Kratom, Cyclobenzaprine, Serotonin Syndrome? Opioid affect on serotonin?

[gingerbaker]

I've been taking kratom 3x daily for a few months for chronic pain, diazepam 5mg BID for anxiety as well as Gabapentin 300mg BID for anxiety.

I have been prescribed cyclobenzaprine (Flexeril) for that musculoskeletal pain (10mg, PRN, Q 8hrs).

Now, it seems that cyclobenzaprine has the risk of Serotonin Syndrome, so:
1. My main question is what, if any, pharmacological consequences there would be with concurrent administration of Flexeril and Kratom (in addition to 5mg diazepam BID)?
2. Does kratom have any Serotonergic activity? If so, how dangerous would it be with clinical amounts of Flexeril (10mg)?
3. Additionally, I have Promethazine and Hydroxyzine prescribed for insomnia as a PRN and am curious if this would also be worth consideration due to possible anti-cholinergic additive problems.

Also, I've read some that opioids might have some effect on serotonin syndrome although I wonder if that's not the "dumbing down" that they do for those taking Tramadol (which obviously would be of issue, and sadly is my PRN for breakthrough pain).

That being said, if opioids do contribute to risk of SS, than the various opioid agonism of kratom (mu, kappa and delta to my understanding) have any influence on serotonin?

Thank you, I look forward to any responses.

 

[sekio]

Opioid activity does not cause or contribute to SS and kratom is not directly serotonergic.

Kratom is basically not researched in the formal medical literature so you are on your own with respect to drug interactions, but treating it like a typical opioid (hydrocodone) is probably a good place to start.

 

[gingerbaker]

Thanks for the response.

I understand that cyclobenzaprine's MOA is anticholinergic (in part) so what danger/effect would there be from concurrent use of promethazine or hydroxyzine with 10mg of cyclobenzaprine?

 

[al-laddin]

I don't know about that.....kratom definitely has opiod effects but it has an indole ring (tryptamine) as its backbone, which is pretty odd. I don't know much about chemistry but this must indicate some pharmacological differences....I could be mistaken. Ive read that kratom MAY have some light MAO activity but I understand theres been many people that mix kratom with sustances and no severe interactions have been reported to my knowledge.

I too have been concerned about kratoms interactions with other drugs and have found nothing. If it helps, Ive taken kratom along side LSD , mushrooms and various opiods if that helps any. Theres probably more combos but I cant think any off the top of my head.

 

[Snake_Eyes]

I've taken a single dose of kratom (and weed) with flexeril a few times and other than some bad cotton mouth I can't remember having any problems.

 

[Xorkoth]

I've definitely combined kratom with cyclobenzaprine multiple times and nothing bad happened, I just got more sedated than usual.

 

[al-laddin]

Thanks xorkoth and snake_eyes! My good friend has a back problem is on flexirl and wanted to take kratom instead of hydrocodone that was prescribed to her ....we looked everywhere and couldn't find any info! Good to know brotha!

 

[《Plasticity》]

I guess I'll add my experiences in for comfort. I too have taken cyclobenzaprine with kratom a couple times, once at 10 and the other at 20mgs (I think they were 10mg each, they were the yellow ones). They gave me really bad cottonmouth though, that I remember. Anyways, nothing serious.

To date I've yet to find any drug that's definately contraindicated with kratom...from antibiotics to aMT to MDxx to MXE, I've taken kratom alongside just about every drug I experimented with in the past four or so years, which was also the peak of my RC experimentation and nothing dangerously noteworthy, aside from common stuff you would expect like kratom plus alcohol equals increased nausea etc. Mixed with monoamine releasers it does tend cause some increased body temps I guess, but not dangerously so. I'm not saying any of this is reccomended, but kratom seems very safe to combine with other drugs.

I also want to question the legitamacy of mitragynine being a 5-ht2a antagonst, wouldn't daily use of kratom then produce receptor downregulation rendering psychedelics innefective? Because that's not the case at all, I was always capable of tripping pretty damn hard. I haven't seen any evidence gearing towards mitragynine being a 5-ht2a antagonist... even on several overviews on the alkaloids in kratom say "possible psychedelic (5-HT2A) antagonist". It does compliment psychedelics more so than opiates for some reason though. DOC and kratom comes to mind, as does aMT and kratom.

 

[sekio]

Mitragynine doesn't hit 5ht2a at any sort of appreciable level you'd see in a typical biological system.

 

[《Plasticity》]

Yeah, I don't understand where that claim even came from... but it seems to be on every alkaloid profile I've seen and occasionally comes up in discussion about "kratom and serotonin". It doesn't even feel psychedelic, although like I said it synergizes quite well with certain psychs without dulling the experience too much like a typical opioid would, unrrlated to any psychedelic activity though I would assume.