SHM Converge Scientific Abstract ePoster Gallery-Fueled Up: A Gas Station Supplement Linked to Serotonin Syndrome

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This case report describes a 43-year-old man who presented with altered mental status, agitation, incoherent speech, tremors, rigidity, clonus, tachycardia, diaphoresis, flushing, and mild fever after taking a dose of a new batch of Kratom. He reportedly was adherent to his home medications, including paroxetine, and disclosed daily Kratom use for chronic back pain.<br /><br />His presentation was most consistent with serotonin syndrome. An extensive diagnostic work-up was largely negative, including infectious, metabolic, toxicologic, and neuroimaging studies, which increased suspicion for a medication or supplement-related cause. He was treated with benzodiazepines, cyproheptadine, and supportive care, leading to marked improvement within 48 hours.<br /><br />The authors conclude that serotonin syndrome was likely caused by the interaction between Kratom and paroxetine. Kratom is an unregulated botanical supplement containing psychoactive alkaloids that can produce stimulant-like effects at low doses and opioid-like effects at higher doses. It is also associated with significant adverse effects and is not FDA approved.<br /><br />The report highlights a likely pharmacokinetic mechanism: Kratom inhibits cytochrome P450 enzymes, especially CYP2D6, which can raise levels of serotonergic medications such as paroxetine and contribute to serotonin toxicity. The patient also met DSM-5 criteria for substance use disorder related to Kratom use and was discharged on buprenorphine.<br /><br />The main clinical takeaway is that clinicians should ask specifically about herbal and supplement use, including Kratom, when evaluating unexplained serotonin syndrome or toxidromes. As Kratom use becomes more common, awareness of Kratom-drug interactions and related adverse events is increasingly important.

Asset Subtitle

Rachel M. Rainier

Meta Tag

Author List Haley Briggs, PA-C, Henry R. Kramer, Laura Freese, Rachel M. Rainier

Category Clinical Vignettes

Concept Kratom

Concept Serotonin Syndrome

Concept Serotonergic Medication

Concept Altered Mental Status

Concept Supplement History

Distinguished Finalist

Presenter Organization University of Colorado

Presenting Author Rachel M. Rainier

Track Adult

Keywords

Kratom

serotonin syndrome

paroxetine

drug interaction

CYP2D6 inhibition

serotonin toxicity

herbal supplement

altered mental status

cyproheptadine

substance use disorder

Kratom

Serotonin Syndrome

Serotonergic Medication

Altered Mental Status

Supplement History