Kava
HerbalAlso called · 7 names▾▴
kava kava, kava-kava, kawa, awa, ava pepper, ava root, Piper methysticum
Herbal supplement (anxiety and relaxation)
Herbs and supplements are not FDA-approved before sale. About these sources
- Capsule/tablet
- Liquid extract
- Tea
- Powder
Research strength: 2 / 5
NCCIH says kava may have special risks during pregnancy because it contains plant compounds called pyrones. EMA's herbal committee judged the benefit-risk balance unfavorable and said an EU herbal monograph could not be established. One 2024 case report described a newborn with a scaly rash after the mother used a combined kava and kratom product throughout pregnancy. The authors argued that kava may have caused it, but the product's kava amount was unknown and the infant had critical illness, so this single report cannot establish cause. FSANZ found no pregnancy outcome data for kava beverages and advises against their use during pregnancy. NCCIH reports rare liver injury with kava products, including some serious or fatal cases and some water-prepared beverages. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- NCCIH: KavaUS government
- EMA: Public statement on Piper methysticumEU agencyEuropean guidance
- Spungen et al., Journal of Medical Toxicology: Neonatal and Maternal Ichthyosiform Dermopathy in Association with Kava Use during PregnancyUS government
- Food Standards Australia New Zealand: Kava Risk Assessment
Research strength: 2 / 5
NCCIH says kava may have special risks during pregnancy because it contains plant compounds called pyrones. EMA's herbal committee judged the benefit-risk balance unfavorable and said an EU herbal monograph could not be established. One 2024 case report described a newborn with a scaly rash after the mother used a combined kava and kratom product throughout pregnancy. The authors argued that kava may have caused it, but the product's kava amount was unknown and the infant had critical illness, so this single report cannot establish cause. FSANZ found no pregnancy outcome data for kava beverages and advises against their use during pregnancy. NCCIH reports rare liver injury with kava products, including some serious or fatal cases and some water-prepared beverages. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- NCCIH: KavaUS government
- EMA: Public statement on Piper methysticumEU agencyEuropean guidance
- Spungen et al., Journal of Medical Toxicology: Neonatal and Maternal Ichthyosiform Dermopathy in Association with Kava Use during PregnancyUS government
- Food Standards Australia New Zealand: Kava Risk Assessment
Research strength: 2 / 5
NCCIH says kava may have special risks during pregnancy because it contains plant compounds called pyrones. EMA's herbal committee judged the benefit-risk balance unfavorable and said an EU herbal monograph could not be established. One 2024 case report described a newborn with a scaly rash after the mother used a combined kava and kratom product throughout pregnancy. The authors argued that kava may have caused it, but the product's kava amount was unknown and the infant had critical illness, so this single report cannot establish cause. FSANZ found no pregnancy outcome data for kava beverages and advises against their use during pregnancy. NCCIH reports rare liver injury with kava products, including some serious or fatal cases and some water-prepared beverages. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- NCCIH: KavaUS government
- EMA: Public statement on Piper methysticumEU agencyEuropean guidance
- Spungen et al., Journal of Medical Toxicology: Neonatal and Maternal Ichthyosiform Dermopathy in Association with Kava Use during PregnancyUS government
- Food Standards Australia New Zealand: Kava Risk Assessment
Kava — Breastfeeding
Research strength: 1 / 5
FSANZ found no human data measuring kava in breast milk or describing effects in infants. It says transfer into milk is unclear and advises against kava beverages while breastfeeding because these data are missing. NCCIH also says kava may have special risks during breastfeeding because of pyrone compounds. No human milk-transfer study or infant outcome study was identified. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- NCCIH: KavaUS government
- Food Standards Australia New Zealand: Kava Risk Assessment
Pregnancy
Human pregnancy evidence is limited to one 2024 case report. A 41-year-old mother used a combined kava/kratom product throughout pregnancy, and both she and her newborn developed a scaly skin condition. The newborn's rash resolved by day 22 and had not returned at nine-month follow-up. The authors argued that in-utero kava exposure could have caused the rash because of its timing, appearance, and resolution after exposure ended. They also acknowledged that the product's kava amount and other ingredients were unknown, no product or clinical samples were tested, and the infant had critical illness, so a single case cannot establish cause. EMA's 2017 assessment predates this case and says there were no studies on herbal preparations; FSANZ's 2022 beverage assessment found no pregnancy outcome data. No larger human pregnancy study or trimester comparison was identified.
Breastfeeding
FSANZ found no data on kava beverage use while breastfeeding or on possible infant developmental effects. It says transfer of kavalactones into human milk is unclear; their molecular size and lipid solubility may support passive transfer, but this is not a human milk measurement. FSANZ advises against kava beverage use while breastfeeding because outcome data are missing. NCCIH also notes possible special risks during breastfeeding. The 2024 case report does not provide milk-exposure evidence: the newborn was formula-fed because clinicians were concerned about kratom exposure through breast milk. No human milk-level or infant-outcome study was identified.
Kava is made from the root or rhizome of Piper methysticum. The plant contains compounds called kavalactones; NCCIH separately identifies pyrone constituents as a reason for pregnancy and breastfeeding concern. Commercial preparations vary by plant material, extraction method, and concentration. The 2024 case involved a proprietary blend of kava root extract and kratom leaf, and the kava dose was not determined.
