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Kratom Kratom + Montelukast= rapid withdrawal?!? WTFuck just happened?

Anonymous Dissident

Bluelighter
Joined
Mar 27, 2017
Messages
1,264
I started a new asthma medication (montelukast aka singulair) this morning. I waited about an hour after taking my 1st dose, then went to do some cycling to see if it was going to be of any use in allowing me to get out more without asthma attacks that I’ve been having, far more frequently than normal due to wildfire smoke. Normally my asthma is controlled to the point that I only need albuterol once or twice a year.

Within 10 minutes of pedaling out of my driveway, I started to feel slightly off. Within just a few more minutes, I started getting much more uncomfortable. This discomfort rapidly escalated into full on withdrawal. Before anyone suggests placebo effect, I should mention that every physiological symptom of withdrawal was present. Profuse sweating, dilated pupils, diarrhea, vomiting, the worst restlessness I’ve ever had, physical tremors, watery eyes, runny nose, joint and muscle pain; essentially the whole 9 yards. Psychologically, I was too stunned and bewildered to be depressed, though there was a major anxiety component to the agony. When I got home, I was looking so bad my brother thought I was going to have a seizure and was ready to call an ambulance.

Once home, I immediately downed 15g of green dragon kratom, recognizing what was happening, completely blowing my taper. Within about 30 minutes, my condition began improving, but I was still crazy uncomfortable. I then took another 15g and I was on my way back to normal, but I still am not entirely right. Getting close to normal required about 90 minutes, though I’m still sweating quite a bit and a little unsteady. This should have taken me about 5 minutes to type up, but it took close to 30 minutes, as I constantly had to correct errors resulting from difficulty hitting the right keys and a lot of difficulty concentrating.

I had only taken my 1st dose of kratom about two hours earlier, and I don’t usually start getting too uncomfortable until the last hour or so before my nightly dose, close to 7 hours later than this incident. This was entirely unexpected. I had asked my doctor ahead of time if it would have any reaction with any of my meds and supplements and he assured me that a leukotriene antagonist would not have any interaction. For the record, I’m open with him about my kratom use and he’s aware that I’m in the middle of a taper.

This was beyond a doubt the most uncomfortable experience of my life. I’m still stunned by this whole fiasco. I did some cursory research into the pharmacology and metabolism of montelukast prior to taking it. Its something I always do when starting a new medication; I trust my doctor, but it seems like a good idea since no doctor can be aware of every aspect of how every medication in existence works. I ran it through the online P.D.R. and found nothing worrying. I scanned pubmed.gov to see if there were any isolated instances of interactions and found nothing applicable there as well. I’m now going to do some more in-depth research into if montelukast is an inducer of any enzyme responsible for the metabolism of mitragynine and related compounds. I looked for this already, but I’m on a mission to find some kind of concrete explanation for what I just went through. It was what I would have expected from a MOR antagonist, not an asthma medication!

Has anyone else experienced something like this with montelukast combined with any kind of opioid? I can't be the only kratom user on montelukast.

Does anyone have any theories about the mechanism that might have caused this? I need to figure this out asap, if only to help prevent anyone else from this hell. I’m also concerned about how much of a setback this could be to my long fought taper. I don’t want to go back to square one, I’ve worked too damn hard to get this far.

If any lurkers out there can shed any light on this, please register and let me know! Any help sorting out this clusterfuck is greatly appreciated!
 
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Damn... I feel for you.

FWIW - half life seems to be around 4 - 5 hours for montelukast. If your symptoms don't improve with time get help and I do hope you have someone to watch you now. If not can you get someone competent to (help) make medical decisions for you to watch you until you are better? I think that would be good HR.

This could be a weird one off, but there's a bit of history with this drug - FDA filed post-market study data - that inidicates to me to take adverse events seriously. Anaphylaxis and other severe immune reactions to montelukast alone have occurred in clinical use of this compound.

Be on the conservative side is my thought, with some decent knowledge of pharmacology - I'm no kid - I see it is a new compound to you and possibly there could be enzyme, immune or drug action interactions b/w it and your body chemistry and maybe kratom.

Wishing you the best, check in when you wish - I'm concerned for you.
 
Damn... I feel for you.

FWIW - half life seems to be around 4 - 5 hours for montelukast. If your symptoms don't improve with time get help and I do hope you have someone to watch you now. If not can you get someone competent to (help) make medical decisions for you to watch you until you are better? I think that would be good HR.

