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• W2806110830 abstract "Kratom (Mitragyna speciosa) comes from an evergreen tree in the Rubiaceae family, which includes coffee plants. 1 Prozialeck W.C. Jivan J.K. Andurkar S.V. Pharmacology of kratom: An emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012; 112: 792-799 PubMed Google Scholar It is native to southeastern Asia, including Thailand, and its use has become of interest in the United States owing to an increase in documented numbers of calls to poison centers as well as patients seeking alternate therapy to opioids because of the opioid epidemic currently plaguing the United States. 2 Anwar M. Law R. Schier J. Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers—United States, 2010–2015. MMWR. 2016; 65: 748-749 PubMed Google Scholar , 3 Fluyau D. Revadigar N. Biochemical benefits, diagnosis, and clinical risks evaluation of Kratom. Front Psychiatry. 2017; 8: 1-8 PubMed Google Scholar , 4 U.S. Food and Drug Administration Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s scientific evidence on the presence of opioid compounds in kratom, underscoring its potential for abuse. FDA Statement. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm595622.htmDate accessed: March 1, 2018 Google Scholar Kratom can be found on the Internet, at gas stations, and at smoke shops and is available in the form of capsules, tablets, powder, and chopped leaves. 1 Prozialeck W.C. Jivan J.K. Andurkar S.V. Pharmacology of kratom: An emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012; 112: 792-799 PubMed Google Scholar , 3 Fluyau D. Revadigar N. Biochemical benefits, diagnosis, and clinical risks evaluation of Kratom. Front Psychiatry. 2017; 8: 1-8 PubMed Google Scholar It has been used in dietary supplements, teas, and capsules. The powder is used in capsules and then consumed. Each capsule contains around 0.5 g kratom. Consumers usually start with around 2 g and then increase by 0.5 g at a time until the desired effect is attained. 5 Kratom Guides How much kratom dosage to take in capsules?. http://kratomguides.com/how-much-kratom-dosage-take-capsules/Date accessed: May 6, 2018 Google Scholar In February 2018, the U.S. Food and Drug Administration stated that opioid compounds have been detected in kratom. 4 U.S. Food and Drug Administration Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s scientific evidence on the presence of opioid compounds in kratom, underscoring its potential for abuse. FDA Statement. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm595622.htmDate accessed: March 1, 2018 Google Scholar It consists of the active ingredients mitragynine and 7-hydroxymitragynine, which stimulate the mu- and delta-opioid receptors, 1 Prozialeck W.C. Jivan J.K. Andurkar S.V. Pharmacology of kratom: An emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012; 112: 792-799 PubMed Google Scholar resulting in improved mood and decreased anxiety, delivering feelings similar to opium, that help with withdrawal symptoms from heroin or other opiates; the 7-hydroxymitragynine compound is more potent than the mitragynine. 1 Prozialeck W.C. Jivan J.K. Andurkar S.V. Pharmacology of kratom: An emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012; 112: 792-799 PubMed Google Scholar Kratom also consists of 25 alkaloids that possess antidepressant, muscle relaxant, and anti-inflammatory properties. 2 Anwar M. Law R. Schier J. Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers—United States, 2010–2015. MMWR. 2016; 65: 748-749 PubMed Google Scholar , 3 Fluyau D. Revadigar N. Biochemical benefits, diagnosis, and clinical risks evaluation of Kratom. Front Psychiatry. 2017; 8: 1-8 PubMed Google Scholar The Drug Enforcement Administration currently classifies kratom as a “drug of concern,” and it is banned from entering several states and cities. 1 Prozialeck W.C. Jivan J.K. Andurkar S.V. Pharmacology of kratom: An emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012; 112: 792-799 PubMed Google Scholar , 2 Anwar M. Law R. Schier J. Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers—United States, 2010–2015. MMWR. 2016; 65: 748-749 PubMed Google Scholar , 4 U.S. Food and Drug Administration Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s scientific evidence on the presence of opioid compounds in kratom, underscoring its potential for abuse. FDA Statement. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm595622.htmDate accessed: March 1, 2018 Google Scholar Because of this, kratom has also been identified as “an emerging drug of abuse” by the National Institute of Drug Abuse. 2 Anwar M. Law R. Schier J. Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers—United States, 2010–2015. MMWR. 2016; 65: 748-749 PubMed Google Scholar Adverse effects reported with kratom include tachycardia (25%), 2 Anwar M. Law R. Schier J. Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers—United States, 2010–2015. MMWR. 2016; 65: 748-749 PubMed Google Scholar agitation and irritability (24%), 2 Anwar M. Law R. Schier J. Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers—United States, 2010–2015. MMWR. 2016; 65: 748-749 PubMed Google Scholar drowsiness (19%), 2 Anwar M. Law R. Schier J. Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers—United States, 2010–2015. MMWR. 2016; 65: 748-749 PubMed Google Scholar nausea (14.7%), 2 Anwar M. Law R. Schier J. Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers—United States, 2010–2015. MMWR. 2016; 65: 748-749 PubMed Google Scholar hypertension (12%), 2 Anwar M. Law R. Schier J. Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers—United States, 2010–2015. MMWR. 2016; 65: 748-749 PubMed Google Scholar delusions, hallucinations, respiratory depression with rare cases of seizures, coma, and death. 1 Prozialeck W.C. Jivan J.K. Andurkar S.V. Pharmacology of kratom: An emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012; 112: 792-799 PubMed Google Scholar , 2 Anwar M. Law R. Schier J. Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers—United States, 2010–2015. MMWR. 2016; 65: 748-749 PubMed Google Scholar , 3 Fluyau D. Revadigar N. Biochemical benefits, diagnosis, and clinical risks evaluation of Kratom. Front Psychiatry. 2017; 8: 1-8 PubMed Google Scholar Causality may be difficult to assess owing to concomitant administration of other drugs and supplements. Two published case reports describe cholestatic liver injury in kratom users. 6 Kapp F.G. Maurer H.H. Auwarter V. et al. Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa). J Med Toxicol. 2011; 7: 227-231 Crossref PubMed Scopus (108) Google Scholar , 7 Riverso M. Change M. Soldevila-Pico C. Lai J. Lui X. Histologic characterization of kratom use–associated liver injury. Gastroenterol Res. 2019; 11: 79-82 Crossref Google Scholar We report a case of hepatotoxicity likely due to kratom. Carrie L. Griffiths, PharmD, BCCCP, Associate Professor of Pharmacy, Wingate School of Pharmacy, Wingate, NC Nidhi Gandhi, BS, PharmD, Wingate School of Pharmacy, Wingate, NC Jacqueline L. Olin, MS, PharmD, BCPS, FASHP, FCCP, Professor of Pharmacy, Wingate School of Pharmacy, Wingate, NC" @default.
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• W2806110830 title "Possible kratom-induced hepatomegaly: A case report" @default.
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