1
|
Emerick T, Durbhakula S, Eibel MR, Kohan L. Kratom: a primer for pain physicians. Curr Opin Anaesthesiol 2024:00001503-990000000-00214. [PMID: 39011659 DOI: 10.1097/aco.0000000000001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW Kratom is used commonly in the United States, usually to mitigate pain, opioid withdrawal, or fatigue. A comprehensive discussion on kratom, tailored to pain management physicians, is needed, given its associated risks and potential interactions. RECENT FINDINGS Kratom and its main metabolites, mitragynine and 7-OH-mitragynine, bind to a variety of receptors including mu opioid receptors. Still, kratom cannot be described as a classic opioid. Kratom has been utilized without FDA approval as an alternative to traditional medications for opioid use disorder and opioid withdrawal. Lower doses of kratom typically cause opioid-like effects while higher doses can have sedating effects. Tolerance, dependence and withdrawal still occur, although kratom withdrawal appears to be more moderate than opioid withdrawal. Contamination with heavy metals and biological toxins is concerning and there is potential for serious complications, including seizures and death. SUMMARY The use of kratom as an opioid-sparing alternative as a part of a multimodal pain regimen is not without significant risks. It is of utmost importance for pain physicians to be aware of the risks and adverse effects associated with kratom use.
Collapse
Affiliation(s)
- Trent Emerick
- UPMC Department of Anesthesiology and Perioperative Medicine, Pittsburgh, Pennsylvania
| | | | - Maria R Eibel
- UPMC Department of Anesthesiology and Perioperative Medicine, Pittsburgh, Pennsylvania
| | - Lynn Kohan
- UVA Health Department of Anesthesiology, Charlottesville, Virginia, USA
| |
Collapse
|
2
|
Helander A, Rylski A. Drug testing for mitragynine and kratom: Analytical challenges and medico-legal considerations. Drug Test Anal 2023; 15:213-219. [PMID: 36258649 PMCID: PMC10098727 DOI: 10.1002/dta.3391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
Abstract
Mitragyna speciosa, known as kratom, is a tropical tree native to Southeast Asia that has long been used to increase energy and in traditional medicine. Kratom leaves contain several indole alkaloids including mitragynine, mitraciliatine, speciogynine, and speciociliatine, which have the same molecular formula and connectivity, but different spatial arrangements (i.e., diastereomers). A routine liquid-chromatographic-high-resolution mass-spectrometric (LC-HRMS) multi-analyte method for addictive and herbal drugs in urine did not separate mitragynine from speciogynine and speciociliatine. Separation and individual measurement of the four diastereomers was possible with an improved LC method. All diastereomers were detected in 29 patient urine samples who tested positive for mitragynine with the routine method, albeit at variable absolute amounts and relative proportions. The presence of all diastereomers rather than individual substances indicated that they originated from the intake of kratom (i.e., plant material). Speciociliatine dominated in most samples (66%), whereas mitragynine and mitraciliatine were the highest in 17% each. A kratom product (powdered plant material) marketed in Sweden contained all diastereomers with mitragynine showing the highest level. In Sweden, there are signs of an increasing use of kratom in society, based on the results from drug testing, the number of poisons center consultations on intoxications, and customs seizure statistics. Because there may be health risks associated with kratom use, including dependence, serious adverse reactions, and death, analytical methods should be able to identify and quantify all diastereomers. In Sweden, this is important from a legal perspective, as only mitragynine is classified, whereas the other three diastereomers, and kratom (plant material), are not.
