be significantly less risky to take in the same day as kava or an equal risk to prescribed SSRIs(plus kava)? ...and would taking would only taking St John's Wort in the morning and having kava at night reduce interaction risk?

St. Johns wort itself can interact with lots things, possibly including kava. Here is a review:

https://www.medscape.com/viewarticle/713605

According to that article, it, like kava, has numerous complex actions, some of which overlap with the actions of kava, such as dopamine and norepinephrine activity. Also it is an inducer of a number of the same enzymes involved with kava metabolism.

So, yes, there would be some risk combining it with kava--I can't say if that risk would be more or less than a pharmaceutical antidepressant. It's possible that because SJW induces some enzymes that metabolize kava, it could just make the kava less effective because it would be metabolized more quickly.

The elimination half life of hypericin, one of the active chemicals in SJW is about 25-27 hours, which is pretty long, and another component, pseudohypericin, is even longer, up to 36 hours:

https://www.ncbi.nlm.nih.gov/pubmed/7857509

That means if you take St. John's wort every day it will build up to a steady state in your system, so it wouldn't matter what time you drink kava; it could still interact 24 hours a day.

 

[ThatDankK]

I take Zoloft 100mg, Im fairly sure excess amounts of kava wont have any interaction. I also hope that Zoloft doesnt take away effects of kava like it does with other things such as LSD/MDMA. Correct me if im wrong.

 

[Intrepidus_dux]

I’m sure you’ve already done this, but do a drug interaction checker online. Then go with what your body tells you when you drink kava.

 

[Plantacious]

Kava has an effect on subtype MAO-B, not MAO-A. That is important because it means it does not have any effect on serotonin levels like I said, incorrectly, above. It does have an effect on norepinephrine, so there is still a potential for interaction. (There is also a possibility of metabolic interaction)

The fact that Kava has an effect on norepinephrine would concern me because Effexor has an effect on Norepinephrine, which is what the letter "N" stands for in SNRI, since Effexor is an SNRI, rather than SSRI.

Anyone else have input on that information ?

 

[verticity]

The fact that Kava has an effect on norepinephrine would concern me because Effexor has an effect on Norepinephrine, which is what the letter "N" stands for in SNRI, since Effexor is an SNRI, rather than SSRI.

Anyone else have input on that information ?

I'm not anyone else, but your concern is quite reasonable and caution is always advised when combining kava with any medication, especially one like Effexor with specific reasons to believe that interactions might be possible.

 

[Plantacious]

I'm not anyone else, but your concern is quite reasonable and caution is always advised when combining kava with any medication, especially one like Effexor with specific reasons to believe that interactions might be possible.

Ha, I was including you in the term "anyone else". Your reply was welcomed and appreciated.