What is the pattern of liver injury associated with Kratom?
According to the cited reference “Of the 8 cases of liver injury associated with kratom, a causal association was established in 7; 6 occurred in men, the median age was 46 (range 25 to 70), and 6 were Caucasian. All used alcohol and none had major comorbidities. Five used kratom for its psychotropic effects and 1 for joint pain. The mean BMI was 24.3 kg/m2. Products were used for a median of 22 days (range 15-49) before onset of injury; 5 had jaundice, 6 itching, 5 abdominal pain, 3 fever, and none had rash. Median ALT at onset was 326 U/L (range 52-588), AST 154 U/L (29-367), Alk P 292 U/L (181-365), and total bilirubin 9.5 mg/dL (5.2-36.2). The corresponding peak values were 362 U/L (62-588), 154 U/L (53-462), 294 U/L (264-836), and 20.1 mg/dL (6.8-41.1). The median R-value at onset was 3.0 (0.9-3.2), indicating a mixed hepatocellular and cholestatic injury. Two patients underwent biopsy showing cholestasis”. (Navarro V, et al. Liver injury associated with kratom, a botanical product with opioid-like activity. AASLD 2019; Abstract 0212.)
Submitted by: Christy Cheruvil, Pharm.D, Upstate Medical University, Syracuse NY