Kava Withdrawal: Can It Be Severe?

study PMID: 40541460

Quick Summary: A recent study showed that stopping heavy kava use can lead to serious withdrawal symptoms, like hallucinations and anxiety. Doctors successfully treated these symptoms in one person using medication.

What The Research Found

This research looked at one person who experienced severe withdrawal symptoms after stopping a drink containing kava. The symptoms included seeing and hearing things that weren't there, feeling anxious, having trouble sleeping, and muscle jerks. Doctors treated the person with a medication called phenobarbital, which helped ease the symptoms. This case suggests that kava withdrawal, though rare, can be serious enough to need medical care.

Study Details

Who was studied: A 45-year-old man who had been drinking a beverage containing both kava and kratom.

How long: The study doesn't specify how long the person used kava or kratom.

What they took: The person was given phenobarbital to help with withdrawal symptoms. Later, they were switched to diazepam, another medication.

What This Means For You

Be aware: Kava is often marketed as a natural way to reduce anxiety. However, this study shows that stopping heavy use can cause withdrawal symptoms.

Talk to your doctor: If you're using kava regularly and want to stop, talk to your doctor first. They can help you do it safely.

Watch out for combinations: This study involved a drink with both kava and kratom. Using multiple substances can increase the risk of problems.

Study Limitations

One person: This study only looked at one person, so we can't say for sure how common severe kava withdrawal is.

Kratom involved: The person was also using kratom, so it's hard to know if all the symptoms were from kava alone.

Unclear dosage: The study didn't say how much kava the person was taking.

More research needed: We need more research to understand kava withdrawal better and how to treat it.

Key Findings

This case study reports the successful management of severe kava withdrawal symptoms using phenobarbital in a 45-year-old man. The patient experienced auditory/visual hallucinations, anxiety, insomnia, and muscle jerking after discontinuing heavy use of a kava-kratom beverage. While kratom withdrawal was initially suspected and treated with buprenorphine, ED evaluation identified GABAergic withdrawal linked to kava use. Phenobarbital administration led to significant symptom improvement, followed by transition to diazepam. The study highlights that kava withdrawal, though rarely documented, can be severe enough to require hospitalization and may respond to GABAergic agents.

Study Design

This was a single-case observational study published in 2025. The subject was a 45-year-old male with a history of heavy consumption of a supplemental beverage containing both kava and kratom. The timeline of use and withdrawal duration prior to ED presentation was unspecified, but symptoms emerged after abrupt discontinuation. No control group, randomization, or structured follow-up was reported.

Dosage & Administration

The study does not specify the exact doses or duration of kava or kratom consumption by the patient. For withdrawal management, phenobarbital was administered intravenously (exact dosage unspecified in the summary), followed by a transition to oral diazepam.

Results & Efficacy

Phenobarbital led to "significant improvement" in withdrawal symptoms, including resolution of hallucinations and muscle jerking, though no quantitative metrics (e.g., symptom severity scores, biomarkers) were reported. The patient was discharged in good condition after several days, suggesting clinical efficacy in managing acute symptoms. No statistical analysis (p-values, confidence intervals) was applicable due to the single-case design.

Limitations

Single-case design: Findings cannot be generalized to broader populations.
Concurrent kratom use: The beverage contained both kava and kratom, complicating attribution of withdrawal symptoms solely to kava.
Lack of standardized dosing: No data on the patient’s kava/kratom intake amounts or duration.
No pharmacokinetic analysis: Mechanisms of kava withdrawal or treatment response remain speculative.
Potential recall bias: Patient-reported usage history may be inaccurate.
Future research should explore kava-specific withdrawal syndromes, optimal treatment protocols, and the role of combined herbal supplement use.

Clinical Relevance

This case underscores that heavy kava use may lead to severe withdrawal requiring medical intervention, despite its common marketing as a "safe" anxiolytic. Clinicians should consider GABAergic agents (e.g., phenobarbital, benzodiazepines) for managing kava withdrawal symptoms, particularly in cases involving neuropsychiatric manifestations. Supplement users should be aware that abrupt cessation of chronic kava consumption could trigger adverse effects, and combinations with substances like kratom may compound risks. However, the lack of dose-response data and confounding from kratom use limits definitive recommendations.

Source: PubMed Case Study (2025)