A Case of Potential Pharmacokinetic Kratom-drug Interactions Resulting in Toxicity and Subsequent Treatment of Kratom Use Disorder With Buprenorphine/Naloxone.
A Case of Potential Pharmacokinetic Kratom-drug Interactions Resulting in Toxicity and Subsequent Treatment of Kratom Use Disorder With Buprenorphine/Naloxone.
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DOI：
10.1097/adm.0000000000000968
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发表时间：
2022-09-01
影响因子：
5.5
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中科院分区：
文献类型：
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植物产品Krtom在高剂量下产生阿片样效应，有时被阿片使用障碍患者用于阿片类药物替代。米特拉吉宁是鸡冠花叶中的一种主要生物碱，在体外对多种细胞色素P450(CYP450)有抑制作用，包括细胞色素P2D6和细胞色素P3A。因此，当与某些药物联合使用时，KrATOM可能会导致药代动力学药物相互作用。我们提出了一个病例，患者每天服用150 mg文拉法辛(CYP2D6/3A底物)，300 mg奎硫平(CYP3A底物)，以及高剂量的KrATOM(~90g)。患者在急诊科就诊时出现了5-羟色胺综合征和纠正的心电图异常，这些异常可能是由于超治疗暴露于文拉法辛和/或奎硫平引起的。患者的症状在停止使用文拉法辛和奎硫平后消失。他接受了Krtom停药的药物治疗，并成功地完成了丁丙诺啡/纳洛酮的在家诱导。这份病例报告增加了有关Krtom潜在药代动力学-药物相互作用的文献，并表明丁丙诺啡/纳洛酮可以促进Krtom使用障碍的恢复。
The botanical product kratom produces opioid-like effects at high doses and is sometimes used for opioid replacement by individuals with opioid use disorder. Mitragynine, a major alkaloid contained in kratom leaves, has been shown to inhibit multiple cytochromes P450 (CYPs) in vitro, including CYP2D6 and CYP3A. As such, kratom may precipitate pharmacokinetic drug interactions when co-consumed with certain medications. We present a case of a patient taking 150 mg venlafaxine (CYP2D6/3A substrate), 300 mg quetiapine (CYP3A substrate), and a high amount of kratom (~90 g) daily. The patient presented to the emergency department with serotonin syndrome and corrected electrocardiogram abnormalities that may have been secondary to supratherapeutic exposure to venlafaxine and/or quetiapine. The patient’s symptoms resolved after discontinuation of venlafaxine and quetiapine. He was amenable to medication therapy for kratom discontinuation and successfully completed an at-home induction with buprenorphine/naloxone. This case report adds to the literature about potential pharmacokinetic kratom-drug interactions and suggests that buprenorphine/naloxone can facilitate recovery from kratom use disorder.