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35th AM (2025) - Poster Session
Respiratory Depression Following Haloperidol Admin ...
Respiratory Depression Following Haloperidol Administration in a Patient with Suspected Kratom Toxicity
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Pdf Summary
This case report discusses a 21-year-old male presenting to the emergency department with altered mental status and agitation after ingesting kratom (Mitragyna speciosa) and inhaling nitrous oxide. The patient, with a psychiatric history of major depressive disorder and prior suicide attempts, was treated with intramuscular haloperidol due to agitation. Subsequently, he developed respiratory depression characterized by somnolence, hypoventilation, and oxygen desaturation, requiring intubation and ICU admission. He was managed with supportive care and recovered without complications.<br /><br />Kratom contains active alkaloids, mainly mitragynine and 7-hydroxymitragynine, which exert stimulant and opioid-like effects. These compounds inhibit several cytochrome P450 enzymes involved in drug metabolism, notably CYP2D6 and CYP3A4, which are key pathways for haloperidol metabolism. Mitragynine acts as a potent inhibitor of CYP2D6 and a time-dependent inhibitor of CYP3A4, thereby reducing haloperidol clearance and increasing its serum concentration. This interaction likely amplified haloperidol's central nervous system depressant effects, resulting in respiratory depression observed in the patient.<br /><br />The case emphasizes that kratom, despite its legal status and popularity for self-managing opioid withdrawal, presents significant risks due to complex pharmacodynamic interactions and varied alkaloid content. Clinicians should exercise caution when prescribing haloperidol or other drugs metabolized by these cytochrome enzymes to patients using kratom, as toxicity risk increases with higher kratom doses or in individuals with impaired CYP2D6 function.<br /><br />Overall, this report highlights the need for heightened awareness of kratom-drug interactions, careful pharmacologic management in such contexts, and further research to establish safety guidelines for kratom in combination with other medications.
Keywords
Kratom
Mitragyna speciosa
Haloperidol
Respiratory depression
CYP2D6 inhibition
CYP3A4 inhibition
Drug interactions
Altered mental status
Nitrous oxide inhalation
Major depressive disorder
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