Module 3
Drug Interaction Checker
Screen 24 substances against kava's CYP450 inhibition profile. Color-coded severity matrix with mechanism explanations and PRI protocol notes.
Alcohol
HARD STOPMechanism
Additive GABA suppression plus combined hepatotoxicity; liver enzyme induction from both.
PRI Protocol
No alcohol same day as kava ceremony; 24-hr washout minimum; mezcal toast = 1 to 2 sip ceremonial only.
Benzodiazepines (all)
HARD STOPMechanism
Combined GABA-A potentiation leading to respiratory depression; CYP3A4 inhibition elevates benzo blood levels.
PRI Protocol
Taper and clear before PRI entry; 2-week minimum washout; physician oversight required.
Alprazolam (Xanax)
CRITICALMechanism
Documented case of semicomatose state from kava plus alprazolam combination.
PRI Protocol
Absolute contraindication, no exceptions in ceremonial context.
Opioids (all)
HARD STOPMechanism
CNS depression compounded; CYP2D6 inhibition raises opioid blood levels; respiratory depression risk.
PRI Protocol
Active opioid use = disqualification; document opioid history at intake.
Buprenorphine (Suboxone)
CRITICALMechanism
Use with buprenorphine can lead to respiratory distress, coma, or death.
PRI Protocol
Absolute contraindication regardless of MAT status.
SSRIs and SNRIs
MODERATEMechanism
CYP2D6 inhibition elevates SSRI levels; serotonergic activity overlap; unpredictable interaction profile.
PRI Protocol
Physician clearance required; most SSRIs require case-by-case evaluation; avoid ceremonial kava on SSRIs without MD sign-off.
MAOIs (irreversible)
HARD STOPMechanism
Kava MAO-B inhibition + irreversible MAOI = dangerous amplification of monoamine pathways.
PRI Protocol
14-day minimum washout before any kava; critical for peyote/mescaline sequencing context.
Statins
MODERATEMechanism
CYP3A4 inhibition raises statin blood levels leading to increased myopathy risk.
PRI Protocol
Physician review of statin dosing required for regular kava practitioners.
Warfarin (blood thinners)
MODERATEMechanism
CYP2C9 inhibition 92% elevates warfarin leading to bleeding risk.
PRI Protocol
Not appropriate without hematology clearance.
Acetaminophen (Tylenol)
CAUTIONMechanism
Combined hepatotoxic pathway burden; both deplete liver glutathione.
PRI Protocol
Avoid within 48 hours of kava session; use ibuprofen if pain relief needed.
Anesthesia (surgical)
HARD STOPMechanism
Kava potentiates anesthetic effect; blood pressure instability documented.
PRI Protocol
Stop kava minimum 2 weeks before any scheduled surgery.
Parkinson's medications (Levodopa)
HARD STOPMechanism
Kava may worsen Parkinson's symptoms by interfering with dopamine function; counteracts L-DOPA.
PRI Protocol
Parkinson's diagnosis = absolute contraindication.
Cannabis (THC)
COMPLEXMechanism
Yangonin has CB1 receptor affinity; cannabis plus kava may produce unpredictable CNS depression amplification.
PRI Protocol
Cannabis use disclosures required at intake; 12-hour abstinence before ceremony.
Peyote (Mescaline)
RESEARCH FRONTIERMechanism
MAO-B mild inhibition from kava; mescaline is a phenethylamine metabolized partly by MAO-B; theoretical potentiation not clinically quantified.
PRI Protocol
24-hour minimum separation; kava as preparation night before only.
Psilocybin mushrooms
RESEARCH FRONTIERMechanism
Psilocybin metabolized by CYP2D6 which kava inhibits 73%; potential elevation of psilocin levels; no clinical data in humans.
PRI Protocol
Kava preparation night before only, not same day; precautionary 12-hr separation minimum.
MDMA
ELEVATED RISKMechanism
CYP2D6 inhibition 73% significantly elevates MDMA blood levels; serotonin syndrome risk amplified; hepatic stress combined.
PRI Protocol
MDMA use disclosures mandatory; recent MDMA use = defer ceremony minimum 2 weeks.
Methamphetamine (ICE)
COMPLEXMechanism
Opposite pharmacological axes: CNS stimulant vs CNS depressant; kava studied in harm reduction context for meth comedowns; not concurrent use.
PRI Protocol
Never concurrent; minimum 48-72 hour abstinence from meth before kava; community facilitator oversight required.
Kratom
ELEVATED RISKMechanism
CNS depressant overlap; opioid-mimicking kratom plus kava GABA = respiratory depression concern.
PRI Protocol
7-day abstinence before ceremony.
St. John's Wort
CAUTIONMechanism
Combined serotonergic activity; opposite CYP enzyme directions: kava inhibits, SJW induces.
PRI Protocol
Disclose at intake; adjust kava dosing downward if SJW active.
Antifungals (ketoconazole)
MODERATEMechanism
CYP3A4 competition; combined liver enzyme stress.
PRI Protocol
Defer kava ceremony during active antifungal treatment course.
Caffeine
NOTABLEMechanism
Kava inhibits CYP1A2 by 56%; caffeine metabolized 56% slower, lasts longer, feels stronger.
PRI Protocol
No coffee 4+ hours before kava ceremony; disclose daily caffeine intake at intake.
Valerian / Melatonin
ADDITIVEMechanism
Both produce sedation; combined effect may overshoot into excessive drowsiness.
PRI Protocol
Use intentionally for sleep optimization night before ceremony; reduce both doses if combining.
Ashwagandha (adaptogens)
GENERALLY OKMechanism
No hepatotoxic overlap with noble kava; cortisol modulation may complement anxiolysis.
PRI Protocol
Compatible with PRI protocol; popular commercial kava blends already combine these.
L-Theanine
SYNERGISTICMechanism
Both modulate GABA; theanine promotes alpha waves; complementary anxiolysis without sedation overshoot.
PRI Protocol
Excellent combination for facilitators and participants during prep work.
CYP450 Enzyme Inhibition Profile
Kava's kavalactone components inhibit five major liver enzymes. This is the primary mechanism by which kava interacts with medications.
CYP1A2
56%Affected medications: Caffeine, theophylline, some antidepressants
CYP2C9
92%Affected medications: Warfarin, some statins, NSAIDs
CYP2C19
86%Affected medications: PPIs, clopidogrel, some antidepressants
CYP2D6
73%Affected medications: Antidepressants, opioids, beta-blockers, MDMA, psilocybin
CYP3A4
78%Affected medications: Benzodiazepines, statins, HIV meds, antifungals
NOT affected by kava:
CYP2A6, CYP2C8, CYP2E1