What was tested
Direct human pregnancy evidence consists of one case report, not a controlled study or cohort. FSANZ's 2022 assessment addressed kava beverage and found no pregnancy outcome data or human milk-transfer data. EMA's 2017 assessment reviewed earlier non-clinical evidence and said there were no studies on herbal preparations; its assessment predates the 2024 case. CDC's 2026 report analyzed poison-center reports from 2000 through 2025, which do not measure population incidence or pregnancy outcomes.
General-population kava beverage use and reported liver injury
- Source A says
- NCCIH reports rare liver injury, including serious or fatal cases and some involving water-prepared beverages. EMA records spontaneous reports of liver failure, transplants, and deaths and judged the benefit-risk balance unfavorable. (NCCIH: Kava, EMA: Public statement on Piper methysticum)
- Source B says
- WHO reports little documented evidence of adverse health effects with traditional moderate kava beverage use. FSANZ notes the long cultural history of moderate beverage use prepared in line with historical practices. (FAO/WHO: Kava beverage review, Food Standards Australia New Zealand: Kava Risk Assessment)
- Why they differ
- These sources address different exposures and questions: rare adverse reports and a regulator's product-level benefit-risk assessment versus traditional moderate beverage use. Poison-center and spontaneous reports cannot measure an individual's chance of injury, and historical use does not establish equivalent risk across concentrated extracts, commercial blends, or people with liver disease.
- What the evidence shows overall
- Both positions can be true at the same time. A long history of moderate traditional beverage use does not show that every commercial extract or mixture has the same risk. NCCIH reports include some water-prepared beverages, so water preparation does not remove the reported liver concern. This general-population context does not fill the separate evidence gaps for pregnancy and breastfeeding.
Not enough research found yet.
General research, not specific to pregnancy.
Multiple sources report rare, sometimes severe or fatal liver injury associated with kava. NCCIH says cases have involved alcohol- or acetone-extracted products and some water-prepared beverages; it also advises against combining kava with benzodiazepines or alcohol. EMA's herbal committee records spontaneous reports of liver failure, transplants, and deaths and judged the benefit-risk balance unfavorable for an EU herbal monograph. EMA also cites carcinogenic potential in animals for an herbal preparation; this does not establish human cancer risk. The FDA memo records a March 2002 warning about serious liver damage, while BfArM's 2019 action applied to specified medicinal products, not every beverage or supplement. BfR's 2002 physicians' notice records a warning that liver damage from consumption could not be excluded.
- NCCIH reports rare liver injury, sometimes serious or fatal, with products extracted using alcohol or acetone and with some water-prepared beverages. It also says not to combine kava with substances such as benzodiazepines or alcohol that have sedative effects. (NCCIH: Kava)
- FDA's 2020 memorandum records that on March 25, 2002, the agency warned that kava may be linked to serious liver damage. (FDA: Scientific Memorandum, Review of published literature pertaining to the safety of Kava for use in conventional foods)
- EMA's 2017 public statement records spontaneous liver adverse-reaction reports, including liver failure, transplants, and deaths. Its assessment also describes animal carcinogenic potential for an herbal preparation. (EMA: Public statement on Piper methysticum, EMA: Final assessment report on Piper methysticum)
- The German BfR/BgVV 2002 physicians' notice records the warning that liver damage from kava consumption could not be excluded. (BfR/BgVV: Physicians' notice on poisonings, 2002)
- BfArM's December 2019 notice concerned revocation of authorizations for kava- or kavain-containing medicinal products, including specified homeopathic preparations. It was not a universal action on all kava beverages or supplements. (BfArM: Medicinal products containing kava-kava, risk of severe hepatic injury)
- CDC's 2026 analysis reports 203 kava-related poison-center exposures in 2025; 61 (30%) involved kava and kratom together. Serious outcomes were reported in 32% of exposures in 2025, compared with 12% in 2000, and reached a 39% peak in 2024. These are poison-center reports, not population incidence. (CDC MMWR: Kava-Related Exposures Reported to U.S. Poison Centers, 2000-2025)
- NCCIH: KavaUS governmentSecondary
- EMA: Public statement on Piper methysticumEU agencySecondaryPage dated 2017-11-21Independent checkEuropean guidance
- EMA: Final assessment report on Piper methysticumEU agencySecondaryPage dated 2017-11-21Independent checkEuropean guidance
- Food Standards Australia New Zealand: Kava Risk AssessmentSecondaryPage dated 2022-10-06Independent check
- Spungen et al., Journal of Medical Toxicology: Neonatal and Maternal Ichthyosiform Dermopathy in Association with Kava Use during PregnancyUS governmentPrimary
- FAO/WHO: Kava beverage reviewInternational agencySecondaryIndependent check
- FDA: Scientific Memorandum, Review of published literature pertaining to the safety of Kava for use in conventional foodsUS governmentSecondaryPage dated 2020-08-11
- CDC MMWR: Kava-Related Exposures Reported to U.S. Poison Centers, 2000-2025US governmentSecondaryPage dated 2026-04-02
- BfR/BgVV: Physicians' notice on poisonings, 2002SecondaryPage dated 2002-10-23Independent check
- BfArM: Medicinal products containing kava-kava, risk of severe hepatic injurySecondaryPage dated 2019-12-23Independent check
Last reviewed 2026-10-16
Independent check 2026-10-16
Not yet clinician-reviewed
Ask your provider about your situation.