N-Acetylcysteine for Acute Hepatitis Induced by Kratom Herbal Tea

Mousa, Mina; Sephien, Andrew; Gutierrez, Juliana; OʼLeary, Charlotte

doi:10.1097/mjt.0000000000000631

Cited by 17 publications

(22 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The highest alkaline phosphatase recorded was 790 units/L (reference 35-129 units/L). Complete normalization of total bilirubin and alkaline phosphatase occurred approximately 2 months after cessation [61,65]. Early reports of KIH confirmed intrahepatic cholestasis based on hepatic function tests, abdominal and hepatic imaging, and histological findings.…”

Section: Interventionmentioning

confidence: 89%

“…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: 92%

“…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%

See 3 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

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

Section: Interventionmentioning

confidence: 89%

Section: Interventionmentioning

confidence: 92%

Section: Literature Case Reviewmentioning

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 labwork was pending, a literature search showed several case reports of patients presenting with acute hepatitis thought to be induced by kratom tea who benefited from N-acetylcysteine (NAC) [6]. Patient therefore received a loading dose of 150 mg/kg/h of NAC, but developed an anaphylactic reaction and subsequent doses were held.…”

Section: Hospital Coursementioning

confidence: 99%

Kratom: a dangerous player in the opioid crisis

Tayabali

Bolzon

Foster

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

Kratom use as a herbal supplement is on the rise in the United States, with reported medical outcomes and lethal effects suggesting a public health threat. Even though the Drug Enforcement Administration has included kratom on its drugs of concern list and the FDA has published a press release to identify it as an opioid with a potential for abuse, its therapeutic and side effects are still not well defined in the literature. Here, we present a case of a 32-year-old man with a history of kratom use who became acutely ill with a brief prodromal illness, followed by jaundice and elevated liver enzymes showing a cholestatic picture, and his successful treatment. In this case, we emphasize the need for awareness of kratom exposure as a key contributor in the expansion of the opioid crisis, with therapeutic benefits earned at the expense of potentially lethal side effects.

show abstract

Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

Hartley

Bulloch

Penzak

2022

The Journal of Clinical Pharma

View full text Add to dashboard Cite

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.

show abstract

N-Acetylcysteine for Acute Hepatitis Induced by Kratom Herbal Tea

Cited by 17 publications

References 6 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: a dangerous player in the opioid crisis

Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

Contact Info

Product

Resources

About