This could be a weird one off, but there's a bit of history with this drug - FDA filed post-market study data - that inidicates to me to take adverse events seriously. Anaphylaxis and other severe immune reactions to montelukast alone have occurred in clinical use of this compound.

Be on the conservative side is my thought, with some decent knowledge of pharmacology - I'm no kid - I see it is a new compound to you and possibly there could be enzyme, immune or drug action interactions b/w it and your body chemistry and maybe kratom.

Wishing you the best, check in when you wish - I'm concerned for you.
Thanks. I'm at home with my brother and a close friend, both of who are fully up to speed on what I'm going through today, so no worries about me being alone. I won't hesitate to seek medical attention if it comes to that. I have had to take another 10g of kratom, but I am starting to feel significantly better. I'm going to talk to my doctor on Monday to see what he thinks about all of this, but I'm not going to take it again until I figure out exactly what happened.

Its not an immediate, precipitated withdrawal, just kratom I've been using to taper from the same kilo that worked fine until today is suddenly wearing off so rapidly that I'm going into withdrawal many hours before I should even be starting to get a little uncomfortable. That's what my reasoning is behind the enzymatic induction causing a sudden spike in one or more of the cytochromes responsible for the metabolism of the alkaloids in kratom. I haven't found anything that can empirically demonstrate that this is what I'm experiencing, but at least that explanation has some logic behind it.

On the bright side, I'm not having any symptoms of anaphylaxis or neurological problems, I'm just suddenly and seemingly inexplicably metabolizing kratom at a rate I'd have thought was impossible before today.

Hopefully I'll figure this out soon!
 
This was quite the experience lol. Have you found anything to explain why the substances coincide? Jesus.
 
On a slightly more alarming note, I'm experiencing the same, seemingly impossibly fast rate of breakdown with my alprazolam as well. I have extra alprazolam as well as diazepam and clonazepam, so I think I can keep myself out of serious danger of seizures, but fuck me, this is INSANE.

I'm crashing (not sure how much sleeping I'll be doing, hopefully can at least get rest if not sleep...)on my couch tonight with my brother on the love seat so that if I do have something serious happen, a grand mal seizure for example, someone who knows what is going on can call 911 and explain the situation. In taking 2mg clonazepam and 30 mg diazepam as soon as I finish this post. I'm hoping longer lived benzodiazepines will help.

If things keep escalating, I may end up at the hospital tonight. If I start getting an aura, like I do prior to almost every seizure I've had other than the first one where I didn't know what I needed to look out for, I'll seek immediate medical help.

I think I'm going to double my dose of keppra tonight to be on the safe side as well. If anyone has any suggestions as to what else I should be doing, I'd love to hear then!
 
The clonazepam and diazepam have helped a lot, especially after I took my nightly dose of kratom. That dose ended up being 20g followed by another 10g around an hour later. I can't believe how much kratom and benzodiazepines I've gone through just today. Even with 45mg mirtazapine and 150mg of diphenhydramine on top of everything else I've taken tonight, I'm still not anywhere near being able to fall asleep and don't feel like I will be anytime soon.

I feel the closest to normal that I have since this shitshow started though, so at least theres that...
 
I made it through a rough night without a seizure, but I'm still feeling uncomfortable and I still seem to be metabolizing everything at an inordinately rapid pace. I opened a kilo of a different strain of kratom (red elephant) last night just to be 100% certain I wasn't experiencing some kind of rapid, inexplicable loss of potency of that last kilo, but the exact same thing is still happening. Definitely have to talk to my Dr. tomorrow morning...
 
Well, I just got off the phone with my Dr and he's going to send in a prescription for a weeks worth of clonazepam (2x 1 mg a day) to augment my alprazolam because he wants to be sure I don't go into benzodiazepine withdrawal before my next fill (Monday is when it should fill) and said to let him know on Thursday if things haven't improved, so he can approve an early fill of alprazolam if needed for Friday so I don't run out over the weekend when my only option for medical treatment would be the ER, and he will give me an order for bloodwork if things haven't improved, but he doesn't think that's necessitated just yet. He's expecting me to improve rapidly, but at least he's not writing this off as all in my head. I've been going to him for long enough for him to know better.

I found 1 reference to montelukast acting as a cytochrome inducer in rare (approximately 1 in 500,000 patients) circumstances. Unfortunately, the abstract I found only states "CYP1A4 and other cytochromes", so that's certainly not a guarantee its what I'm experiencing. He had never heard of this as a side effect before, but said he was was going to do some research himself to try to get a better handle on what's going on with me.

