AHPA Botanical Safety Handbook

The revisions mainly brought forth and documented a variety of scientific updates surrounding the use of “traditional” kava and “contemporary” kava products. Traditional kava products were defined as water-based extracts, whereas contemporary products use organic-based extraction methods. It is pointed out in the handbook that the association between kava-related liver injury and organic-based extraction methods is tenuous at best. The handbook clearly identifies that quality control issues may be more to blame, including the use of inappropriate plant parts, improper drying practices, and improper cultivars. 

The safety sections were updated to include all human clinical trial results showing that liver injury is rare.

The use of kava as a food was added to the handbook to clearly demonstrate that kava had been used in the United States prior to 1958. Despite this, the FDA does not recognize kava as GRAS, though the Hawaii State Department of Health formally rejected the FDA’s position and made kava water-based extract GRAS in Hawaii. 

The required trade statement from AHPA remains the same for products containing kava, “Caution: US FDA advises that a potential risk of rare, but severe, liver injury may be associated with kava-containing dietary supplements. Ask a healthcare professional before use if you have or have had liver problems, frequently use alcoholic beverages, or are taking any medication. Stop using and see a doctor if you develop symptoms that may signal liver problems (e.g., unexplained fatigue, abdominal pain, loss of appetite, fever, vomiting, dark urine, pale stools, yellow eyes, or skin). Not for use by persons under 18 years of age or by pregnant or breastfeeding women. Not for use with alcoholic beverages. Excessive use, or use with products that cause drowsiness, may impair your ability to operate a vehicle or dangerous equipment.”

In conclusion, the AHPA BSH update represents an important milestone in updating the frame of reference for kava and its safety profile in the context of the most up to date science. It is clear that kava is a well tolerated substance whether consumed in a traditional manner or through modern extraction techniques. This forms the basis for the continued safe use and expansion of kava use to those who seeks its benefits.

The second edition of the Botanical Safety Handbook was updated for Piper methysticum (kava) root rhizome in March 2024. This update to the entry for kava is a reflection as to how far the science has come in relation to kava and, importantly, shows that claims of liver injury from both kava water extracts and modern extract formats are tenuous at best.

The safety classification remains unchanged, with kava placed into categories 2b and 2c, which are as follows:

• 2b: Not to be used during pregnancy

• 2c: Not to be used while nursing

And kava was placed in interaction class B, which is as follows: 

• Interaction Class B: Herbs for which clinically relevant interactions are biologically