Cases That Test Your Skills

The consequences of sipping ‘tea’

Current Psychiatry. 2006 November;5(11):132-145

References

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Treatment: quick resolution

We admit Mr. J to the inpatient psychiatry unit. There, we continue his outpatient prescription medications at the same dosages and block access to nonprescription substances. His symptoms begin to improve during the first day of hospitalization. His choreoathetosis, hallucinations, and confusion resolve within 48 hours, and he is medically stable.

We discharge Mr. J after 2 days and continue citalopram and clonazepam at the same dosages.

The authors’ observations

Kava reaches peak plasma levels 1.8 hours after oral dosing and has a short (9-hour) elimination half-life. As a result, kava intoxication symptoms tend to resolve rapidly, as in Mr. J’s case.

Although Mr. J is medically stable, liver damage associated with kava use can be irreversible, prompting some European countries to ban its sale. Make sure patients who report kava use are aware of its hepatotoxicity risk.

Follow-up: kicking the kava habit

Two weeks after Mr. J’s discharge, his psychiatrist notes that his mental status has returned to baseline and that his skin has improved dramatically. The patient is following his citalopram and clonazepam regimen, and he seems more aware of kava’s potential adverse effects.

Mr. J reports that he has not consumed kava since his hospitalization. He has been eating four meals per day and has gained 9 lb. He is pleased with his improved appetite and is motivated to continue abstaining from kava.

Related resources

National Center for Complementary and Alternative Medicine. http://nccam.nih.gov.
Physicians Desk Reference (PDR) for herbal medicines, 3rd ed. Montvale, NJ: Thomson PDR; 2004.
Ernst E, Pittler MH, Stevinson C, et al. The desktop guide to complementary and alternative medicine. Edinburgh, UK: Mosby; 2001.

Drug brand name

Alprazolam • Xanax
Buspirone • BuSpar
Carbamazepine • Equetro, others
Carbidopa • Lodosyn
Citalopram • Celexa
Clonazepam • Klonopin
Clozapine • Clozaril
Trazodone • Desyrel

Disclosures

The authors report no financial relationship with any company whose products are mentioned in this article, or with manufacturers of competing products.

The consequences of sipping ‘tea’

References

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