SHM Converge Scientific Abstract ePoster Gallery-Naltrexone - Induced Kratom Withdrawal: A Call for Awareness

Pdf Summary

This case highlights a clinically important and often overlooked interaction between kratom and naltrexone. A 34-year-old woman with alcohol use disorder developed severe withdrawal symptoms about one hour after taking her first dose of naltrexone for alcohol cravings. She presented with yawning, anxiety, irritability, tachycardia, muscle cramps, mydriasis, and hyperreflexia. Initial treatment with benzodiazepines was ineffective, and routine toxicology testing was negative.<br /><br />A more detailed history revealed that she had been taking 12 kratom capsules daily to self-treat opioid withdrawal symptoms and chronic pain. Kratom contains active alkaloids, especially mitragynine and 7-hydroxymitragynine, which can act on mu-opioid receptors and produce opioid-like effects at higher doses. Because naltrexone is a mu-opioid receptor antagonist, it displaced these alkaloids from the receptors and triggered acute kratom withdrawal. Once sublingual buprenorphine/naloxone was started, her symptoms improved rapidly and resolved.<br /><br />The report emphasizes that kratom is a non-FDA-approved herbal supplement with addictive potential and that its use may go unrecognized because standard drug screens do not detect it. It is estimated that 1–2% of U.S. adults use kratom for pain or opioid dependence. Clinicians should specifically ask about kratom use before prescribing naltrexone, particularly in patients with substance use disorders or chronic pain. Awareness of this interaction is important to prevent precipitated withdrawal and to guide appropriate management, including the use of buprenorphine/naloxone when indicated.

Asset Subtitle

Donnee Athem

Meta Tag

Author List Donnee Athem, Folashade Arinze

Category Clinical Vignettes

Concept Kratom

Concept Mu-Opioid Receptor

Concept Naltrexone

Concept Kratom Withdrawal

Concept Alkaloids

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Regional Medical Center

Presenting Author Donnee Athem

Track Adult

Keywords

kratom

naltrexone

precipitated withdrawal

opioid withdrawal

buprenorphine/naloxone

mitragynine

7-hydroxymitragynine

substance use disorder

alcohol use disorder

herbal supplement

Kratom

Mu-Opioid Receptor

Naltrexone

Kratom Withdrawal

Alkaloids