Kava (Piper methysticum) (Piper Latin for "pepper", methysticum Greek for "intoxicating") is an ancient crop of the western Pacific. Other names for kava include ʻawa (Hawaiʻi), 'ava (Samoa), yaqona (Fiji), and sakau (Pohnpei). The word kava is used to refer both to the plant and the beverage produced from its roots. Kava is a tranquilizer primarily consumed to relax without disrupting mental clarity. Its active ingredients are called kavalactones. In some parts of the Western World, kava extract is marketed as herbal medicine against stress, insomnia, and anxiety. A Cochrane Collaboration systematic review of its evidence concluded that it was likely to be more effective than placebo at treating short-term social anxiety. Safety concerns have been raised over liver toxicity, although research indicates that this may be largely due to the use of stems and leaves in supplements, which were not used indigenously. Effects of kavalactones include mild sedation, a slight numbing of the gums and mouth, and vivid dreams. Kava has been reported to improve cognitive performance and promote a cheerful mood. Muscle relaxant, anaesthetic, anticonvulsive and anxiolytic effects are thought to result from direct interactions of kavalactones with voltage-gated ion channels. [6] Research currently suggests that kavalactones potentiate GABAA activity but do not alter levels of dopamine and serotonin in the CNS. Heavy, long-term kava use does not cause any reduction of ability in saccade and cognitive tests but is associated with elevated liver enzymes. Desmethoxyyangonin, one of the six major kavalactones, is a reversible MAO-B inhibitor (Ki 280 nM) and is able to increase dopamine levels in the nucleus accumbens. This finding might correspond to the slightly euphoric action of kava. Kavain, in both enantiomeric forms, inhibits the reuptake of noradrenalin at the transporter (NAT), but not of serotonin (SERT). An elevated extracellular NA level in the brain may account for the reported enhancement of attention and focus.