{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T13:28:22Z","timestamp":1773149302494,"version":"3.50.1"},"reference-count":27,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"3","license":[{"start":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T00:00:00Z","timestamp":1620777600000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Kratom is an herbal supplement that has gained popularity for recreational use within the United States. Kratom exerts opioid-like effects and, although not US FDA approved, is commonly used for self-treatment of pain, withdrawal management from opioids, and euphoria. Drug-related hepatic injury has been associated with kratom use. All of this raises concern for patient safety and monitoring. The potential for additive liver toxicity must be considered when kratom is used concurrently with hepatotoxic, over-the-counter, herbal, and prescription medications. This case report describes a case of kratom-induced liver inflammation complicated by opioid withdrawal that was precipitated by initiation of IM naltrexone. To our knowledge, there are no published case reports related to opioid withdrawal following naltrexone administration in patients using kratom (without other opioids). The purpose of this case report is to demonstrate potential complications that may arise with kratom use and considerations that should be taken prior to initiation of naltrexone in kratom users.<\/jats:p>","DOI":"10.9740\/mhc.2021.05.220","type":"journal-article","created":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T21:26:26Z","timestamp":1620854786000},"page":"220-224","source":"Crossref","is-referenced-by-count":9,"title":["Kratom-induced transaminitis with subsequent precipitated opioid withdrawal following naltrexone"],"prefix":"10.9740","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4680-7347","authenticated-orcid":true,"given":"Aimee N.","family":"Jensen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1933-9082","authenticated-orcid":true,"given":"Quynh-Nhu","family":"Truong","sequence":"additional","affiliation":[{"name":"PGY-2 Pharmacy Administration and Leadership Resident, Bay Pines VA Healthcare System, Department of Veterans Affairs, Bay Pines, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6854-0300","authenticated-orcid":true,"given":"Melanie","family":"Jameson","sequence":"additional","affiliation":[{"name":"PGY-1 Pharmacy Practice Resident, Bay Pines VA Healthcare System, Department of Veterans Affairs, Bay Pines, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9256-9004","authenticated-orcid":true,"given":"Celeste N.","family":"Nadal","sequence":"additional","affiliation":[{"name":"Psychiatrist, Bay Pines VA Healthcare System, Department of Veterans Affairs, Bay Pines, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4719","published-online":{"date-parts":[[2021,5,12]]},"reference":[{"key":"2021051221423703700_i2168-9709-11-3-220-b01","doi-asserted-by":"crossref","unstructured":"Cinosi\n              E,\n            \n            \n              Martinotti\n              G,\n            \n            \n              Simonato\n              P,\n            \n            \n              Singh\n              D,\n            \n            \n              Demetrovics\n              Z,\n            \n            \n              Roman-Urrestarazu\n              A,\n            \n            et al.\n          \n          Following \u201cthe roots\u201d of kratom (Mitragyna speciosa): the evolution of an enhancer from a traditional use to increase work and productivity in Southeast Asia to a recreational psychoactive drug in western countries.\n\t\t\t\t\tBiomed Res Int.\n\t\t\t\t\t2015;\n\t\t\t\t\t2015(3):\n\t\t\t\t\t1-\n\t\t\t\t\t11.\n\t\t\t\t\tDOI: 10.1155\/2015\/968786. PubMed PMID: 26640804; PubMed Central PMCID: PMC4657101.","DOI":"10.1155\/2015\/968786"},{"key":"2021051221423703700_i2168-9709-11-3-220-b02","doi-asserted-by":"crossref","unstructured":"Jansen\n              KLR,\n            \n            \n              Prast\n              CJ\n            .