Kratom is often described as “natural,” but natural does not mean risk-free. Federal health agencies, poison control data and case reports have documented a range of side effects — most mild, some serious. This article summarizes what is known from sources including the National Institute on Drug Abuse (NIDA), the FDA, the CDC and the World Health Organization.
If someone has trouble breathing, has a seizure, becomes unresponsive or may have overdosed, call 911 right away. Poison Control is available 24/7 at 1-800-222-1222.
Common side effects
The side effects most often reported by people who use kratom include:
- Nausea and vomiting
- Constipation
- Dry mouth
- Sweating and itching
- Loss of appetite and weight loss
- Increased urination
- Dizziness and drowsiness
- Trouble sleeping
These effects tend to be more likely with larger amounts, with frequent use, and in people who are new to kratom.
Serious adverse effects
Less common but more serious effects have been reported in case reports and poison control data, including:
- Seizures
- Liver injury, sometimes with jaundice
- Rapid heart rate and high blood pressure
- Agitation, confusion and hallucinations
- Breathing problems, particularly when kratom is combined with other depressants
An analysis of US poison center calls found that agitation and rapid heart rate were among the most commonly reported effects, while a smaller share of cases involved seizures, hallucinations or respiratory depression.
The biggest danger: mixing kratom with other substances
Many of the most serious outcomes linked to kratom, including deaths, involved more than one substance. According to NIDA, many people who use kratom also use other drugs or take prescription medicines, and combinations have been linked to severe effects. The highest-risk combinations involve other substances that slow breathing or the nervous system:
- Alcohol
- Opioids, including prescription pain medicines
- Benzodiazepines and other sedatives
- Some sleep medications and antihistamines
We explain the alcohol risk in detail in Kratom and Alcohol: Why Mixing Them Is Risky.
Kratom may also interact with medicines processed by the liver. If you take any prescription medication, talk with a doctor or pharmacist before using kratom.
Contamination and product quality
Because kratom is not regulated as a drug, quality varies. Problems that have been documented include:
- Salmonella — a 2018 multistate outbreak was linked to kratom products and led to recalls.
- Heavy metals — FDA testing has found lead and nickel in some kratom products.
- Undisclosed additives or enhanced alkaloids — some products contain more mitragynine or 7-OH than natural leaf, or synthetic compounds.
Third-party testing reduces, but does not eliminate, these risks. See How to Read a Kratom Label and Lab Report.
Dependence and withdrawal
Regular kratom use can lead to physical dependence. People who stop after regular use may experience withdrawal symptoms such as muscle aches, irritability, insomnia, runny nose and mood swings. Research suggests withdrawal is usually mild to moderate, but it can be significant for some people. We cover this in detail in Kratom Dependence and Withdrawal.
Pregnancy and breastfeeding
Very little research exists on kratom use during pregnancy. Case reports describe newborns showing withdrawal symptoms after their mothers used kratom during pregnancy. If you are pregnant, planning a pregnancy or breastfeeding, talk with your healthcare provider about any kratom use.
Who should be especially careful
- People with liver disease or heart conditions
- People with a history of seizures
- People taking prescription medications, especially sedatives or opioids
- People with a history of substance use disorder
- Anyone under 21 — many states set a minimum purchase age
Frequently asked questions
Can kratom damage your liver?
Cases of liver injury have been reported in people using kratom, though it appears uncommon. Symptoms such as yellowing skin or eyes, dark urine or upper-right abdominal pain should be checked by a doctor promptly.
Can you overdose on kratom?
Deaths involving kratom have been reported, mostly alongside other substances. Combining kratom with alcohol, opioids or sedatives greatly increases the risk.
Is kratom safer than opioids?
This is debated, and the research is limited. Kratom is not an approved treatment, and it carries its own risks, including dependence. If you are trying to stop using opioids, FDA-approved medications such as buprenorphine and methadone are proven options — a doctor or SAMHSA’s helpline can help you find them.
This article is for general information and is not medical advice. If you have questions about kratom and your health, talk with a qualified healthcare provider.
Sources
- National Institute on Drug Abuse: Kratom
- U.S. Food and Drug Administration: FDA and Kratom
- CDC MMWR: Kratom-Related Overdose Deaths, 2016–2017
- CDC: Multistate Outbreak of Salmonella Infections Linked to Kratom Products (2018)
- FDA: Laboratory Analysis of Kratom Products for Heavy Metals
- World Health Organization: Kratom, Mitragynine, 7-Hydroxymitragynine Pre-Review Report
- SAMHSA National Helpline
Kratom Universe publishes independent educational information. Nothing on this site is medical or legal advice. Kratom is not approved by the FDA to diagnose, treat, cure or prevent any disease. Talk with a healthcare provider before using kratom, and check your state and local laws. If you or someone you know is struggling with substance use, call SAMHSA’s free, confidential National Helpline at 1-800-662-4357.
