Re: Advisory: Kava-kava and asarum (aristolochic acid)

Issue: BCMJ, vol. 55, No. 2, March 2013, Page 73 Letters
By: H.C. George Wong, MD, FRCPC

Health Canada intermittently issues advisories with a warning or stop-sale order on harmful complementary and alternative medicines. Homeopathic medicine is supposed to be safe to use because of its extreme dilution. However, there are reports of adverse reactions from homeopathic medicine including kava-kava, aconite, arsenic, and thallium.[1-3]

Severe hepatic toxicity was noted in patients taking kava products in 2001. In the following year, several European countries, including Switzerland, France, the Netherlands, and Britain, banned the sale of kava-kava. Canada Health also issued a stop-sale order.[4] In 2005 Health Canada issued a warning on products containing aristolochic acid stating that they can cause cancer, cell mutation, and kidney failure.[5]

Kava-kava tablets (labeled Comprimes Kava-Kava-Medicament homeopathique/Kava-Kava Tabletten-Homoopathisches Arzneimittel) have been found for sale in a pharmacy in Geneva, Switzerland. A Chinese herbal shop in Shanghai, China, carries a Chinese proprietary medicine with herbal content, Xiaoqinglong Heji. Asarum is among the eight Chinese herbs listed in this preparation. Asarum is one of the several herbs known to contain aristolochic acid in the advisory.

Patients should be advised to be careful when purchasing complementary and alternative medicines overseas. There is a potential for serious adverse reaction including hepatotoxic, carcinogenic, mutagenic, and nephrotoxic reaction present in some preparations.
—H.C. George Wong, MD
Vancouver

References

1.    Guha S, Dawn B, Dutta G, et al. Bradycardia, reversible panconduction defect and syncope following self-medication with a homeopathic medicine. Cardiology 1999;91:268-271.
2.    Chakraborti D, Mukherjee SC, Saha KC. et al. Arsenic toxicity from homeopathic treatment. J Toxicol Clin Toxicol 2003;41:963-967.
3.    Stevens WJ. Thallium intoxication caused by a homeopathic preparation. Toxicol Eur Res 1978;1:317-320.
4.    Kava-Kava is a no-no, says Health Canada. Accessed 3 January 2013. www.cbc.ca/news/canada/ottawa/story/2002/08/21/kava020821.html.
5.    Health Canada reminds consumers not to use products containing aristolochic acid. Accessed 1 January 2013. www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2005/2005_08-eng.php.

H.C. George Wong, MD, FRCPC. Re: Advisory: Kava-kava and asarum (aristolochic acid). BCMJ, Vol. 55, No. 2, March, 2013, Page(s) 73 - Letters.


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