\n\t\t\t\t\t\n          Ethnopharmacology of kratom and the Mitragyna alkaloids.\n\t\t\t\t\tJ Ethnopharmacol.\n\t\t\t\t\t1988;\n\t\t\t\t\t23(1):\n\t\t\t\t\t115-\n\t\t\t\t\t9.\n\t\t\t\t\tDOI: 10.1016\/0378-8741(88)90121-3. PubMed PMID: 3419199.","DOI":"10.1016\/0378-8741(88)90121-3"},{"key":"2021051221423703700_i2168-9709-11-3-220-b03","doi-asserted-by":"crossref","unstructured":"Veltri\n              C,\n            \n            \n              Grundmann\n              O.\n            \n          \n          Current perspectives on the impact of kratom use.\n\t\t\t\t\tSubst Abuse Rehabil.\n\t\t\t\t\t2019;\n\t\t\t\t\t10:\n\t\t\t\t\t23-\n\t\t\t\t\t31.\n\t\t\t\t\tDOI: 10.2147\/SAR.S164261. PubMed PMID: 31308789; PubMed Central PMCID: PMC6612999.","DOI":"10.2147\/SAR.S164261"},{"key":"2021051221423703700_i2168-9709-11-3-220-b04","doi-asserted-by":"crossref","unstructured":"Smith\n              KE,\n            \n            \n              Lawson\n              T.\n            \n          \n          Prevalence and motivations for kratom use in a sample of substance users enrolled in a residential treatment program.\n\t\t\t\t\tDrug Alcohol Depend.\n\t\t\t\t\t2017;\n\t\t\t\t\t180:\n\t\t\t\t\t340-\n\t\t\t\t\t8.\n\t\t\t\t\tDOI: 10.1016\/j.drugalcdep.2017.08.034. PubMed PMID: 28950240.","DOI":"10.1016\/j.drugalcdep.2017.08.034"},{"key":"2021051221423703700_i2168-9709-11-3-220-b05","unstructured":"Raffa\n              RB\n            .\n\t\t\t\t\t\n          Kratom and other mitragynines: the chemistry and pharmacology of opioids from a non-opium source.\n\t\t\t\t\tBoca Raton (FL):\n\t\t\t\t\tCRC Press;2014."},{"key":"2021051221423703700_i2168-9709-11-3-220-b06","doi-asserted-by":"crossref","unstructured":"Kruegel\n              AC,\n            \n            \n              Grundmann\n              O.\n            \n          \n          The medicinal chemistry and neuropharmacology of kratom: a preliminary discussion of a promising medicinal plant and analysis of its potential for abuse.\n\t\t\t\t\tNeuropharmacology.\n\t\t\t\t\t2018;\n\t\t\t\t\t134(Pt A):\n\t\t\t\t\t108-\n\t\t\t\t\t20.\n\t\t\t\t\tDOI: 10.1016\/j.neuropharm.2017.08.026. PubMed PMID: 28830758.","DOI":"10.1016\/j.neuropharm.2017.08.026"},{"key":"2021051221423703700_i2168-9709-11-3-220-b07","doi-asserted-by":"crossref","unstructured":"Voelker\n              R.\n            \n          \n          Kratom products seized.\n\t\t\t\t\tJAMA.\n\t\t\t\t\t2016;\n\t\t\t\t\t316(11):\n\t\t\t\t\t1142.\n\t\t\t\t\tDOI: 10.1001\/jama.2016.12571. PubMed PMID: 27654595.","DOI":"10.1001\/jama.2016.12571"},{"key":"2021051221423703700_i2168-9709-11-3-220-b08","doi-asserted-by":"crossref","unstructured":"Babu\n              KM,\n            \n            \n              McCurdy\n              CR,\n            \n            \n              Boyer\n              EW\n            .\n\t\t\t\t\t\n          Opioid receptors and legal highs: Salvia divinorum and kratom.\n\t\t\t\t\tClin Toxicol (Phila).\n\t\t\t\t\t2008;\n\t\t\t\t\t46(2):\n\t\t\t\t\t146-\n\t\t\t\t\t52.\n\t\t\t\t\tDOI: 10.1080\/15563650701241795. PubMed PMID: 18259963.","DOI":"10.1080\/15563650701241795"},{"key":"2021051221423703700_i2168-9709-11-3-220-b09","doi-asserted-by":"crossref","unstructured":"Matsumoto\n              K,\n            \n            \n              Horie\n              S,\n            \n            \n              Ishikawa\n              H,\n            \n            \n              Takayama\n              H,\n            \n            \n              Aimi\n              N,\n            \n            \n              Ponglux\n              D,\n            \n            et al.\n          \n          Antinociceptive effect of 7-hydroxymitragynine in mice: discovery of an orally active opioid analgesic from the Thai medicinal herb Mitragyna speciosa.\n\t\t\t\t\tLife Sci.\n\t\t\t\t\t2004;\n\t\t\t\t\t74(17):\n\t\t\t\t\t2143-\n\t\t\t\t\t55.