For most adults, kava is generally considered low risk when it is used occasionally, as directed, and never with alcohol. It is not risk free: kava has been linked to rare cases of serious liver injury, and some people should skip it or talk to a doctor first. Here is what the research says, in plain language.
In This Guide
If you are curious about kava as an alcohol-free way to unwind, it is smart to ask about safety first. A quick search turns up everything from glowing reviews to old headlines about liver damage, and it can be hard to tell what still applies.
This article walks through the history, what health agencies say today, and the practical steps that matter most. It is for general information and is not medical advice. For background on kava itself, see What Is Kava? and our guide to kava as an alcohol alternative.
The Early-2000s Liver Reports
Kava has been prepared and shared across the Pacific Islands for centuries, traditionally by mixing ground root with water. In the 1990s, kava extracts became popular dietary supplements in Europe and the US, often sold as pills made with solvents like acetone or ethanol rather than water.
Around the turn of the century, European regulators received reports of serious liver injury in people who had taken kava supplements, including some cases that led to liver transplants. Several countries restricted or pulled kava products from the market. (Germany, one of the first, later saw its restrictions overturned in court.)
In March 2002, the US Food and Drug Administration issued a consumer advisory warning about the potential risk of rare but severe liver injury from kava-containing dietary supplements. The FDA did not ban kava, and it remains legal in the US, but the advisory shaped how kava has been viewed ever since.
Many of the reported cases involved concentrated supplement pills, often taken with alcohol or medications. That does not make the reports unimportant. It does help explain why later researchers looked closely at how kava was made and used.
What Later Reviews Found
In 2007, the World Health Organization published an assessment of the risk of liver toxicity with kava products. Its overall view was that serious liver problems linked to kava appear to be rare, and that a number of factors may have played a role in the reported cases, including:
- Poor-quality raw material, or the use of plant parts other than the peeled root, such as stems, leaves or peelings
- Extraction with organic solvents instead of water
- Use of non-noble kava varieties
- Use alongside alcohol or medications that affect the liver
- Individual differences between people
The WHO report suggested that water-based preparations made from the peeled root of noble kava varieties, similar to traditional preparation, were the better-supported approach.
Today, the National Center for Complementary and Integrative Health (NCCIH), part of the NIH, still notes that kava has been associated with a risk of severe liver damage, and that it may cause side effects and interact with medications. In short: the risk appears to be rare, but it is real enough that health agencies continue to flag it.
| Year | Source | What it said |
|---|---|---|
| 2002 | US FDA | Consumer advisory on the potential risk of rare but severe liver injury from kava supplements |
| 2007 | World Health Organization | Liver problems appear rare; plant quality, plant parts, extraction method and use with alcohol or medications may play a role |
| Today | NIH (NCCIH) | Kava has been associated with a risk of severe liver damage; it may cause side effects and interact with medications |
Why Preparation and Noble Varieties Come Up
Noble varieties. Kava plants are grouped by cultivar. "Noble" varieties are the ones traditionally preferred for regular drinking in places like Vanuatu, which regulates which varieties can be exported. Other types, sometimes called "tudei" (two-day) kava, are known for longer-lasting effects and are generally not recommended for regular use.
Plant part and preparation. Traditional kava uses the peeled root mixed with water. Stems, leaves and peelings have a different chemical makeup. That is why many kava sellers describe both the variety and the plant part on their labels.
If you are buying kava in any form, look for a seller who tells you what is in the product and how much. Ready-to-drink seltzers list the kava or kavalactone amount per can right on the label.
Reported Side Effects
Many people describe kava as relaxing and social. Others notice effects they do not enjoy. Commonly reported side effects include:
- A numb or tingly mouth and tongue (this is expected with traditional kava and usually fades quickly)
- Upset stomach
- Headache
- Drowsiness
- Dry, scaly skin, which has been associated with heavy, long-term use
Stop using kava and contact a doctor if you notice yellowing of the skin or eyes, dark urine, unusual tiredness, or nausea or stomach discomfort that does not go away.
Kava and Alcohol, and Kava and Driving
Do not combine kava with alcohol. Both can cause drowsiness, and health agencies advise against using them together. If kava is part of your plan to drink less, keep it as the alcohol-free option for the night, not an add-on.
Do not drive after drinking kava until you know how it affects you, and never drive if you feel any effects. The same goes for operating machinery.
Who Should Skip Kava or Talk to a Doctor First
- People who are pregnant or nursing. There is not enough research to show kava is safe during pregnancy or breastfeeding.
- Anyone with a liver condition, or a history of liver problems.
- People taking medications, especially any that affect the liver or cause drowsiness. Kava may interact with some medications.
- Anyone planning surgery. Let your doctor know about any supplements or botanicals you use, including kava.
- Anyone under 18.
It also helps to read the whole label. Some kava drinks include other botanicals; our No. 505 Kava Seltzer, for example, also contains ashwagandha. If you take medications or are pregnant, ask your doctor about every ingredient, not only the kava.
Start Low, Go Slow
If you and your doctor are comfortable with you trying kava, start low and go slow:
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Read the label first
Check how much kava or kavalactones each serving contains, and what else is in it.
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Sip slowly and wait
Wait at least 30 minutes before having more so you know how kava affects you.
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Keep it alcohol-free
Do not mix kava with alcohol, and do not drive if you feel any effects.
For serving tips and the difference between traditional kava and kava seltzers, see How to Drink Kava.
Shop This Guide
If you decide kava is right for you, our kava-only seltzers list exactly what is in every can. Browse the full kava collection.
Grapefruit Paloma flavor, alcohol-free. Label: 100mg of kava per 16 oz can.
$38.00
Shop the 4-pack
Hops and orange flavor, alcohol-free. Label: 150mg kavalactones and 300mg ashwagandha per 16 oz can.
$38.00
Shop the 4-packFrequently Asked Questions
Is kava bad for your liver?
Kava has been linked to rare but serious cases of liver injury, mostly reported in the late 1990s and early 2000s. Later reviews, including a 2007 World Health Organization assessment, judged the risk to be rare and pointed to factors such as plant quality, plant parts used, extraction methods, and use alongside alcohol or medications. The NIH still notes a possible risk of liver damage, so anyone with a liver condition should talk to a doctor first.
What are the side effects of kava?
Commonly reported effects include a numb or tingly mouth, upset stomach, headache, and drowsiness. Heavy, long-term use has been associated with dry, scaly skin. Stop using kava and contact a doctor if you notice signs of liver trouble, such as yellowing skin or eyes, dark urine, unusual tiredness, or nausea that does not go away.
Can you drink kava every day?
There is limited research on daily use of modern kava drinks, and reported problems tend to involve heavy, long-term use. Follow the label, start low and go slow, and if kava is becoming a daily habit, check in with your doctor.
Can you mix kava and alcohol?
No. Do not combine kava with alcohol. Both can cause drowsiness, and health agencies advise against using them together.
Is it safe to drive after drinking kava?
Kava can make some people drowsy. Do not drive or operate machinery until you know how kava affects you, and never drive if you feel any effects.
Who should avoid kava?
Skip kava, or talk to your doctor first, if you are pregnant or nursing, have a liver condition, take medications (especially any that affect the liver or cause drowsiness), or are under 18.
Sources & References
- National Center for Complementary and Integrative Health (NIH). Kava. https://www.nccih.nih.gov/health/kava
- US Food and Drug Administration. Consumer Advisory: Kava-Containing Dietary Supplements May Be Associated With Severe Liver Injury. March 25, 2002.
- World Health Organization. Assessment of the Risk of Hepatotoxicity with Kava Products. Geneva: WHO, 2007.