Collapse
Affiliation(s)
- Anders Helander
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexia Rylski
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
3
|
Limcharoen T, Pouyfung P, Ngamdokmai N, Prasopthum A, Ahmad AR, Wisdawati W, Prugsakij W, Warinhomhoun S. Inhibition of α-Glucosidase and Pancreatic Lipase Properties of Mitragyna speciosa (Korth.) Havil. (Kratom) Leaves. Nutrients 2022; 14:nu14193909. [PMID: 36235558 PMCID: PMC9572452 DOI: 10.3390/nu14193909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 01/24/2023] Open
Abstract
Kratom (Mitragyna speciosa (Korth.) Havil.) has been used to reduce blood sugar and lipid profiles in traditional medicine, and mitragynine is a major constituent in kratom leaves. Previous data on the blood sugar and lipid-altering effects of kratom are limited. In this study, phytochemical analyses of mitragynine, 7-hydroxymitragynine, quercetin, and rutin were performed in kratom extracts. The effects on α-glucosidase and pancreatic lipase activities were investigated in kratom extracts and mitragynine. The LC-MS/MS analysis showed that the mitragynine, quercetin, and rutin contents from kratom extracts were different. The ethanol extract exhibited the highest total phenolic content (TPC), total flavonoid content (TFC), and total alkaloid content (TAC). Additionally, compared to methanol and aqueous extracts, the ethanol extract showed the strongest inhibition activity against α-glucosidase and pancreatic lipase. Compared with the anti-diabetic agent acarbose, mitragynine showed the most potent α-glucosidase inhibition, with less potent activity of pancreatic lipase inhibition. Analysis of α-glucosidase and pancreatic lipase kinetics revealed that mitragynine inhibited noncompetitive and competitive effects, respectively. Combining mitragynine with acarbose resulted in a synergistic interaction with α-glucosidase inhibition. These results have established the potential of mitragynine from kratom as a herbal supplement for the treatment and prevention of diabetes mellitus.
Collapse
Affiliation(s)
- Thanchanok Limcharoen
- School of Medicine, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Center of Excellent in Marijuana, Hemp and Kratom, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Phisit Pouyfung
- Center of Excellent in Marijuana, Hemp and Kratom, Walailak University, Nakhon Si Thammarat 80160, Thailand
- School of Public Health, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Ngamrayu Ngamdokmai
- School of Medicine, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Center of Excellent in Marijuana, Hemp and Kratom, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Aruna Prasopthum
- School of Pharmacy, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Biomass and Oil Palm Center of Excellent, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Aktsar Roskiana Ahmad
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmacy, Universitas of Muslim Indonesia, Makassar 90241, Indonesia
| | - Wisdawati Wisdawati
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmacy, Universitas of Muslim Indonesia, Makassar 90241, Indonesia
| | - Woraanong Prugsakij
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sakan Warinhomhoun
- School of Medicine, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Center of Excellent in Marijuana, Hemp and Kratom, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Correspondence:
| |
Collapse
|
4
|
Karunakaran T, Ngew KZ, Zailan AAD, Mian Jong VY, Abu Bakar MH. The Chemical and Pharmacological Properties of Mitragynine and Its Diastereomers: An Insight Review. Front Pharmacol 2022; 13:805986. [PMID: 35281925 PMCID: PMC8907881 DOI: 10.3389/fphar.2022.805986] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
Mitragynine, is a naturally occurring indole alkaloid that can be isolated from the leaves of a psychoactive medicinal plant. Mitragyna speciosa, also known as kratom, is found to possess promising analgesic effects on mediating the opioid receptors such as µ (MOR), δ (DOR), and κ (KOR). This alkaloid has therapeutic potential for pain management as it has limited adverse effect compared to a classical opioid, morphine. Mitragynine is frequently regarded to behave like an opioid but possesses milder withdrawal symptoms. The use of this alkaloid as the source of an analgesic candidate has been proven through comprehensive preclinical and clinical studies. The present data have shown that mitragynine is able to bind to opioid receptors, particularly MOR, to exhibit the analgesic effect. Moreover, the chemical and pharmacological aspects of mitragynine and its diastereomers, speciogynine, speciociliatine, and mitraciliatine, are discussed. It is interesting to know how the difference in stereochemical configuration could lead to the difference in the bioactivity of the respective compounds. Hence, in this review, the updated pharmacological and toxicological properties of mitragynine and its diastereomers are discussed to render a comprehensive understanding of the pharmacological properties of mitragynine and its diastereomers based on their structure–activity relationship study.
