Considering kratom? Before you decide, it’s vital to understand kratom risks—from common side effects to serious safety concerns and drug interactions. This caution guide gives clear, fact-checked safety info to help you make informed choices and know when to get help.

In this article

What Is Kratom?

Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia. Its leaves contain alkaloids—primarily mitragynine and 7‑hydroxymitragynine—that act on opioid and other receptors in the brain.

In the U.S., kratom is sold as powders, capsules, teas, and extracts. The FDA has not approved kratom for any medical use. Product quality and potency vary widely, increasing safety risks.

Kratom Risks at a Glance

  • Dependence and withdrawal (similar to, but usually milder than, opioids)
  • Gastrointestinal issues: nausea, vomiting, constipation
  • Sleep and mood changes: drowsiness, agitation, anxiety, insomnia
  • Liver injury (rare but reported), typically within weeks of starting
  • Seizures and heart rhythm changes, especially with other substances
  • Overdose risk when combined with opioids, benzodiazepines, or alcohol
  • Contamination/adulteration (e.g., salmonella, heavy metals, hidden drugs)
  • Risks in pregnancy and breastfeeding (including neonatal withdrawal)

Common Adverse Effects

Short-term

  • Nausea, vomiting, constipation
  • Dizziness, sedation, sweating, dry mouth
  • Fast heart rate, blood pressure changes
  • Anxiety, irritability, tremors

With frequent/heavy use

  • Dependence and withdrawal on stopping
  • Insomnia, low appetite, weight loss
  • Skin darkening (rare, reported with long-term use)
  • Hallucinations or psychosis (rare; usually high-dose or with co-use)

Serious Safety Concerns

Liver Injury

Drug-induced liver injury linked to kratom has been reported. Symptoms often start 2–8 weeks after use begins and can include fatigue, itching, dark urine, jaundice, and abdominal pain. Most cases resolve after stopping; severe cases may require hospitalization.

Dependence and Withdrawal

Regular use can lead to dependence. Withdrawal may involve muscle aches, insomnia, irritability, anxiety, runny nose, sweating, and gastrointestinal upset. Symptoms usually begin within 1–2 days of stopping and may last days to weeks.

Overdose and Breathing Problems

On its own, kratom has caused serious toxicity, but the greatest risk is mixing with opioids, benzodiazepines, alcohol, or other sedatives. This combination increases the chance of respiratory depression, coma, and death.

Seizures and Heart Effects

Seizures have been reported, particularly with high potency products or co-use with medications like tramadol. Some cases note arrhythmias; caution is advised if you have heart disease or take QT‑prolonging drugs.

Contamination and Adulteration

Outbreaks of salmonella linked to kratom products and FDA findings of heavy metals (lead, nickel) highlight quality risks. Some products have been adulterated with opioids or other drugs without disclosure.

Pregnancy and Breastfeeding

Kratom exposure during pregnancy has been associated with neonatal abstinence syndrome (withdrawal) in newborns. Avoid during pregnancy and breastfeeding unless advised by a clinician.

Drug Interactions and Who Should Avoid Kratom

High-risk interactions

  • Opioids, benzodiazepines, alcohol, gabapentinoids: additive sedation and overdose risk
  • Antidepressants and MAOIs: potential serotonin syndrome (case reports)
  • Stimulants: blood pressure, heart rate, and anxiety spikes
  • Medications metabolized by CYP2D6/CYP3A: kratom may alter levels (theoretical/early evidence)

Avoid or use only with medical guidance if you:

  • Are pregnant, planning pregnancy, or breastfeeding
  • Have liver, kidney, or serious heart disease, or sleep apnea
  • Have a history of substance use disorder
  • Take sedatives, opioids, or multiple psychiatric medications
  • Are under 21 (developing brain; higher risk-taking)
Always share all supplements and kratom products with your clinician and pharmacist. Do not mix kratom with alcohol or sedatives.

Real-Life Example (Composite Case)

Alex, 34, started using kratom tea for back pain after reading about it online. Within a month, they developed severe itching, dark urine, and fatigue. Blood tests showed a cholestatic liver injury. After stopping kratom and receiving supportive care, liver tests normalized over several weeks. Alex also noticed anxiety and insomnia for a few days after stopping—consistent with withdrawal. This case mirrors patterns described in medical reports.

What to Do If You Have Side Effects

  1. Stop using kratom and avoid alcohol or sedatives.
  2. Seek medical care if you have yellow skin/eyes, dark urine, severe vomiting, chest pain, seizure, confusion, or trouble breathing.
  3. Call Poison Control at 1-800-222-1222 (U.S.) or use poison.org for guidance.
  4. Bring product labels/lot numbers to your appointment if available.
  5. Tell your clinician about all medications and supplements you take.

Harm-Reduction Caution Guide

This section provides safety info for those seeking to reduce risk. It is not an endorsement of use.

  • Avoid mixing with opioids, benzodiazepines, alcohol, or other sedatives.
  • Do not drive or operate machinery while affected.
  • If you have liver disease or symptoms of liver trouble, avoid kratom and get checked.
  • Start with the smallest possible amount and space out uses to limit tolerance and dependence.
  • Use only products with published lab testing from reputable sources; avoid “extra strength” or “enhanced” claims.
  • Store out of reach of children and pets.
  • If you decide to stop after regular use, taper with medical guidance to reduce withdrawal symptoms.
Considering kratom for pain, mood, or opioid withdrawal? Talk with a healthcare professional about safer, evidence-based options first.

When to Seek Emergency Help

  • Blue lips/skin, slowed or stopped breathing
  • Seizure, unresponsiveness, or severe confusion
  • Chest pain, fainting, or irregular heartbeat
  • Severe allergic reaction (swelling of face/tongue, trouble breathing)

Call 911 for emergencies. For substance use support, call SAMHSA’s 24/7 helpline at 1-800-662-HELP (4357). For mental health crises, call or text 988 in the U.S.

Conclusion: Make an Informed Choice About Kratom Risks

Kratom carries real risks—from common side effects to dependence, liver injury, and dangerous interactions. Because quality varies and safety data are limited, proceed with caution and seek professional guidance.

If you’re considering kratom, or want help stopping, talk with your clinician or pharmacist first. You can also contact Poison Control at 1-800-222-1222 for immediate advice.

FAQs

Is kratom safe?

No substance is risk-free. Kratom has caused dependence, liver injury, seizures, and overdoses—especially when mixed with sedatives or opioids. The FDA has not approved kratom for any medical use.

Can kratom cause addiction or withdrawal?

Yes. Regular use may lead to dependence. Withdrawal can include anxiety, insomnia, muscle aches, sweating, and nausea, typically starting 1–2 days after stopping.

Does kratom harm the liver?

Liver injury linked to kratom is uncommon but documented. Watch for itching, dark urine, yellow eyes/skin, or right‑upper abdominal pain and seek care promptly.

What drugs should never be mixed with kratom?

Avoid opioids, benzodiazepines, alcohol, and other sedatives. Use caution with antidepressants, stimulants, and medications processed by CYP enzymes. Always ask your clinician or pharmacist.

Is kratom legal where I live?

U.S. federal law does not schedule kratom, but some states and cities restrict or ban it. Check your state and local government websites for current regulations.

How can I stop kratom safely?

Discuss a personalized taper with your clinician to reduce withdrawal symptoms. Get support if you have cravings or mood changes. In emergencies, call 911; for guidance, call 1-800-222-1222.