\n\t\t\t\t\tDOI: 10.1016\/j.lfs.2003.09.054. PubMed PMID: 14969718.","DOI":"10.1016\/j.lfs.2003.09.054"},{"key":"2021051221423703700_i2168-9709-11-3-220-b10","doi-asserted-by":"crossref","unstructured":"Vijeepallam\n              K,\n            \n            \n              Pandy\n              V,\n            \n            \n              Kunasegaran\n              T,\n            \n            \n              Murugan\n              DD,\n            \n            \n              Naidu\n              M.\n            \n          \n          \n            Mitragyna speciosa leaf extract exhibits antipsychotic-like effect with the potential to alleviate positive and negative symptoms of psychosis in mice.\n\t\t\t\t\tFront Pharmacol.\n\t\t\t\t\t2016;\n\t\t\t\t\t7:\n\t\t\t\t\t464.\n\t\t\t\t\tDOI: 10.3389\/fphar.2016.00464. PubMed PMID: 27999544; PubMed Central PMCID: PMC5138496.","DOI":"10.3389\/fphar.2016.00464"},{"key":"2021051221423703700_i2168-9709-11-3-220-b11","doi-asserted-by":"crossref","unstructured":"Koehl\n              JL,\n            \n            \n              Zimmerman\n              DE,\n            \n            \n              Bridgeman\n              PJ\n            .\n\t\t\t\t\t\n          Medications for management of opioid use disorder.\n\t\t\t\t\tAm J Health Syst Pharm.\n\t\t\t\t\t2019;\n\t\t\t\t\t76(15):\n\t\t\t\t\t1097-\n\t\t\t\t\t103.\n\t\t\t\t\tDOI: 10.1093\/ajhp\/zxz105. PubMed PMID: 31361869.","DOI":"10.1093\/ajhp\/zxz105"},{"key":"2021051221423703700_i2168-9709-11-3-220-b12","doi-asserted-by":"crossref","unstructured":"Kapp\n              FG,\n            \n            \n              Maurer\n              HH,\n            \n            \n              Auw\u00e4rter\n              V,\n            \n            \n              Winkelmann\n              M,\n            \n            \n              Hermanns-Clausen\n              M.\n            \n          \n          Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa).\n\t\t\t\t\tJ Med Toxicol.\n\t\t\t\t\t2011;\n\t\t\t\t\t7(3):\n\t\t\t\t\t227-\n\t\t\t\t\t31.\n\t\t\t\t\tDOI: 10.1007\/s13181-011-0155-5. PubMed PMID: 21528385; PubMed Central PMCID: PMC3550198.","DOI":"10.1007\/s13181-011-0155-5"},{"key":"2021051221423703700_i2168-9709-11-3-220-b13","doi-asserted-by":"crossref","unstructured":"Griffiths\n              CL,\n            \n            \n              Gandhi\n              N,\n            \n            \n              Olin\n              JL\n            .\n\t\t\t\t\t\n          Possible kratom-induced hepatomegaly: a case report.\n\t\t\t\t\tJ Am Pharm Assoc (2003).\n\t\t\t\t\t2018;\n\t\t\t\t\t58(5):\n\t\t\t\t\t561-\n\t\t\t\t\t3.\n\t\t\t\t\tDOI: 10.1016\/j.japh.2018.05.006. PubMed PMID: 30041853.","DOI":"10.1016\/j.japh.2018.05.006"},{"key":"2021051221423703700_i2168-9709-11-3-220-b14","doi-asserted-by":"crossref","unstructured":"Osborne\n              CS,\n            \n            \n              Overstreet\n              AN,\n            \n            \n              Rockey\n              DC,\n            \n            \n              Schreiner\n              AD\n            .\n\t\t\t\t\t\n          Drug-induced liver injury caused by kratom use as an alternative pain treatment amid an ongoing opioid epidemic.\n\t\t\t\t\tJ Investig Med High Impact Case Rep.\n\t\t\t\t\t2019;\n\t\t\t\t\t7:\n\t\t\t\t\t232470961982616.\n\t\t\t\t\tDOI: 10.1177\/2324709619826167. PubMed PMID: 30791718; PubMed Central PMCID: PMC6350132.","DOI":"10.1177\/2324709619826167"},{"key":"2021051221423703700_i2168-9709-11-3-220-b15","doi-asserted-by":"crossref","unstructured":"Fernandes\n              CT,\n            \n            \n              Iqbal\n              U,\n            \n            \n              Tighe\n              SP,\n            \n            \n              Ahmed\n              A.\n            \n          \n          Kratom-induced cholestatic liver injury and its conservative management.\n\t\t\t\t\tJ Investig Med High Impact Case Rep.\n\t\t\t\t\t2019;\n\t\t\t\t\t7:\n\t\t\t\t\t232470961983613.