Kava (Piper methysticum) in the treatment of anxiety

Kava (Piper methysticum) has been popularized in recent decades in Western countries, with dozens of kava products (of varying quality) being sold for anxiety and sleep disorders. Although compelling evidence supports the use of kava in the treatment of anxiety (Pittler and Ernst 2003), concerns about hepatotoxicity have led to its withdrawal or restriction in many countries since 2002 (Clouatre 2004). These concerns led to recent research on water-soluble extracts that use “noble” peeled rootstock (Savage et al. 2015). In this chapter, I discuss current evidence of kava’s psychopharmacological activity, efficacy, safety issues, and clinical considerations and provide a case study