1
|
Annuar NAK, Azlan UK, Mediani A, Tong X, Han R, Al-Olayan E, Baharum SN, Bunawan H, Sarian MN, Hamezah HS, Jantan I. An insight review on the neuropharmacological effects, mechanisms of action, pharmacokinetics and toxicity of mitragynine. Biomed Pharmacother 2024; 171:116134. [PMID: 38219389 DOI: 10.1016/j.biopha.2024.116134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024] Open
Abstract
Mitragynine is one of the main psychoactive alkaloids in Mitragyna speciosa Korth. (kratom). It has opium-like effects by acting on μ-, δ-, and κ-opioid receptors in the brain. The compound also interacts with other receptors, such as adrenergic and serotonergic receptors and neuronal Ca2+ channels in the central nervous system to have its neuropharmacological effects. Mitragynine has the potential to treat diseases related to neurodegeneration such as Alzheimer's disease and Parkinson's disease, as its modulation on the opioid receptors has been reported extensively. This review aimed to provide an up-to-date and critical overview on the neuropharmacological effects, mechanisms of action, pharmacokinetics and safety of mitragynine as a prospective psychotropic agent. Its multiple neuropharmacological effects on the brain include antinociceptive, anti-inflammatory, antidepressant, sedative, stimulant, cognitive, and anxiolytic activities. The potential of mitragynine to manage opioid withdrawal symptoms related to opioid dependence, its pharmacokinetics and toxic effects were also discussed. The interaction of mitragynine with various receptors in the brain produce diverse neuropharmacological effects, which have beneficial properties in neurological disorders. However, further studies need to be carried out on mitragynine to uncover its complex mechanisms of action, pharmacokinetics, pharmacodynamic profiles, addictive potential, and safe dosage to prevent harmful side effects.
Collapse
Affiliation(s)
- Nur Aisyah Khairul Annuar
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Ummi Kalthum Azlan
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Ahmed Mediani
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Xiaohui Tong
- School of Life Sciences, Anhui University of Chinese Medicine, Hefei, China
| | - Rongchun Han
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Ebtesam Al-Olayan
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Syarul Nataqain Baharum
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Hamidun Bunawan
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Murni Nazira Sarian
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Hamizah Shahirah Hamezah
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia.
| | - Ibrahim Jantan
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| |
Collapse
|
2
|
Muacevic A, Adler JR, Stevanovic N. Adverse Drug Interaction Between Kratom and Amitriptyline With Gastrointestinal and Mild Hepatic Effects. Cureus 2023; 15:e33809. [PMID: 36819306 PMCID: PMC9929492 DOI: 10.7759/cureus.33809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
Kratom (Mitragyna speciosa) is a tropical evergreen plant native to Southeast Asia, where it has been used historically for its various psychoactive and analgesic properties. In recent years, the popularity of kratom has surged in the United States as a supplement for treating opioid withdrawal/addiction, anxiety, depression, and chronic pain, among others. However, much of Kratom processing and sales remain largely unregulated, with little clinical research to demonstrate the effects of kratom on physiologic processes such as potential drug interactions. Here, we present a case of Kratom interaction with Amitriptyline in a patient recovering from Opioid Use Disorder.
Collapse
|
3
|
Swogger MT, Smith KE, Garcia-Romeu A, Grundmann O, Veltri CA, Henningfield JE, Busch LY. Understanding Kratom Use: A Guide for Healthcare Providers. Front Pharmacol 2022; 13:801855. [PMID: 35308216 PMCID: PMC8924421 DOI: 10.3389/fphar.2022.801855] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/02/2022] [Indexed: 12/12/2022] Open
Abstract
Kratom (Mitragyna speciosa Korth., Rubiaceae) is a plant native to Southeast Asia, where it has been used for centuries as a mild stimulant and as medicine for various ailments. More recently, as kratom has gained popularity in the West, United States federal agencies have raised concerns over its safety leading to criminalization in some states and cities. Some of these safety concerns have echoed across media and broad-based health websites and, in the absence of clinical trials to test kratom’s efficacy and safety, considerable confusion has arisen among healthcare providers. There is, however, a growing literature of peer-reviewed science that can inform healthcare providers so that they are better equipped to discuss kratom use with consumers and people considering kratom use within the context of their overall health and safety, while recognizing that neither kratom nor any of its constituent substances or metabolites have been approved as safe and effective for any disease. An especially important gap in safety-related science is the use of kratom in combination with physiologically active substances and medicines. With these caveats in mind we provide a comprehensive overview of the available science on kratom that has the potential to i clarity for healthcare providers and patients. We conclude by making recommendations for best practices in working with people who use kratom.
