Herb-Induced Liver Injury With Cholestasis and Renal Injury Secondary to Short-Term Use of Kratom (Mitragyna speciosa)

Antony, Andrew; Lee, Tai-Ping

doi:10.1097/mjt.0000000000000802

Cited by 24 publications

(23 citation statements)

References 5 publications

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“…Jaundice was reported in four cases where the total bilirubin was the highest of all KIH cases, ranging from 6.5 mg/dL to 33.7 mg/dL (reference < 1 mg/dL) [58,59,63,64]. After kratom cessation, total bilirubin decreased within 2 days to 7 days [58][59][60][61][62][63][64]. The highest alkaline phosphatase recorded was 790 units/L (reference 35-129 units/L).…”

Section: Interventionmentioning

confidence: 91%

“…Overall, there were 41 cases on kratom-associated adverse events or toxicities (Table 1). Kratom-associated adverse events were as follows: kratom-associated withdrawal symptoms (KAWS) in adults [41][42][43][44][45][46][47][48][49][50][51][52], kratom-associated neonatal abstinence syndrome (KANAS) [48,[52][53][54][55][56], hypothyroidism [43], hypogonadism [57], kratom-induced hepatoxicity (KIH) [58][59][60][61][62][63][64][65], CNS effects causing seizure and coma or posterior reversible encephalopathy syndrome (PRES) [39,66,67], acute respiratory distress syndrome (ARDS) [68,69], overdose toxidrome [70,71], and fatalities [72][73][74][75][76][77][78][79][80]. There were six case series of aggregated patient's data [48,…”

Section: Literature Case Reviewmentioning

confidence: 99%

“…Kratom-Induced Hepatoxicity [58][59][60][61][62][63][64][65] Kratom-induced hepatotoxicity (KIH) has been reported after 2 to 4 weeks of use and rechallenge has led to recurrence [59,65]. The reported dose resulting in KIH was 14 to 21 g per day.…”

Section: Interventionmentioning

confidence: 99%

“…An extensive workup for acute viral hepatitis A, B, and C and assays of hepatotoxic substances such as salicylates, acetaminophen, and CNS medications were used to determine if the exhibited hepatotoxic effects were correlated. Four case reports studied the likelihood of KIH using association scales in which all found a 'probable' association [62][63][64][65]. Scales used included the Roussel Uclaf Causality Assessment Method, World Health Organization Uppsala Monitoring Centre and the International Organizations of Medical Sciences Scale.…”

Section: Interventionmentioning

confidence: 99%

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Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Alsarraf

Myers

Culbreth

et al. 2019

Curr Emerg Hosp Med Rep

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Purpose of Review This review describes case reports for patients with kratom-associated adverse events in order to assist clinicians with patient management. A stepwise approach is proposed for assessing active kratom users as well as considerations for the management of toxicities or withdrawal. Recent Findings Multiple in vitro and in vivo studies illustrate the pharmacologic and toxicologic effects of kratom extract. No randomized controlled trials in humans exist that assess the safety and efficacy of the substance. Cross-sectional surveys from active users and reports from poison control centers have shown acute and chronic physiological and psychological adverse events. Summary Reports of adverse effects associated with kratom use have demonstrated hypothyroidism, hypogonadism, hepatitis, acute respiratory distress syndrome, posterior reversible encephalopathy syndrome, seizure, and coma. Overdose toxidrome leads to respiratory failure, cardiac arrest, and fatalities. Adult and neonatal withdrawal symptoms have also occurred. Clinicians should be aware of the risks and benefits of kratom use.

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Section: Interventionmentioning

confidence: 91%

Section: Literature Case Reviewmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

See 2 more Smart Citations

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Alsarraf

Myers

Culbreth

et al. 2019

Curr Emerg Hosp Med Rep

View full text Add to dashboard Cite

show abstract

“…While several studies attempted to understand the addictive potential of kratom [5-7], reports describing kratom toxicity manifesting in specific organs are relatively few [8-11]. Also, although kratom-induced cholestatic and/or hepatocellular pattern liver injuries have been reported [12-14], reports with detailed histopathologic examination of the liver biopsy are rare [15-17].…”

Section: Introductionmentioning

confidence: 99%

Kratom-Induced Cholestatic Liver Injury Mimicking Anti-Mitochondrial Antibody-Negative Primary Biliary Cholangitis: A Case Report and Review of Literature

et al. 2019

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Kratom is an herbal supplement used to relieve chronic pain or opioid withdrawal symptoms. Recent news articles covering adverse effects associated with kratom use have brought attention to its organ toxicities. Reports of kratom-induced hepatic toxicity are limited and only three case reports of kratom-induced liver injury with histopathologic examination of the liver biopsies are available. A 40-year-old female presented with symptoms of mixed cholestatic and hepatocellular liver injury without clear etiology. The laboratory and imaging workup suggested possibilities of autoimmune hepatitis, autoimmune hepatitis-primary biliary cholangitis (PBC) overlap syndrome, or drug-induced liver injury. Autoantibodies including anti-mitochondrial antibody (AMA) were negative. Liver biopsy showed granulomatous hepatitis with prominent duct injury, suggestive of AMA-negative PBC. She subsequently was referred to a hepatologist and a history of recent kratom use was finally revealed. Kratom was discontinued and the symptoms improved. Kratom-induced hepatic toxicity may manifest with variable biochemical and clinical abnormalities. Histologically, it may mimic AMA-negative PBC. Our case highlights the importance of thorough history taking, interdisciplinary approach and communication for optimal patient care.

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Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

Hartley

Bulloch

Penzak

2022

The Journal of Clinical Pharma

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Kratom (Mitragyna speciosa) consists of over 40 alkaloids, with 2 of them, mitragynine and 7-OH-mitragynine (7-OH-MG) being the main psychoactive compounds. Mitragynine and 7-OH-mitragynine each target opioid receptors and have been referred to as atypical opioids. They exert their pharmacologic effects on the mu, delta, and kappa opioid receptors. In addition, they affect adrenergic, serotonergic, and dopaminergic pathways. Kratom has been touted as an inexpensive, legal alternative to standard opioid replacement therapy such as methadone and buprenorphine. Other uses for kratom include chronic pain, attaining a "legal high," and numerous central nervous system disorders, including anxiety, depression, and posttraumatic stress disorder. Kratom induces analgesia and mild euphoria, with a lower risk of respiratory depression or adverse central nervous system effects compared to traditional opioid medications. Nonetheless, kratom has been associated with both physical and psychological dependence, with some individuals experiencing classic opioid withdrawal symptoms upon abrupt cessation. Kratom use has been linked to serious adverse effects, including liver toxicity, seizures, and death. These risks are often compounded by polysubstance abuse. Further, kratom may potentiate the toxicity of coadministered medications through modulation of cytochrome P450, P-glycoprotein, and uridine diphosphate glucuronosyltransferase enzymes. In 2016, the US Drug Enforcement Administration took steps to classify kratom as a federal schedule 1 medication; however, due to public resistance, this plan was set aside. Until studies are conducted that define kratom's role in treating opioid withdrawal and/or other central nervous system conditions, kratom will likely remain available as a dietary supplement for the foreseeable future.

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Herb-Induced Liver Injury With Cholestasis and Renal Injury Secondary to Short-Term Use of Kratom (Mitragyna speciosa)

Cited by 24 publications

References 5 publications

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Kratom-Induced Cholestatic Liver Injury Mimicking Anti-Mitochondrial Antibody-Negative Primary Biliary Cholangitis: A Case Report and Review of Literature

Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

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