Pharmacologic and clinical assessment of kratom

White, C. Michael

doi:10.2146/ajhp161035

Cited by 42 publications

(11 citation statements)

References 24 publications

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“…Other names include Thom, Thang, Kakuam, Ketom, and Biak. Although reports of its use in these indigenous regions date back to the 1800s, it is now being cultivated in other parts of the world [2]. Traditional use involved chewing the fresh leaves or preparing tea from its dried leaves.…”

Section: Introductionmentioning

confidence: 99%

“…Routes of use include inhalation and oral ingestion. Kratom is also added to cocktails, caffeinated beverages, cough syrup, and cannabinoid preparations for recreational use [2].…”

Section: Introductionmentioning

confidence: 99%

“…Fentanyl and fentanyl analogs were the most frequently identified co-occurring substances in these deaths. Reports of other co-occurring substances in fatal overdoses have cited propylhexedrine (Datura stramonium), carisoprodol, morphine, and even seemingly innocuous agents such as diphenhydramine and caffeine [2,10,12]. The last two, however, have typically led to fatalities in combination with morphine.…”

Section: Introductionmentioning

confidence: 99%

“…The last two, however, have typically led to fatalities in combination with morphine. Considering that diphenhydramine is a CYP 2D6 inhibitor, one can understand how the toxicity risk of combination products containing diphenhydramine can be elevated [2].…”

Section: Introductionmentioning

confidence: 99%

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A Case of Kratom-induced Seizures

Afzal¹,

Esang²,

Rahman³

2020

Cureus

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Kratom or Mitragna speciosa is a tropical tree that is indigenous to Southeast Asia, where it has been used for various medicinal reasons. In the West, it is used in the self-treatment of opioid withdrawal, pain, and a variety of mood and anxiety states. Two active ingredients in kratom are mitragynine and 7-hydroxymitragynine, which have affinity at the mu-opioid receptor among others. Kratom is easily available over the Internet and its use is increasing in the United States. It is currently listed by the Drug Enforcement Administration as a drug of concern. In 2017, the U.S. Food and Drug Administration started issuing a series of warnings about kratom, and by early 2018, it released a statement identifying 44 deaths related to kratom use. The Centers for Disease Control and Prevention has also reported 91 deaths directly linked to kratom use in 2019. Although its safety profile needs additional research for clarification, there have been reports of kratom-induced or kratom-related respiratory depression, hypothyroidism, secondary hypogonadism, hyperprolactinemia, psychosis, and seizures. We report a case of kratom-induced tonic-clonic seizures in a 27-year-old Caucasian male with a psychiatric history of anxiety, attention-deficit/hyperactivity disorder, benzodiazepine use disorder, and opioid use disorder. He was hospitalized after a witnessed tonic-clonic seizure. There was no significant metabolic abnormality on laboratory testing. Spinal cord and brain imaging were unremarkable, whereas his urine toxicology was positive for opioids only, which was likely a false-positive result due to cross-reactivity with his sleeping aids. He was evaluated by the Consultation-Liaison Psychiatry team for psychotic symptoms. On evaluation, the patient's psychosis had resolved, but he endorsed racing thoughts, significant anxiety, and insomnia. He admitted to drinking three to four 8-mL bottles of Kratom daily for one-and-ahalf years to self-medicate his anxiety after losing his health insurance. In the hospital, he was treated with anxiolytics, counseled to abstain from Kratom use, and was referred for substance use disorder treatment. This case highlights the life-threatening complications of Kratom that is easily available online.

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Section: Introductionmentioning

confidence: 99%

“…Routes of use include inhalation and oral ingestion. Kratom is also added to cocktails, caffeinated beverages, cough syrup, and cannabinoid preparations for recreational use [2].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Case of Kratom-induced Seizures

Afzal¹,

Esang²,

Rahman³

2020

Cureus

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“…Castillo et al (20) reported a case of kratom-induced PRES in a patient on fluoxetine for depression with dextroamphetamine misuse. Kratom exerts α2-adrenoreceptor agonistic effects and is known to induce high blood pressure, particularly when combined with other drugs (68). Mitragynine, the major indole-based alkaloid of kratom, is extensively metabolized by hepatic cytochrome P450 (CYP) isoform 3A4 and 2D6 (69).…”

