Natural drugs, not so natural effects: Neonatal abstinence syndrome secondary to ‘kratom’

Davidson, L. S. P.; Rawat, Munmun; Stojanovski, Sasko D.; Chandrasekharan, Praveen

doi:10.3233/npm-1863

Cited by 35 publications

(51 citation statements)

References 18 publications

(11 reference statements)

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“…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-Associated Neonatal Abstinence Syndrome [48,[52][53][54][55][56] In Smid and colleagues' case, kratom use was stopped and kratom-associated neonatal abstinence syndrome (KANAS) was prevented when a buprenorphine regimen was started in week 22 of gestation. However, this same regimen failed to prevent KANAS in another pregnant woman when it was started at week 19 of gestation [52].…”

Section: Interventionmentioning

confidence: 99%

“…It was used in three KANAS cases to grade the severity and guide therapy [54][55][56]. Their Finnegan score was calculated to be at the "Severe" category threshold (> 9 points) on presentation.…”

Section: Interventionmentioning

confidence: 99%

“…Almost all cases used morphine; only one case used intravenous methadone. Two cases reported using morphine as 10 mcg/kg/h either continuously or administered every 3 h [48,54] and one case used 100 mcg/kg/day [55]. In all cases, the neonate responded to therapy on initiation.…”

Section: Interventionmentioning

confidence: 99%

“…Total days of stay for patients ranged from 8 to 14 days but weaning off morphine can take up to 2 months due to risk of rebound KANAS [56]. In Davidson and colleagues' case report, the neonate was monitored for 48 h after discontinuation of therapy [55].…”

Section: Interventionmentioning

confidence: 99%

See 4 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

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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: Literature Case Reviewmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

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

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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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Potential benefits versus hazards of herbal therapy during pregnancy; a systematic review of available literature

Balarastaghi

Delirrad

Jafari

et al. 2022

Phytotherapy Research

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The use of herbal medicine has considerably grown worldwide in the past two decades. Studies have shown that the prevalence of herbal diet therapy in pregnancy ranged from 1% to 60% in different societies. Many clinical reports have shown that some herbal medicines may have toxic effects on pregnant women and their fetuses because active ingredients of some medicinal plants can readily pass through the biological barriers (e.g., placental barrier). In the present study, we aimed to systematically review the literature to discover potential benefits versus the hazards of herbal therapy during pregnancy. For this purpose, a comprehensive literature review was performed, and after the literature search and selection of the appropriate documents, the desired data were extracted and reported. From 35 articles with a total of 39,950 study population, the results showed that some medicinal plants could cause severe toxicity on mothers and fetuses, in addition to abortion during pregnancy. It was also shown that some plants may lead to developmental abnormalities or fetal death. Findings of this survey showed that some herbal medicines have toxic, teratogenic, and abortive potential, particularly in the first trimester of pregnancy because active ingredients of some medicinal plants are able to pass through the placental barrier and reach the fetus.

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Natural drugs, not so natural effects: Neonatal abstinence syndrome secondary to ‘kratom’

Abstract: Physicians should be aware of these herbal supplements and its potential withdrawal effects in newborn which cannot be picked up by the standard toxicology screen.

Cited by 35 publications

References 18 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

Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

Potential benefits versus hazards of herbal therapy during pregnancy; a systematic review of available literature

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