Kratom (Mitragynine) Ingestion Requiring Naloxone Reversal

Overbeek, Daniel L.; Abraham, Jonathan; Munzer, Brendan W.

doi:10.5811/cpcem.2018.11.40588

Cited by 36 publications

(25 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Kratom [75][76][77][78][79][80] Kratom (Mitragyna speciosa) is a plant indigenous to southeast Asia that contains several indole alkaloids, principally mitragynine and 7-hydroxymitragynine, with variable pharmacological properties including agonism at the μ-opioid, δ-opioid, and κ-opioid receptors. Kratom is currently regulated in the USA as a dietary supplement and is banned in the UK.…”

Section: Ibogaine 69-74mentioning

confidence: 99%

New directions in the treatment of opioid withdrawal

2020

View full text Add to dashboard Cite

The treatment of opioid withdrawal is an important area of clinical concern when treating patients with chronic, non-cancer pain, patients with active opioid use disorder, and patients receiving medication for opioid use disorder. Current standards of care for medically supervised withdrawal include treatment with μ-opioid receptor agonists, (eg, methadone), partial agonists (eg, buprenorphine), and α2-adrenergic receptor agonists (eg, clonidine and lofexidine). Newer agents likewise exploit these pharmacological mechanisms, including tramadol (μ-opioid receptor agonism) and tizanidine (α2 agonism). Areas for future research include managing withdrawal in the context of stabilising patients with opioid use disorder to extended-release naltrexone, transitioning patients with opioid use disorder from methadone to buprenorphine, and tapering opioids in patients with chronic, non-cancer pain.

show abstract

Section: Ibogaine 69-74mentioning

confidence: 99%

New directions in the treatment of opioid withdrawal

2020

View full text Add to dashboard Cite

show abstract

“…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%

“…Toxidromes and Fatalities [70][71][72][73][74][75][76][77][78][79][80] Kratom toxicity is presumed to resemble an opioid toxidrome: manifested by mydriasis, depressed respiratory function, altered mental status, hypotension, and hypothermia. Two recent case reports showed the role of naloxone reversal on the kratom toxidrome, although it was administered due to suspected co-intoxication with an opioid [70,71]. In the case of Overbeek and colleagues, the patient received two prehospital doses of naloxone 0.4 mg which led to improvement in respiratory rate and mental status [70].…”

Section: Interventionmentioning

confidence: 99%

“…Two recent case reports showed the role of naloxone reversal on the kratom toxidrome, although it was administered due to suspected co-intoxication with an opioid [70,71]. In the case of Overbeek and colleagues, the patient received two prehospital doses of naloxone 0.4 mg which led to improvement in respiratory rate and mental status [70]. With supportive care and intravenous fluids, the patient continued to improve over a of 24-h period and ultimately survived.…”

Section: Interventionmentioning

confidence: 99%

See 1 more Smart Citation

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

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.

show abstract

“…Opioids interact with mu-opioid receptors located throughout the respiratory centers in the brainstem, which under certain circumstances may suppress various components of respiratory drive. Pre-BötC pre-Bötzinger complex synthetic cannabinoids, valerian root, and kava [82][83][84][85][86]. Although additional research is needed to determine the specific effects of these agents on respiratory drive, clinicians must provide proper education to patients with chronic pain regarding the risks associated with concomitant use of supplements with their current prescriptions.…”

Section: Herbal Supplementsmentioning

confidence: 99%

The Physiology and Maintenance of Respiration: A Narrative Review

Webster

Karan

2020

Pain Ther

View full text Add to dashboard Cite

Chronic pain is one of the most common reasons adults seek medical care and is often managed with opioid analgesics; however, opioids may cause respiratory depression by suppressing various components of respiration. Respiration is the physiological process that facilitates gas exchange and is mediated through the proper function of and communication among central neural control (respiratory drive), sensory input systems, the lungs, and the muscles involved in respiration. Normal respiratory function can be dampened with the use of central nervous system (CNS) depressants and/or underlying health conditions. Patients with chronic pain are often exposed to CNS depressants other than opioids, including benzodiazepines, barbiturates, nonbenzodiazepine sedative-hypnotics, and ethanol, which can function synergistically with opioids to increase the risk of respiratory depression. Some patients may also have underlying health issues, such as obstructive sleep apnea, that can be exacerbated with the use of opioids and other CNS depressants and further contribute to respiratory depression. Clinicians should have a thorough understanding of respiration, recognize how various CNS depressants suppress it, and take necessary steps to mitigate the risk of opioid-induced respiratory depression by collaborating with a multidisciplinary team (i.e., sleep and pain specialists), choosing appropriate medications, and educating patients on the proper use and storage of opioids.

show abstract

Kratom (Mitragynine) Ingestion Requiring Naloxone Reversal

Cited by 36 publications

References 10 publications

New directions in the treatment of opioid withdrawal

New directions in the treatment of opioid withdrawal

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

The Physiology and Maintenance of Respiration: A Narrative Review

Contact Info

Product

Resources

About