Kava kava: examining new reports of toxicity
Kava kava: examining new reports of toxicity
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DOI：
10.1016/j.toxlet.2003.07.005
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发表时间：
2004-04-15
影响因子：
3.5
通讯作者：
Clouatre, DL
中科院分区：
文献类型：
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作者：
Clouatre, DL
1998年以前，卡瓦胡椒的提取物被认为是非常安全的抗焦虑药物的替代品，并可能发挥广泛的其他益处。2002年底发表的主要评论继续证实卡瓦的安全性和有效性。然而，到2003年1月，卡瓦提取物已在整个欧洲联盟和加拿大被禁止，并受到美国食品和药物管理局的警告和建议，因为有11例肝功能衰竭导致肝脏移植，其中包括4例死亡。据报道，共有78例肝毒性病例与摄入卡瓦有关，可从各种数据库中进行审查。在这些不良事件中，4个可能与单独服用卡瓦内酯有关，另外23个可能与摄入卡瓦内酯有关，但也涉及同时摄入其他具有潜在肝毒性的化合物。卡瓦内酯肝毒性的三种可能机制是已知的：抑制细胞色素P450，降低肝脏谷胱甘肽含量，以及更遥远的抑制环氧化酶活性。在任何分析中，卡瓦提取物的直接毒性都很小，但药物相互作用和/或其他化合物毒性增强的可能性很大。目前，卡瓦的毒性似乎是“特殊的”。然而，与用于治疗焦虑的其他药物相比，卡瓦提取物的风险-收益比仍然很好。2004爱思唯尔爱尔兰有限公司版权所有。
Before 1998, extracts of kava kava, Piper methysticum, were considered to be very safe alternatives to anxiolytic drugs and to possibly exert a wide range of other benefits. Major reviews published through the end of 2002 continued to confirm kava's safety and efficacy. Nevertheless, by January 2003 kava extracts had been banned in the entire European Union and Canada, and were subject to cautions and advisories by the US FDA as a result of I I cases of hepatic failure leading to liver transplants, including four deaths. A total of 78 cases of hepatotoxicity reputedly linked to kava ingestion are available for review from various databases. Of these adverse events, four probably are linked to kavalactones taken alone and another 23 are potentially linked to kava intake, but also involve the concomitant ingestion of other compounds with potential hepatotoxicity. Three possible mechanisms for kavalactone hepatotoxicity are known: inhibition of cytochrome P450, reduction in liver glutathione content and, more remotely, inhibition of cyclooxygenase enzyme activity. The direct toxicity of kava extracts is quite small under any analysis, yet the potential for drug interactions and/or the potentiation of the toxicity of other compounds is large. Presently, kava toxicity appears to be "idiosyncratic." The risk-to-benefit ratio of kava extracts, nevertheless, remains good in comparison with that of other drugs used to treat anxiety. (C) 2004 Elsevier Ireland Ltd. All rights reserved.