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Khat - Drug Interactions, Side Effects and Precautions of Use

Taxonomic class

Celastraceae.

Common Forms of Khat

Available as raw leaves.

Source

The raw leaves and tender twigs of Catha edulis are harvested for khat. The tree, a member of the staff tree family, grows to 80' and is native to East Africa and the highlands of the Arabian peninsula.

Chemical Components

Leaves of khat contain the alkaloids cathinone and cathine. Cathinone is structurally related to amphetamine, and although it is a more powerful stimulant than cathine, it degrades rapidly in the presence of oxygen. Cathine has been identified as norpseudoephedrine. Other similar alkaloids (cathinine, cathidine, eduline, ephedrine), phenylpropyl, phenylpentenylamines, and tannins have also been identified. Fresh leaves contain the most cathinone.

Actions

Cathinone is a sympathomimetic agent with potent CNS-stimulating properties. Based on data obtained from animal and human studies, cathinone is considered a naturally occurring amphetamine analogue. Khat chewing causes anorexia, mydriasis, and vasoconstriction; elevates blood pressure; increases heart rate; and produces other amphetamine­like effects. CNS effects range from mild stimulation to euphoria to mania. Psychic dependence, tolerance, and addiction have also occurred.

Blood glucose levels were reduced in animals but not in humans. An anti-inflammatory effect has been demonstrated in rats for a khat flavonoid. Cathinone suppresses serum testosterone levels, decreases sperm count and motility, and promotes degeneration of testicular tissue in animals .

Uses and Benefits

Khat is claimed to be beneficial for treating depression, obesity, and ulcers. It is used in East Africa and the Arabian peninsula as an anorexiant and as a stimulant to offset fatigue.

Recommended Dosage for Khat

Usually, 100 to 200 g of raw leaf are chewed at a time. The leaves have a sweet taste and cause dryness of the mouth and oropharynx, typically leading to the consumption of large amounts of fluid.

Adverse Reactions

CNS: aggressiveness, cerebral hemorrhage, euphoria, hallucinations (with overdose), hyperactivity, hyperthermia, mania, migraine headache, reduced performance on perceptual-visual memory and decision speed tests (with chronic use), psychoses.

CV: arrhythmias, hypertension, cardiac arrest, tachycardia.

EENT: decreased intraocular pressure, mydriasis, bilateral optic atrophy (possibly idiosyncratic reaction), oral cancers, periodontal disease.

GI: anorexia, constipation, esophagitis, gastritis, hepatotoxicity, stomatitis.

GU: decreased libido (in men), low sperm count, reduced sperm motility (animal and human studies).

Respiratory: pulmonary edema.

Skin: sweating.

Interactions for Khat

Antiarrhythmics, antihypertensives, beta blockers, decongestants, MAO inhibitors, other sympathomimetics: May cause similar interactions as with amphetamines. Avoid administration with khat.

Contraindications and Precautions

Khat is contraindicated in patients with CV or renal disease or hypertension. Also avoid its use in pregnant or breast-feeding patients because cathinone is a suspected teratogen.

Special Considerations with Khat

1. Monitor the patient for psychological dependence to khat. Depression and sedation may be symptoms of khat withdrawal. Physical dependence and addiction appear unlikely.

2. Caution the patient against chewing khat leaves or products because of the herb's deleterious effects on nutrition and GI function and its association with oral cancer.

3. Inform the elderly patient that adverse reactions are likely to occur.

4. Advise women to avoid using khat during pregnancy or when breast­feeding.

Points of Interest

1. At least one case ofleukoencephalopathy has been linked with khat misuse.

2. Khat is consumed in daily social gatherings and deeply rooted in cultural tradition, especially among Yemen men. Khat chewing is also deeply rooted in religious beliefs; Muslims use it to gain a good level of concentration for prayer.

3. Khat chewing has become a popular form of drug abuse in East Africa. The "red" type of khat is thought to be superior to the "white" type, which contains less cathinone.

4. The sympathetic effects of khat may be described as greater than those of caffeine but less than those of amphetamine.

Commentary

Khat is chewed in Africa and Arabia for appetite suppression, euphoria, and stimulation. Many reports of adverse consequences of overuse and abuse exist in the literature. Symptoms of addiction, tolerance, and psychological dependence are less strong with khat than with amphetamines. Khat and its active ingredient, cathinone, have few, if any, appropriate medical uses.