Here's hoping things get better soon, but I'm still experiencing the same, seemingly impossibly rapid metabolism of my meds and kratom as of today...
 
Jeez I just read all this. Stay well AD. It does make me wonder if there is a drug that can eliminate other drugs in our system quicker by some mechanism. So I also wonder if you were on a suitable dose of say morphine if the same thing would happen. Things like this are important. When it comes to mixing all kinds of drugs the medical community is kind of reckless so it is up to us to have a handle on how things affect us. I know the kratom was a worry but then it escalated to the alprazolam in your system. I know kratom has a ceiling effect, it also makes me wonder if, let's say you redosed something like morphine if it would have worked better or would that have run out quick too.

Regardless if it were me that would be enough to make me supersticious on the new medication. Asthma is serious and scary enough without the meds adding to it. I know it is a pipe dream but it would be nice of one of the intelligent neuropharmacologists we have here at BL could tell us exactly why that happened. But I suspect it will just be added to the list of side effects and we may never know.
 
Jeez I just read all this. Stay well AD. It does make me wonder if there is a drug that can eliminate other drugs in our system quicker by some mechanism. So I also wonder if you were on a suitable dose of say morphine if the same thing would happen. Things like this are important. When it comes to mixing all kinds of drugs the medical community is kind of reckless so it is up to us to have a handle on how things affect us. I know the kratom was a worry but then it escalated to the alprazolam in your system. I know kratom has a ceiling effect, it also makes me wonder if, let's say you redosed something like morphine if it would have worked better or would that have run out quick too.

Regardless if it were me that would be enough to make me supersticious on the new medication. Asthma is serious and scary enough without the meds adding to it. I know it is a pipe dream but it would be nice of one of the intelligent neuropharmacologists we have here at BL could tell us exactly why that happened. But I suspect it will just be added to the list of side effects and we may never know.
If it had just been the abnormality in kratom metabolism, I wouldn't be nearly as concerned. I have plenty of kratom available to hopefully avoid full withdrawal symptoms, but given my already low seizure threshold, I started getting far more concerned about benzodiazepine withdrawal. Luckily, my Dr knows I've been prescribed alprazolam for many, many years and I've never run out early or requested an early refill. I didn't even ask for any extra benzodiazepines or an early fill today, but I'm very glad he offered to help me out in that department if it becomes necessary.
 
So today, though it's only a minor improvement in the speed at which I metabolize my meds and kratom is, at least noticeably slowing. Hopefully things will get back to normal soon...
 
I just got home from getting 8(!) Vials of blood drawn, I should get results by mid-week. Things are still improving, just very slowly. If it does turn out that enzymatic induction is the cause, does anyone have any idea as to how long it should take for my body to restore homeostasis??
 
Isn’t one of the rare side effects liver enzyme changes? I’m assuming you were unlucky and were that one rare person.
 
Isn’t one of the rare side effects liver enzyme changes? I’m assuming you were unlucky and were that one rare person.
That's the conclusion I came to, but its unusual and alarming enough that I feel some medical attention is needed. I want to be sure that's all it is, instead of something else wrong with me as a result of my sky high kratom doses.
 
Most likely: side effects of the asthma medication itself. It’s a second-line treatment.
Other possibilities: enzyme induction, allergic reaction, panic attack, issues with your taper

I wouldn’t be worried about long-term damage from Kratom. It has little to no long-term damage to you nervous system other than addiction.
 
I would be surprised if this was all due to enzyme induction, since it apparently affected both mitragynine and alprazolam. Seems unlikely but I really don't know anything about montelukast.

I agree with HoldBack, seems more likely to be a mixture of side effects from this new medication.

Could it be that kratom and benzos were actually treating those side effects? As opposed to their metabolism being accelerated in such a drastic matter.
 
Montelukast seems to directly activate opioid receptors, but from what I remember not in an antagonistic fashion. If it really was precipitated withdrawal it might he a matter of competition.

It could also be via other mechanisms, since kratom isn't just an opioid.
 
My bloodwork is supposed to come back Wednesday, so I'll hopefully have something more concrete to go on then. My metabolism is still significantly faster than it should be, but at least it's noticeably slowing by the day. I cannot wait to get this figured out!!
 
Well, my bloodwork came back, but it raises just as many questions as it answers. I dont have elevated cytochromes, but my blood plasma levels of both alprazolam and levetiracetam are far below what they should be given the doses I take. My levetiracetam dose has been doubled (3000mg/day) and my alprazolam raised 50% to 6mg/day. I go back for more bloodwork in a week to see if my levels of meds are back to where they should be...
 
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