Hughes Rhome L
University of North Dakota School of Medicine and Health Sciences, 1301 N. Columbia Rd (Room W430), Grand Forks, ND, 58203, USA.
Forensic Sci Med Pathol. 2019 Mar;15(1):110-113. doi: 10.1007/s12024-018-0049-9. Epub 2018 Nov 29.
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.
kratom是一种具有剂量依赖性混合兴奋剂和阿片样特性的植物，其药理特性和社会影响仍在不断被描述。kratom的主要活性分离物是美登木碱，一种具有阿片样作用的含吲哚生物碱。已经描述了kratom毒性和与kratom相关的死亡事件，包括与其他药物相关的事件。在本文中，我们描述了一名27岁男性的案例，他被发现死亡时血液中喹硫平浓度中毒，同时定性检测出美登木碱。调查和尸检结果提示死前体温过高和类似癫痫的活动。与kratom相关的毒性和死亡事件报告越来越多。对kratom提取物的实验表明其对肝脏CYP酶有抑制作用，导致之前推测kratom与多种药物之间可能存在具有临床意义的相互作用。本文描述了一例因使用美登木碱而并发喹硫平中毒的致命病例。讨论了美登木碱通过抑制肝脏代谢改变处方药药代动力学的潜在能力。
