From the Research
Mitragynine overdose presents with a unique combination of opioid and stimulant toxicity symptoms, and treatment involves supportive care with careful consideration of the patient's respiratory and cardiac status, as evidenced by the most recent study in 2024 1. The clinical presentation of mitragynine overdose can include pinpoint pupils, respiratory depression, sedation, and decreased consciousness, similar to traditional opioid overdoses, as well as agitation, tachycardia, hypertension, and seizures due to its stimulant properties. Some key points to consider in the management of mitragynine overdose include:
- Respiratory depression, which may require naloxone administration (0.4-2mg IV, repeated as needed), although its efficacy may be limited compared to traditional opioid overdoses 1
- Cardiac monitoring, due to the potential for QT interval prolongation and cardiac arrhythmias
- Benzodiazepines, such as diazepam (5-10mg IV), may be needed for seizures or severe agitation
- The risk of overdose increases with high doses, co-ingestion of other substances, or in patients with underlying health conditions The most recent study in 2024 1 provides guidance on the pharmacokinetics of mitragynine and 7-hydroxymitragynine, which is essential for understanding the clinical presentation and management of mitragynine overdose. It is also important to note that mitragynine has a unique mechanism of action, as a partial µ-opioid receptor agonist and competitive antagonist at κ- and δ-opioid receptors, which may contribute to its distinct clinical presentation and treatment approach, as compared to traditional opioids 2, 1.