Collapse
Affiliation(s)
- Marc T Swogger
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Kirsten E Smith
- Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oliver Grundmann
- Department of Pharmaceutical Sciences, Midwestern University College of Pharmacy, Glendale, AZ, United States.,College of Pharmacy, Department of Medicinal Chemistry, University of Florida, Gainesville, FL, United States
| | - Charles A Veltri
- Department of Pharmaceutical Sciences, Midwestern University College of Pharmacy, Glendale, AZ, United States
| | - Jack E Henningfield
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Pinney Associates, Bethesda, MD, United States
| | - Lorna Y Busch
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| |
Collapse
|
4
|
Lund E, Low AB, Allan JD, Puentes JA, Flynn DN. Anesthetic Challenges Posed by Heavy Kratom Users. Cureus 2022; 14:e22864. [PMID: 35399423 PMCID: PMC8982483 DOI: 10.7759/cureus.22864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Kratom is a herbal and natural dietary supplement from Southeast Asia that is gaining popularity in the United States. Its leaves contain multiple psychoactive chemicals that stimulate opioid, alpha-2, and serotonergic receptors. Kratom is used as a stimulant and in the treatment of anxiety, pain, and opioid withdrawal. In most states, kratom can be purchased legally and is sold at smoke shops, gas stations, and online. To date, only limited data is available on the impact of habitual kratom use on patients undergoing anesthesia. The following case report highlights multiple anesthetic challenges posed by a heavy kratom user.
Collapse
|
5
|
Worley J. Substance Use Withdrawal and Detox Strategies That Work. J Psychosoc Nurs Ment Health Serv 2021; 59:12-15. [PMID: 34459674 DOI: 10.3928/02793695-20210816-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Substance use disorders are considered chronic but treatable. The first step in recovery is going through withdrawal or detox from the substance used, which typically involves unpleasant physical and psychological symptoms. Some individuals are able and willing to enter inpatient facilities for withdrawal and detox. In some cases, outpatient withdrawal and detox programs are not available. Several barriers to treatment exist, including inability to pay, unavailability of programs, stigma, and co-occurring mental health disorders. During inpatient withdrawal and detox, patients are supported with medications. There is an underutilization of initiating medication that helps reduce substance use, such as naltrexone and suboxone, during inpatient withdrawal and detox. Many individuals opt or have no other choice but to go through withdrawal and detox on their own. Strategies include illicitly obtaining prescription medications for the symptoms and other measures, such as floating in the bathtub and exercise. Recovery from substance use can be facilitated by health care providers through use of harm reduction strategies, referrals to treatment, and prescribing medications when applicable. [Journal of Psychosocial Nursing and Mental Health Services, 59(9), 12-15.].
Collapse
|
6
|
Groff D, Stuckey H, Philpott C, Van Dyke E, Silvis M, Leong SL, Bone C. Kratom use disorder: a primer for primary care physicians. J Addict Dis 2021; 40:131-141. [PMID: 34281482 DOI: 10.1080/10550887.2021.1950263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Kratom is a substance similar to opioids that is often used for its euphoric effects, however it can be obtained legally in most of the United States. The substance is often not assessed on routine urine drug screen, however it is estimated that millions of people engage in kratom use each year and level of use is rising. Given the increasing prevalence of kratom use, and its potentially lethal consequences, it is imperative that primary care physicians be familiar with this substance and have a framework to approach identification and treatment of individuals with kratom use disorder. This manuscript offers a review of the epidemiology and pharmacology of kratom, along with guidance for care of individuals with kratom use disorder in the primary care setting.
Collapse
Affiliation(s)
- Destin Groff
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Heather Stuckey
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Carolyn Philpott
- UC Health: University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Erika Van Dyke
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Matthew Silvis
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Shou Ling Leong
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Curtis Bone
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|