\n\t\t\t\t\tDOI: 10.1177\/2324709619836138. PubMed PMID: 30920318; PubMed Central PMCID: PMC6440031.","DOI":"10.1177\/2324709619836138"},{"key":"2021051221423703700_i2168-9709-11-3-220-b16","unstructured":"LiverTox: clinical and research information on drug-induced liver injury\n          [Internet].\n\t\t\t\t\tBethesda (MD):\n\t\t\t\t\tNational Institute of Diabetes and Digestive and Kidney Diseases;2012.\n\t\t\t\t\tAvailable from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK547852\/."},{"key":"2021051221423703700_i2168-9709-11-3-220-b17","doi-asserted-by":"crossref","unstructured":"Anwar\n              M,\n            \n            \n              Law\n              R,\n            \n            \n              Schier\n              J.\n            \n          \n          Notes from the field: kratom (Mitragyna speciosa) exposures reported to poison centers\u2014United States, 2010-2015.\n\t\t\t\t\tMMWR Morb Mortal Wkly Rep.\n\t\t\t\t\t2016;\n\t\t\t\t\t65(29):\n\t\t\t\t\t748-\n\t\t\t\t\t9.\n\t\t\t\t\tDOI: 10.15585\/mmwr.mm6529a4. PubMed PMID: 27466822.","DOI":"10.15585\/mmwr.mm6529a4"},{"key":"2021051221423703700_i2168-9709-11-3-220-b18","unstructured":"Roche\n              KM,\n            \n            \n              Hart\n              K,\n            \n            \n              Sangall\n              B,\n            \n            \n              Lefberg\n              J,\n            \n            \n              Bayer\n              M.\n            \n          \n          Kratom: a case of a legal high.\n\t\t\t\t\tJ Clin Toxicol.\n\t\t\t\t\t2008;\n\t\t\t\t\t46(7):\n\t\t\t\t\t598."},{"key":"2021051221423703700_i2168-9709-11-3-220-b19","doi-asserted-by":"crossref","unstructured":"Singh\n              D,\n            \n            \n              M\u00fcller\n              CP,\n            \n            \n              Vicknasingam\n              BK\n            .\n\t\t\t\t\t\n          Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users.\n\t\t\t\t\tDrug Alcohol Depend.\n\t\t\t\t\t2014;\n\t\t\t\t\t139:\n\t\t\t\t\t132-\n\t\t\t\t\t7.\n\t\t\t\t\tDOI: 10.1016\/j.drugalcdep.2014.03.017. PubMed PMID: 24698080.","DOI":"10.1016\/j.drugalcdep.2014.03.017"},{"key":"2021051221423703700_i2168-9709-11-3-220-b20","doi-asserted-by":"crossref","unstructured":"Ward\n              J,\n            \n            \n              Rosenbaum\n              C,\n            \n            \n              Hernon\n              C,\n            \n            \n              McCurdy\n              CR,\n            \n            \n              Boyer\n              EW\n            .\n\t\t\t\t\t\n          Herbal medicines for the management of opioid addiction.\n\t\t\t\t\tCNS Drugs.\n\t\t\t\t\t2011;\n\t\t\t\t\t25(12):\n\t\t\t\t\t999-\n\t\t\t\t\t1007.\n\t\t\t\t\tDOI: 10.2165\/11596830-000000000-00000. PubMed PMID: 22133323.","DOI":"10.2165\/11596830-000000000-00000"},{"key":"2021051221423703700_i2168-9709-11-3-220-b21","unstructured":"Chan\n              KB,\n            \n            \n              Pakiam\n              C,\n            \n            \n              Rahim\n              RA\n            .\n\t\t\t\t\t\n          Psychoactive plant abuse: the identification of mitragynine in ketum and in ketum preparations.\n\t\t\t\t\tBull Narc.\n\t\t\t\t\t2005;\n\t\t\t\t\t57(1-2):\n\t\t\t\t\t249-\n\t\t\t\t\t56.\n\t\t\t\t\tPubMed PMID: 21338025."},{"key":"2021051221423703700_i2168-9709-11-3-220-b22","doi-asserted-by":"crossref","unstructured":"Sabetghadam\n              A,\n            \n            \n              Ramanathan\n              S,\n            \n            \n              Sasidharan\n              S,\n            \n            \n              Mansor\n              SM\n            .\n\t\t\t\t\t\n          Subchronic exposure to mitragynine, the principal alkaloid of Mitragyna speciosa, in rats.\n\t\t\t\t\tJ Ethnopharmacol.\n\t\t\t\t\t2013;\n\t\t\t\t\t146(3):\n\t\t\t\t\t815-\n\t\t\t\t\t23.