Fatal combination of mitragynine and quetiapine – a case report with discussion of a potential herb-drug interaction
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Kratom is a plant with dose-dependent mixed stimulant and opioid properties whose pharmacologic characteristics and social impact continue to be described. The main active isolate of kratom is mitragynine, an indole-containing alkaloid with opioid-like effects. Kratom toxicity and kratom-associated fatalities have been described, including those in association with additional drugs. In this paper we describe the case of a 27-year-old man who was found deceased with a toxic blood concentration of quetiapine in conjunction with the qualitative presence of mitragynine. Investigative and autopsy findings suggested perimortem hyperthermia and seizure-like activity. Kratom toxicity and kratom-associated fatalities are being increasingly reported. Experiments with kratom extracts have shown inhibitory effects upon hepatic CYP enzymes, leading to previous speculation of the potential for clinically significant interactions between kratom and a wide array of medications. Herein is described a fatal case of quetiapine toxicity complicated by mitragynine use. The potential ability of mitragynine to alter the pharmacokinetics of a prescription medication via inhibition of its hepatic metabolism is discussed.
KeywordsKratom Mitragynine Quetiapine Overdose CYP
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- 4.Kratom (Mitragyna speciosa korth). 2013. http://www.deadiversion.usdoj.gov/drug_chem_info/kratom.pdf. Accessed 7 July 2016.
- 7.Food and Drug Administration. 2018. Statement for 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 [Press release]. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm595622.htm. Accessed 2 Aug 2018.
- 12.Baselt RC. Disposition of toxic drugs and chemicals in man. 8th ed. Foster City (CA): Biomedical Publications; 2008.Google Scholar
- 13.Molina DK. Handbook of forensic toxicology for medical examiners. Boca Raton: CRC Press; 2010.Google Scholar
- 15.Raffa RB. Kratom and other mitragynines: the chemistry and pharmacology of opioids from a non-opium source. Boca Raton: CRC Press; 2015.Google Scholar
- 20.Hanapi NA, Ismail S, Mansor SM. Inhibitory effect of mitragynine on human cytochrome P450 enzyme activities. Pharm Res. 2013;5:241–6.Google Scholar