Hepatotoxicity from abuse of kratom: first reported case
May 26, 2011, 8:40 pm
Intrahepatic Cholestasis Following Abuse of Powdered Kratom (Mitragyna speciosa) Kapp FG et al. J Med Toxicol 2011 April 29. [Epub ahead of print]
Kratom is a psychoactive leaf from the southeast asian tree Mitragyna speciosa (picture). This tree is related to the plants that produce coffee. Because there are a number of different alkaloids in kratom and because some of its actions are dose related, ingesting the leaf has been associated with a variety of effects, including sedation, analgesia, increased energy, a sense of well being, and improved mood. Of the major alkaloids, mitragynine is a stimulant and 7-hydroxymitragyine a sedative and analgesic, acting primarily as an agonist at the μ-opioid receptor.
This case report, from Germany, describes a 25-year-old man who developed intrahepatic cholestasis after taking an overdose of kratom powder over the course of several weeks. The product had been purchased at an internet site. A pattern of pure drug-induced cholestatic injury was seen on liver biopsy, other potential causes were ruled out, and alkaloids consistent with kratom ingestion were detected in the patient’s urine. In addition, the kratom powder itself was analyzed and found to contain components of M. speciosa but no adulterants or contaminants.
Using the Naranjo algorithm to analyze this adverse drug reaction, the authors’ claim that kratom was the probable cause of this patient’s hepatic toxicity is reasonable. They are to be commended for the analytical work that went into supporting that claim.
[Picture of kratom leaf from wikipedia.org]