Kratom Guides, Side Effects

Is Kratom Hard on The Liver?

There are a lot of concerns about kratom’s effects on the liver. 

While there’s still no conclusive evidence that suggests kratom can damage the liver, we’ll explore what evidence is available and whether or not these claims are legitimate. 

It’s important to remember that taking any supplement in high doses might impact the liver — especially if combined with other drugs (or alcohol) that have known liver-toxic effects.

Written by Marcel Deer
Last Updated 2 years ago

Marcel Deer

Natural Health Journalist

How Does Kratom Affect The Liver?

The active ingredients of kratom are a group of around 12 alkaloids. Each of these alkaloids needs to be metabolized by the liver before we can eliminate them from the body (primarily via the kidneys). 

This is the same for just about any medication or supplement. 

What makes kratom different is the sheer volume of alkaloids it provides — which places extra strain on the liver to be able to process all of them effectively. 

People with healthy livers are unlikely to have any trouble metabolizing kratom and will therefore not experience any liver injury. 

However, people with a genetic defect, preexisting liver damage, sensitivities to kratom, or those who are taking known liver-toxic medications or substances are at the highest risk of experiencing liver damage after using kratom. 

The most abundant alkaloid in kratom (by far) is called mitragynine. This compound primarily requires the CYP2D6 liver enzyme for metabolism, as well as some help from CYP3A4 and CYP2C9 [1]. 

Therefore, if users have any issues with this particular pathway or are using medications that also affect these enzymes, the risk of liver damage is higher.

List of Drugs That Could Increase the Chance of Liver Damage When Combined With Kratom

Any medication or substance that has known liver-toxic effects will increase the risk of liver damage when combined with kratom. This includes substances such as alcohol, statin drugs, certain antifungals, steroids, or antiretrovirals (HIV medications). 

Below is a brief list of drugs that have a high risk for liver damage when combined with kratom. Please note that this list is far from comprehensive. Always speak to your doctor before taking kratom with any prescription medication. 

Related: Which Medications Are Unsafe To Combine With Kratom?

Drugs considered high-risk for liver injury in combination with kratom: 

  1. Amitriptyline
  2. Alcohol
  3. Azathioprine
  4. Clomipramine
  5. Codeine
  6. Debrisoquine
  7. Desipramine
  8. Dextromethorphan
  9. Encainide
  10. Flecainide
  11. Fluoxetine
  12. Fluvoxamine
  13. Imipramine 
  14. Metoprolol
  15. Methotrexate
  16. Mianserin
  17. Nortriptyline
  18. Paroxetine
  19. Perhexilene
  20. Phenformin
  21. Propafenone
  22. Propranolol
  23. Sparteine
  24. Timolol
  25. Tolterodine
  26. Venlafaxine
  27. Zuclopenthixol

Signs & Symptoms of Liver Damage

The first signs of liver damage or disease include abdominal pain, lasting indigestion or bloating, headaches, dizziness, and nausea. More severe liver damage can cause dark-colored urine, yellowing of the skin (jaundice), and light-colored stool. 

A hospital can run further tests to check for signs of liver damage. These tests will usually check for markers such as AST (aspartate aminotransferase), ALT (alanine aminotransferase), and increased bilirubin levels. 

What Does the Research Say?

The best research available on the effects of kratom on the liver comes from a meta-analysis published in 2020 [2]. 

This analysis examined 26 case reports and abstracts, in addition to 7 cases reported from the Drug-Induced Liver Injury Network, 25 in FDA databases, and 27 in internet user forums.

The study concluded that while the risk of liver injury from kratom exists, the vast majority of users will experience no signs of liver damage. 

Studies also suggest that there is usually a period of 7 to 21 days when these symptoms develop in a person using kratom.

Another study done on kratom’s adverse effects looked at various cases of patients who had severe symptoms related to liver dysfunction [3]. These cases were classified as DILI — Drug-Induced Liver Injury. Out of the 404 patients, only 8 had any history of recent kratom use. 

Out of the eight cases related to kratom, the researchers isolated seven to be actually caused by exposure to kratom. Their consumption of kratom over the 22-day period preceding the onset of their symptoms was used as a determining factor for this. Patients exhibited jaundice-like symptoms with itching and abdominal pain.

Out of the seven, six had to be hospitalized for further treatment. All seven recovered.

Researchers mentioned that although the link between liver injury and kratom has been established in very rare cases, it’s unclear how much of that is caused by contaminants present in the plant matter that are not originally part of the plant.

Related: Making Sense of Kratom Research: Therapeutic Effects, Abuse Potential, & More.

What is Kratom (Mitragyna speciosa)?

Kratom is a popular herbal supplement that is often used as a pain remedy and mood enhancer. In lower doses, it’s used in a similar manner as coffee for boosting energy levels, improving focus, and facilitating a greater level of productivity and work output. 

It’s being studied as a safer alternative to opioid-based pain medication and was traditionally used in parts of Southeast Asia for treating diarrhea, fatigue, and pain.

The Origin of Kratom 

Kratom is a plant that is related to the same family as the coffee plant. Its active compound is an alkaloid, just like coffee. It has been traditionally used in its native areas of Thailand, Malaysia, Myanmar, and Indonesia, where the chewing of the leaf was not uncommon amongst the general population up until recent times. 

After the leaf gained notoriety amongst western users, Thailand (1943) and Malaysia proceeded to ban it. This seems to have been a move to protect the tourism industry and prevent a blow to the national image of the countries. In 2018, it was legalized again in Thailand for medicinal use only.

Indonesia is the primary source country where large amounts of kratom are grown, consumed, and sold at the moment. Almost all of the kratom that is sold in the western world originates from Indonesia.

How to Use Kratom Safely

Kratom leaves come in various supplement forms — including tablets, powders, and tinctures. Avoid using kratom concentrates or buying kratom from the black market. It’s common for these vendors to adulterate kratom powder with other, potentially liver-toxic substances. 

When using kratom for the first time (or after a long hiatus), it’s best to start with a low dose and gradually increase over the course of a few days. 

The recommended dosage range for kratom is between 1 and 12 grams of dried powder (taken orally). Any other form of using kratom aside from oral consumption is not considered safe. 

Start with a dose of 1 gram, then 2, then 3, etc., until you get a feel for how it affects your body individually. 

Never mix kratom with other medications or alcohol, and avoid using kratom on a daily basis. 

If you have any underlying health conditions or are prescribed any medications or supplements, speak to your doctor before using kratom. 

Additionally, if you experience nausea, headaches, dizziness, or fatigue lasting more than 6-hours, visit a doctor immediately. 

If you notice dark urine, pain upon urination, moderate to severe abdominal pain, or yellowing of the skin or eyes — visit a doctor immediately. 

Key Takeaways: Can Kratom Really Harm The Liver?

It’s entirely possible that kratom can harm the liver — but this effect is exceedingly rare, and only appears to affect certain individuals, those with underlying health conditions, or people taking other medications. 

Most people don’t experience any issues with liver damage, even with repeated or prolonged use of kratom. 

With that said, the evidence for its adverse impact on the liver is rare and inconclusive. Direct evidence is only available on a per case basis with various confounding factors such as the simultaneous use of other drugs. 

The sudden increase in the number of users makes it statistically more likely that a few will suffer rare adverse reactions due to unique physiological traits.

Overall, it can be said that kratom has been observed to be relatively safe in low doses. Its effect on the liver can lead to jaundice-like symptoms in rare cases. 

It’s best to avoid mixing kratom with any other medication. In such cases, the guidance of a doctor or physician is recommended before starting on kratom.


Further Reading