Drug General Information (ID: DDIOJS236X)
Drug Name			Ethanol		Drug Info		Kava		Drug Info
Drug Type		Small molecule				Natural product
Therapeutic Class		Analgesics				Herbal Products
Structure

Mechanism of Ethanol-Kava Interaction (Severity Level: Moderate)
Increased risk of hepatotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Ethanol				Kava
Mechanism		Hepatotoxicity				Hepatotoxicity
Key Mechanism Factor 1
		Factor Name		Hepatotoxicity
		Factor Description		Combination of drugs that can induce hepatotoxicity may increase the risk of liver injury. Symptoms vary depending on the level of exposure and the total extent of liver damage, and may cause few symptoms if the damage is mild, and eventually lead to liver failure in patients with severe damage.
Mechanism Description		Increased risk of hepatotoxicity by the combination of Ethanol and Kava

Recommended Action
Management		In general, patients should consult a healthcare provider before taking any herbal or alternative medicine. Use of kava-containing products with alcohol should be avoided. Patients using kava should be instructed to discontinue the drug promptly and seek medical attention if signs and symptoms of hepatic injury develop, including fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.

References
1	Oketch-Rabah HA, Roe AL, Rider CV, et al. United States Pharmacopeia (USP) comprehensive review of the hepatotoxicity of green tea extracts.?Toxicol Rep. 2020;7:386-402. Published 2020 Feb 15. doi:10.1016/j.toxrep.2020.02.008. [PMID: 32140423]
2	Escher M, Desmeules J, Giostra E, Mentha G "Hepatitis associated with Kava, a herbal remedy for anxiety." Br Med J 322 (2001): 139. [PMID: 11159570]
3	Hepatic toxicity possibly associated with kava-containing products--United States, Germany, and Switzerland, 1999-2002. MMWR Morb Mortal Wkly Rep 51 (2002): 1065-7. [PMID: 12500906]
4	Izzo AA, Ernst E "Interactions between herbal medicines and prescribed drugs: a systematic review." Drugs 61 (2001): 2163-75. [PMID: 11772128]
5	Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11. [PMID: 9818800]
6	Russmann S, Lauterburg BH, Helbling A "Kava hepatotoxicity." Ann Intern Med 135 (2001): 68-9. [PMID: 11434754]