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Clinical Pharmacokinetic Assessment of Kratom (Mitragyna speciosa), a Botanical Product with Opioid-like Effects, in Healthy Adult Participants

Increasing use of the botanical kratom to self-manage opioid withdrawal and pain has led to increased kratom-linked overdose deaths. Despite these serious safety concerns, rigorous fundamental pharmacokinetic knowledge of kratom in humans remains lacking. We assessed the pharmacokinetics of a single...

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Autores principales: Tanna, Rakshit S., Nguyen, James T., Hadi, Deena L., Manwill, Preston K., Flores-Bocanegra, Laura, Layton, Matthew E., White, John R., Cech, Nadja B., Oberlies, Nicholas H., Rettie, Allan E., Thummel, Kenneth E., Paine, Mary F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8950611/
https://www.ncbi.nlm.nih.gov/pubmed/35335999
http://dx.doi.org/10.3390/pharmaceutics14030620
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author Tanna, Rakshit S.
Nguyen, James T.
Hadi, Deena L.
Manwill, Preston K.
Flores-Bocanegra, Laura
Layton, Matthew E.
White, John R.
Cech, Nadja B.
Oberlies, Nicholas H.
Rettie, Allan E.
Thummel, Kenneth E.
Paine, Mary F.
author_facet Tanna, Rakshit S.
Nguyen, James T.
Hadi, Deena L.
Manwill, Preston K.
Flores-Bocanegra, Laura
Layton, Matthew E.
White, John R.
Cech, Nadja B.
Oberlies, Nicholas H.
Rettie, Allan E.
Thummel, Kenneth E.
Paine, Mary F.
author_sort Tanna, Rakshit S.
collection PubMed
description Increasing use of the botanical kratom to self-manage opioid withdrawal and pain has led to increased kratom-linked overdose deaths. Despite these serious safety concerns, rigorous fundamental pharmacokinetic knowledge of kratom in humans remains lacking. We assessed the pharmacokinetics of a single low dose (2 g) of a well-characterized kratom product administered orally to six healthy participants. Median concentration-time profiles for the kratom alkaloids examined were best described by a two-compartment model with central elimination. Pronounced pharmacokinetic differences between alkaloids with the 3S configuration (mitragynine, speciogynine, paynantheine) and alkaloids with the 3R configuration (mitraciliatine, speciociliatine, isopaynantheine) were attributed to differences in apparent intercompartmental distribution clearance, volumes of distribution, and clearance. Based on noncompartmental analysis of individual concentration-time profiles, the 3S alkaloids exhibited a shorter median time to maximum concentration (1–2 vs. 2.5–4.5 h), lower area under the plasma concentration-time curve (430–490 vs. 794–5120 nM × h), longer terminal half-life (24–45 vs. ~12–18 h), and higher apparent volume of distribution during the terminal phase (960–12,700 vs. ~46–130 L) compared to the 3R alkaloids. Follow-up mechanistic in vitro studies suggested differential hepatic/intestinal metabolism, plasma protein binding, blood-to-plasma partitioning, and/or distribution coefficients may explain the pharmacokinetic differences between the two alkaloid types. This first comprehensive pharmacokinetic characterization of kratom alkaloids in humans provides the foundation for further research to establish safety and effectiveness of this emerging botanical product.
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spelling pubmed-89506112022-03-26 Clinical Pharmacokinetic Assessment of Kratom (Mitragyna speciosa), a Botanical Product with Opioid-like Effects, in Healthy Adult Participants Tanna, Rakshit S. Nguyen, James T. Hadi, Deena L. Manwill, Preston K. Flores-Bocanegra, Laura Layton, Matthew E. White, John R. Cech, Nadja B. Oberlies, Nicholas H. Rettie, Allan E. Thummel, Kenneth E. Paine, Mary F. Pharmaceutics Article Increasing use of the botanical kratom to self-manage opioid withdrawal and pain has led to increased kratom-linked overdose deaths. Despite these serious safety concerns, rigorous fundamental pharmacokinetic knowledge of kratom in humans remains lacking. We assessed the pharmacokinetics of a single low dose (2 g) of a well-characterized kratom product administered orally to six healthy participants. Median concentration-time profiles for the kratom alkaloids examined were best described by a two-compartment model with central elimination. Pronounced pharmacokinetic differences between alkaloids with the 3S configuration (mitragynine, speciogynine, paynantheine) and alkaloids with the 3R configuration (mitraciliatine, speciociliatine, isopaynantheine) were attributed to differences in apparent intercompartmental distribution clearance, volumes of distribution, and clearance. Based on noncompartmental analysis of individual concentration-time profiles, the 3S alkaloids exhibited a shorter median time to maximum concentration (1–2 vs. 2.5–4.5 h), lower area under the plasma concentration-time curve (430–490 vs. 794–5120 nM × h), longer terminal half-life (24–45 vs. ~12–18 h), and higher apparent volume of distribution during the terminal phase (960–12,700 vs. ~46–130 L) compared to the 3R alkaloids. Follow-up mechanistic in vitro studies suggested differential hepatic/intestinal metabolism, plasma protein binding, blood-to-plasma partitioning, and/or distribution coefficients may explain the pharmacokinetic differences between the two alkaloid types. This first comprehensive pharmacokinetic characterization of kratom alkaloids in humans provides the foundation for further research to establish safety and effectiveness of this emerging botanical product. MDPI 2022-03-11 /pmc/articles/PMC8950611/ /pubmed/35335999 http://dx.doi.org/10.3390/pharmaceutics14030620 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Tanna, Rakshit S.
Nguyen, James T.
Hadi, Deena L.
Manwill, Preston K.
Flores-Bocanegra, Laura
Layton, Matthew E.
White, John R.
Cech, Nadja B.
Oberlies, Nicholas H.
Rettie, Allan E.
Thummel, Kenneth E.
Paine, Mary F.
Clinical Pharmacokinetic Assessment of Kratom (Mitragyna speciosa), a Botanical Product with Opioid-like Effects, in Healthy Adult Participants
title Clinical Pharmacokinetic Assessment of Kratom (Mitragyna speciosa), a Botanical Product with Opioid-like Effects, in Healthy Adult Participants
title_full Clinical Pharmacokinetic Assessment of Kratom (Mitragyna speciosa), a Botanical Product with Opioid-like Effects, in Healthy Adult Participants
title_fullStr Clinical Pharmacokinetic Assessment of Kratom (Mitragyna speciosa), a Botanical Product with Opioid-like Effects, in Healthy Adult Participants
title_full_unstemmed Clinical Pharmacokinetic Assessment of Kratom (Mitragyna speciosa), a Botanical Product with Opioid-like Effects, in Healthy Adult Participants
title_short Clinical Pharmacokinetic Assessment of Kratom (Mitragyna speciosa), a Botanical Product with Opioid-like Effects, in Healthy Adult Participants
title_sort clinical pharmacokinetic assessment of kratom (mitragyna speciosa), a botanical product with opioid-like effects, in healthy adult participants
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8950611/
https://www.ncbi.nlm.nih.gov/pubmed/35335999
http://dx.doi.org/10.3390/pharmaceutics14030620
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