Ca va, c’est Kava

Kava, carbidopa-levodopa, dopamine receptors


This case discusses a pharmacodynamic interaction between the dopamine agonist levodopa and the dopamine receptor antagonist and supplement kava, resulting in increased Parkinsonian symptoms


Kava Kavalactones Dopamine receptor Piper methysticum Dopamine antagonist γ-aminobutyric acid (GABA) Potentiator Parkinson’s disease 


  1. 1.
    Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: a systematic review. Drugs. 2001;61(15):2163–75.PubMedCrossRefGoogle Scholar
  2. 2.
    Izzo AA. Herb–drug interactions: an overview of the clinical evidence. Fundam Clin Pharmacol. 2005;19(1):1–16.PubMedCrossRefGoogle Scholar
  3. 3.
    Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA. 2001;286(2):208–16.PubMedCrossRefGoogle Scholar
  4. 4.
    Pepping J. Kava: Piper methysticum. Am J Health Syst Pharm. 1999;56(10):957–8, 960.PubMedGoogle Scholar
  5. 5.
    Schelosky L, Raffauf C, Jendroska K, et al. Kava and dopamine antagonism. J Neurol Neurosurg Psychiatry. 1995;58(5):639–40.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Meseguer E, Taboada R, Sánchez V, et al. Life-threatening parkinsonism induced by kava-kava. Mov Disord. 2002;17(1):195–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Teschke R, Schwarzenboeck A, Hennermann KH. Kava hepatotoxicity: a clinical survey and critical analysis of 26 suspected cases. Eur J Gastroenterol Hepatol. 2008;20(12):1182–93.PubMedCrossRefGoogle Scholar
  8. 8.
    Lindenberg D, Pitule-Schodel H. D. L-kavain in comparison with oxazepam in anxiety disorders. A double-blind study of clinical effectiveness. Fortschr Med. 1990;108(2):49–50,53–4.PubMedGoogle Scholar
  9. 9.
    Woelk H, Kapoula S, Lehrl S, et al. Treatment of patients suffering from anxiety—double-blind study: kava special extract versus benzodiazepines. Z Allgemeinmed. 1993;69:271–7.Google Scholar
  10. 10.
    Pittler MH, Ernst E. Kava extract for treating anxiety. Cochrane Database Syst Rev. 2003;(1):CD003383.Google Scholar
  11. 11.
    Stevinson C, Huntley A, Ernst E. A systematic review of the safety of kava extract in the treatment of anxiety. Drug Saf. 2002;25(4):251–61.PubMedCrossRefGoogle Scholar
  12. 12.
    Mathews JM, Etheridge AS, Black SR. Inhibition of human cytochrome P450 activities by kava extract and kavalactones. Drug Metab Dispos. 2002;30(11):1153–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineUniversity of WashingtonSeattleUSA
  2. 2.Department of Anesthesiology & Perioperative MedicineOregon Health and Science UniversityPortlandUSA

Personalised recommendations