\n\t\t\t\t\tDOI: 10.1016\/j.jep.2013.02.008. PubMed PMID: 23422336.","DOI":"10.1016\/j.jep.2013.02.008"},{"key":"2021051221423703700_i2168-9709-11-3-220-b23","doi-asserted-by":"crossref","unstructured":"Pantano\n              F,\n            \n            \n              Tittarelli\n              R,\n            \n            \n              Mannocchi\n              G,\n            \n            \n              Zaami\n              S,\n            \n            \n              Ricci\n              S,\n            \n            \n              Giorgetti\n              R,\n            \n            et al.\n          \n          Hepatotoxicity induced by \u201cthe 3Ks\u201d: kava, kratom and khat.\n\t\t\t\t\tInt J Mol Sci.\n\t\t\t\t\t2016;\n\t\t\t\t\t17(4):\n\t\t\t\t\t580.\n\t\t\t\t\tDOI: 10.3390\/ijms17040580. PubMed PMID: 27092496; PubMed Central PMCID: PMC4849036.","DOI":"10.3390\/ijms17040580"},{"key":"2021051221423703700_i2168-9709-11-3-220-b24","doi-asserted-by":"crossref","unstructured":"Harizal\n              SN,\n            \n            \n              Mansor\n              SM,\n            \n            \n              Hasnan\n              J,\n            \n            \n              Tharakan\n              JKJ,\n            \n            \n              Abdullah\n              J.\n            \n          \n          Acute toxicity study of the standardized methanolic extract of Mitragyna speciosa korth in rodent.\n\t\t\t\t\tJ Ethnopharmacol.\n\t\t\t\t\t2010;\n\t\t\t\t\t131(2):\n\t\t\t\t\t404-\n\t\t\t\t\t9.\n\t\t\t\t\tDOI: 10.1016\/j.jep.2010.07.013. PubMed PMID: 20643198.","DOI":"10.1016\/j.jep.2010.07.013"},{"key":"2021051221423703700_i2168-9709-11-3-220-b25","doi-asserted-by":"crossref","unstructured":"Wananukul\n              W,\n            \n            \n              Trakulsrichai\n              S,\n            \n            \n              Sathirakul\n              K,\n            \n            \n              Auparakkitanon\n              S,\n            \n            \n              Krongvorakul\n              J,\n            \n            \n              Sueajai\n              J,\n            \n            et al.\n          \n          Pharmacokinetics of mitragynine in man.\n\t\t\t\t\tDrug Des Devel Ther.\n\t\t\t\t\t2015;\n\t\t\t\t\t9:\n\t\t\t\t\t2421-\n\t\t\t\t\t9.\n\t\t\t\t\tDOI: 10.2147\/DDDT.S79658. PubMed PMID: 25995615; PubMed Central PMCID: PMC4425236.","DOI":"10.2147\/DDDT.S79658"},{"key":"2021051221423703700_i2168-9709-11-3-220-b26","doi-asserted-by":"crossref","unstructured":"Buresh\n              M.\n            \n          \n          Treatment of kratom dependence with buprenorphine-naloxone maintenance.\n\t\t\t\t\tJ Addict Med.\n\t\t\t\t\t2018;\n\t\t\t\t\t12(6):\n\t\t\t\t\t481-\n\t\t\t\t\t3.\n\t\t\t\t\tDOI: 10.1097\/ADM.0000000000000428. PubMed PMID: 29944481.","DOI":"10.1097\/ADM.0000000000000428"},{"key":"2021051221423703700_i2168-9709-11-3-220-b27","doi-asserted-by":"crossref","unstructured":"Khazaeli\n              A,\n            \n            \n              Jerry\n              JM,\n            \n            \n              Vazirian\n              M.\n            \n          \n          Treatment of kratom withdrawal and addiction with buprenorphine.\n\t\t\t\t\tJ Addict Med.\n\t\t\t\t\t2018;\n\t\t\t\t\t12(6):\n\t\t\t\t\t493-\n\t\t\t\t\t5.\n\t\t\t\t\tDOI: 10.1097\/ADM.0000000000000435. PubMed PMID: 30383616.","DOI":"10.1097\/ADM.0000000000000435"}],"container-title":["Mental Health Clinician"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/meridian.allenpress.com\/mhc\/article-pdf\/11\/3\/220\/2826277\/i2168-9709-11-3-220.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/meridian.allenpress.com\/mhc\/article-pdf\/11\/3\/220\/2826277\/i2168-9709-11-3-220.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T16:19:16Z","timestamp":1731687556000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhc.kglmeridian.com\/view\/journals\/mhcl\/11\/3\/article-p220.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,1]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,5,12]]},"published-print":{"date-parts":[[2021,5,1]]}},"URL":"https:\/\/doi.org\/10.9740\/mhc.2021.05.220","relation":{},"ISSN":["2168-9709"],"issn-type":[{"value":"2168-9709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,1]]}}}