Section: Multiple Risk Factors In Substance Abuse Patientsmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports

et al. 2020

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Background: Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological entity characterized by a typical brain edema. Although several case reports have described PRES in a context of poisoning, to our knowledge, a comprehensive assessment has not been performed. The aim of this systematic review was to raise awareness on poisoning-specific PRES features and to encourage consistent and detailed reporting of substance abuse-and drug overdose-associated PRES. Methods: Medline/PubMed, Web of Science, and PsycINFO were screened through May 31, 2019, to systematically identify case reports and case series describing PRES associated with poisoning (i.e., alcohol, drugs, illicit drugs, natural toxins, chemical substances) in accidental context, intentional overdose, and substance abuse. The methodological quality of eligible case reports/series was assessed. Patients and exposure characteristics were recorded; relevant toxicological, radiological, and clinical data were extracted. Results: Forty-one case reports and one case series reporting 42 unique cases were included. The median time to PRES onset from the start of exposure was 3 days (IQR 2-10). Acute high blood pressure, visual disturbance, and seizure were reported in 70, 55, and 50% of patients, respectively. The initial clinical presentation was alertness disorders in 64% of patients. Nine patients (21%) required mechanical ventilation. One-third of patients had at least one risk factor for PRES such as chronic hypertension (17%) or acute/chronic kidney failure (24%). The main imaging pattern (67%) was the combination of classical parieto-occipital edema with another anatomical region (e.g., frontal, basal ganglia, posterior fossa involvement). Vasogenic edema was found in 86% of patients. Intracranial hemorrhage occurred in 14% of patients. Both brain infarction and reversible cerebral vasoconstriction syndrome were diagnosed in 5% of patients. Three patients (12%, 3/25) had non-reversible lesions on follow-up magnetic resonance Largeau et al. PRES in Clinical Toxicology imaging. The median time required to hospital discharge was 14 days (IQR 7-18). Mortality and neurological recurrence rate were null. Conclusions: Comorbidities such as chronic hypertension and kidney failure were less frequent than in patients with other PRES etiologies. Imaging analysis did not highlight a specific pattern for poisoning-induced PRES. Although less described, PRES in the context of poisoning, which shares most of the clinical and radiological characteristics of other etiologies, is not to be ignored.

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Inherent Dangers of Using Non–US Food and Drug Administration–Approved Substances of Abuse

White

Browne

Nafziger

2021

The Journal of Clinical Pharma

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Use of US Food and Drug Administration–approved substances of abuse has innate risks due to pharmacologic and pharmacokinetic properties of the medications, but the risk when using nonapproved drug products is much greater. Unbeknownst to the user, the dose of active ingredients in substances of abuse can vary substantially between different products because of manufacturing practices or improper storage. Even naturally occurring substances of abuse can have extensive dosage variability because of effects of the growing season and conditions, or differences in harvesting, storage, or manufacture of the finished products. Many illicit substances are adulterated, to make up for intentional underdosing or to enhance the effect of the intended active ingredient. These adulterants can be dangerous and produce direct cardiovascular, neurologic, hematologic, or dermatologic reactions or obscure adverse effects. Finally, an illicit substance can be contaminated or substituted for another one during its manufacture, leading to differences in adverse events, adverse event severity, or the drug interaction profile. Substances can be contaminated with microbes that induce infections or heavy metals that can damage organs or cause cancer. This milieu of undisclosed substances can also induce drug interactions. For reasons that are discussed, individuals who use substances of abuse are at increased risk of morbidity or mortality if they develop coronavirus disease 2019. Health professionals who treat patients with acute, urgent events associated with substances of abuse, or those treating the chronic manifestations of addiction, need to appreciate the complex and variable composition of substances of abuse and their potential health effects.

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Pharmacologic and clinical assessment of kratom

Abstract: Kratom exerts opioid and α-2 receptor agonistic effects as well as antiinflammatory and parasympathetic-impeding effects. Human pharmacologic, pharmacokinetic, and clinical data are of low quality, precluding any firm conclusions regarding safety and efficacy.

Cited by 42 publications

References 24 publications

A Case of Kratom-induced Seizures

A Case of Kratom-induced Seizures

Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports

Inherent Dangers of Using Non–US Food and Drug Administration–Approved Substances of Abuse

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