The "Kratom" Question – A Comprehensive Look at Kratom (Mitragyna speciosa)
1. What is Kratom?
Botanical identity: Mitragyna speciosa – a tropical tree in the coffee family (Rubiaceae) native to Southeast Asia (Thailand, Indonesia, Malaysia, Papua New Guinea).
Plant parts used: Leaves are most common; dried leaves, powders, capsules, teas, and extracts are sold worldwide.
Active compounds:
- Mitragynine – the primary alkaloid (~70–90 % of total alkaloids).
- 7-hydroxymitragynine – a minor but far more potent metabolite.
- Other minor alkaloids (e.g., rhynchophylline, corydalis) may modulate effects.
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2. Pharmacological Actions
Mechanism Effect
Partial μ‑opioid receptor agonist Analgesic, mild euphoria, sedation; less respiratory depression than full agonists.
κ‑opioid receptor antagonist (weak) Modulates dysphoric side‑effects; may contribute to reduced abuse potential.
These parameters are derived from the drug’s pharmacokinetic profile and will guide dosing considerations in different patient populations.
3.3 Clinical Dosing Recommendations
Based on the above PK data, the following general recommendations can be made for patients with varying organ function:
Population Dose Adjustment
Renal impairment (CrCl <30 mL/min) Reduce dose by 25% or extend dosing interval to 48 h. Monitor trough levels.
Hepatic impairment (Child-Pugh B/C) Use half the standard adult dose initially; reassess after 1–2 doses.
Dialysis patients Administer immediately post-dialysis if drug is dialyzable; otherwise no adjustment needed.
These are only indicative and must be confirmed by therapeutic drug monitoring (TDM) where available.
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4. How to Use This Cheat Sheet
Step Action Tool
1. Identify the drug Look at the product name or active ingredient on the vial. Product insert, label
2. Pick a patient profile Age/weight, renal function (CrCl), comorbidities. Hospital chart, labs
3. Apply the dosing table Find the row that matches the patient and read the dose. Cheat sheet
4. Check for special conditions If renal failure, liver disease, or drug‑drug interactions present, consult the "special considerations" section. Insert, clinical guidelines
5. Calculate actual dose Multiply the per kg mg by weight (if table gives mg/kg) or use fixed dose if appropriate. Calculator
6. Verify with pharmacist Confirm dose and adjust for infusion rates. Pharmacy
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7. Quick Reference: "What to Do in Common Scenarios"
Scenario Typical Dose Key Points
Child <12 kg, normal renal function 0.5–1 mg/kg IV every 6 h (max 10 mg) Avoid exceeding max; monitor for hypersensitivity.
Child >12 kg, mild renal impairment (CrCl 50‑80 mL/min) Reduce dose by ~30 % or extend interval to 8 h Adjust based on creatinine clearance.
Child with severe renal impairment (CrCl < 30 mL/min) Extend dosing interval to 12–24 h; monitor levels if available Avoid accumulation.
Pediatric patient with seizure disorder requiring long‑term use Initiate at low dose, titrate slowly; continue monitoring for tolerance and side effects Consider alternative agents if breakthrough seizures occur.
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Summary of Key Points
Mechanism – Enhances GABAergic inhibition by blocking chloride channels that normally conduct K⁺, leading to increased neuronal membrane permeability to Cl⁻ (inhibitory) or Na⁺/K⁺ (excitatory).
Indications – Primarily used for status epilepticus; also indicated in certain seizure disorders requiring rapid suppression of seizures.
Contraindications & Precautions – Avoid in patients with severe liver disease, known hypersensitivity to the drug or its excipients, and consider careful monitoring in pregnancy (category C).
Side Effects & Monitoring – Watch for respiratory depression, hypotension, bradycardia; monitor vital signs and arterial blood gases during therapy.
Conclusion
The therapeutic strategy is to administer a rapid‑acting IV agent that reduces intracranial pressure, carefully titrate the dose based on weight and clinical response, monitor hemodynamics, and address any complications promptly. This approach maximizes safety while effectively managing the patient's critical neurologic status.