Kava-containing compound causes fatal liver damage

A 56-year old woman died in Melbourne following the use of a herbal remedy containing kava and passiflora incarnata. The woman's death is believed to be the first in Australia caused by liver failure associated with a preparation containing kava.

The general public and alternative medicine practitioners need to be aware of the potential for non-prescription drugs to cause serious liver problems, according to an article in the current edition of the Medical Journal of Australia.

The article, by Dr Paul Gow and colleagues from the Austin and Repatriation Hospital in Melbourne, examines the circumstances of the woman's death.

"Worldwide, at least 68 cases of suspected liver damage associated with the use of kava-containing products have been reported, including six resulting in liver transplantation and three deaths," said gastroenterologist Dr Gow.

"In February 2002 the Therapeutic Goods Administration (TGA) issued an alert warning of the potential for liver damage associated with the use of products containing kava," he said.

"This alert was widely distributed to doctors, pharmacists and alternative medicine practitioners.

"The patient we described began taking a preparation containing kava after the TGA alert was issued, and apparently was unaware of the alert."

Medication reactions resulting in abnormal liver function are relatively common but rarely result in severe liver injury.

A careful history of any drug or herbal remedy use should be taken in all patients with unexplained hepatitis. Continuing to use the drug after the onset of injury could have catastrophic results. For some patients, a liver transplant may offer the only realistic chance of survival.

"The lack of regulation within the alternative medicine community and general availability of non-prescription medications may have contributed to the death of this woman.

"A statutory obligation for dispensers of non-prescribed medications to provide information to the consumer at the point of sale regarding any future drug alerts may help to limit further morbidity and mortality," Dr Gow said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT: Dr Paul Gow, 03 9888 4064 (H), 0417 528 237

Judith Tokley, AMA, 0408 824 306