Collapse
Affiliation(s)
- Thiruventhan Karunakaran
- Centre for Drug Research, Universiti Sains Malaysia, Pulau Pinang, Malaysia
- School of Chemical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
- *Correspondence: Thiruventhan Karunakaran, ; Vivien Yi Mian Jong,
| | - Kok Zhuo Ngew
- Centre for Drug Research, Universiti Sains Malaysia, Pulau Pinang, Malaysia
- School of Chemical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | | | - Vivien Yi Mian Jong
- Centre of Applied Science Studies, Universiti Teknologi MARA, Kuching, Malaysia
- *Correspondence: Thiruventhan Karunakaran, ; Vivien Yi Mian Jong,
| | - Mohamad Hafizi Abu Bakar
- Bioprocess Technology Division, School of Industrial Technology, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| |
Collapse
|
5
|
Suhaimi FW, Hassan Z, Mansor SM, Müller CP. The effects of chronic mitragynine (Kratom) exposure on the EEG in rats. Neurosci Lett 2021; 745:135632. [PMID: 33444671 DOI: 10.1016/j.neulet.2021.135632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
Mitragynine is the main alkaloid isolated from the leaves of Mitragyna speciosa Korth (Kratom). Kratom has been widely used to relieve pain and opioid withdrawal symptoms in humans but may also cause memory deficits. Here we investigated the changes in brain electroencephalogram (EEG) activity after acute and chronic exposure to mitragynine in freely moving rats. Vehicle, morphine (5 mg/kg) or mitragynine (1, 5 and 10 mg/kg) were administered for 28 days, and EEG activity was repeatedly recorded from the frontal cortex, neocortex and hippocampus. Repeated exposure to mitragynine increased delta, but decreased alpha powers in both cortical regions. It further decreased delta power in the hippocampus. These findings suggest that acute and chronic mitragynine can have profound effects on EEG activity, which may underlie effects on behavioral activity and cognition, particularly learning and memory function.
Collapse
Affiliation(s)
- Farah Wahida Suhaimi
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia.
| | - Zurina Hassan
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Sharif Mahsufi Mansor
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| |
Collapse
|
6
|
Ogata J, Kawamura M, Hakamatsuka T, Kikura-Hanajiri R. [Discrimination of Kratom Products by an Improved PCR-RFLP Method]. YAKUGAKU ZASSHI 2020; 140:1501-1508. [PMID: 33268690 DOI: 10.1248/yakushi.20-00170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In Japan, mitragynine, 7-hydroxymitragynine and Mitragyna speciosa Korth. (M. speciosa, "Kratom") were controlled as Designated Substances under the Pharmaceutical and Medical Device Act from March 2016. In this study, the origins of 16 Kratom products obtained from the illegal drug market in Japan were investigated by DNA analyses and LC-MS analyses. When the PCR-restriction fragment length polymorphism (RFLP) was performed using the restriction enzyme XmaI (as reported by Sukrong et al. to be able to distinguish M. speciosa), the same DNA fragment patterns were obtained from all 16 products. On the other hand, as a result of the identification of the plant species of each product by nucleotide sequence analyses, the sequences of M. speciosa were detected in only 14 products. Despite the facts that mitragynine and 7-hydroxymitragynine were detected also in the other two products by the LC-MS analyses, M. speciosa DNAs were not amplified from these products by the PCR. Moreover, the DNA amplicons of the other psychotropic plant (Mesembryanthemum sp., e.g. "Kanna") were detected. This plant PCR amplicon has the restriction site for the XmaI at the same position of the M. speciosa PCR amplicon and it is difficult to distinguish "Kratom" and "Kanna" by the conventional PCR-RFLP. When the restriction enzyme XhoI was used simultaneously with the Xmal, the specific DNA fragment was only observed from the M. speciosa amplicon and it was possible to distinguish both species using this improved PCR-RFLP method. This method is useful to identify the origin of Kratom products distributed in the illegal drug market.
Collapse
Affiliation(s)
- Jun Ogata
- Division of Pharmacognosy, Phytochemistry and Narcotics, National Institute of Health Sciences
| | - Maiko Kawamura
- Division of Pharmacognosy, Phytochemistry and Narcotics, National Institute of Health Sciences
| | - Takashi Hakamatsuka
- Division of Pharmacognosy, Phytochemistry and Narcotics, National Institute of Health Sciences
| | - Ruri Kikura-Hanajiri
- Division of Pharmacognosy, Phytochemistry and Narcotics, National Institute of Health Sciences
| |
Collapse
|