Is It Safe to Take Kratom With Amoxicillin?

Does Kratom Interact With Amoxicillin?

The chances of interaction between these drugs are low but not nonexistent.

Kratom and amoxicillin have totally different mechanisms of action. Kratom works on opioid, dopamine, serotonin, and norepinephrine receptors to exert its effects [1]. Amoxicillin prevents the formation of the cell wall of bacteria [2].

The metabolism pathways of kratom and amoxicillin show significant differences. Kratom is mainly metabolized by liver CYP enzymes CYP3A4, CYP3A5, and CYP2D6 [3]. Amoxicillin is poorly metabolized in the liver, and about 50-85% of the drug is excreted unchanged in urine [4,5].

Thus, these two drugs do not interact directly, but many other factors could cause problems in practice.

For example, both drugs are rapidly absorbed from the gastrointestinal tract [6,7]. If they are used simultaneously, they will compete for the surface of absorption and stay in the gastric fluid for a longer-than-normal period.

The acidity of the gastric fluid potentiates the solubility of kratom. Still, if kratom stays in the same gastric environment for an increased period, it loses its properties as it is acid-labile [8]. But, amoxicillin is an acid-stable drug [9]. The chances of lower bioavailability of kratom are high if co-administered with another acid-stable, rapidly absorbable drug like amoxicillin.

Therefore, both kratom and amoxicillin could be less effective if taken together. The easiest way to reduce this effect is to space the dosing of each substance apart by at least 2 hours.

Kratom & Antibiotics: Drug Interactions

Amoxicillin belongs to the penicillin group of antibiotics. Other antibiotics that may interact with kratom include:

• Benzylpenicillin
• Penicillin
• Pivampicillin
• Pivmecillinam

Is It Safe To Take Kratom With Amoxicillin?

You might not experience any problems when taking kratom with amoxicillin, but it’s wise to avoid this combination. No good studies have been conducted to examine this combination, and there’s a possibility the combination could negate the beneficial effects of both substances.

If the effects of amoxicillin are blocked or reduced, it may become ineffective at treating the infection, leading to serious consequences.

With that said, kratom and amoxicillin have entirely different mechanisms of action. Their metabolism pathways are also very different, so no direct interactions are expected.

As always, it’s best to consult your physician before taking amoxicillin and kratom.

What Is Amoxicillin?

Amoxicillin is an aminopenicillin prepared by adding an extra amino group to penicillin. The drug was developed to combat penicillin-resistant bacteria [10]. It is a semi-synthetic derivative of penicillin and has structural similarities, but it has better oral absorption [11].

This antibiotic acts on susceptible bacteria by inhibiting cell wall mucopeptide biosynthesis and causing an impairment in bacteria multiplication. Amoxicillin achieves this by inhibiting the transpeptidase enzyme, which is crucial for the final step of bacterial cell wall synthesis, i.e., cross-linking of peptidoglycan.

It is used for the treatment of various bacterial infections. It is effective against mainly gram-positive bacteria like Streptococcus spp. [12],  Listeria monocytogenes [13], and Enterococcus spp. [14]. It also covers some gram-negative bacteria, e.g., Escherichia coli, Salmonella spp., Clostridium spp., Shigella spp., etc.

Unfortunately, most gram-negative bacteria have developed various resistance mechanisms against amoxicillin [15].

Some of the most common brand names of amoxicillin are Amoxil, Moxatag, and Trimox.

Amoxicillin Specs:

Drug Name	Amoxicillin
Trade Name	Amoxil, Moxatag, Trimox
Classification	Aminopenicillin
CYP Metabolism	NA
Interaction With Kratom	Indirect
Risk Of Interaction	Mild

What Is Amoxicillin Used For?

Amoxicillin is an antibiotic with a long list of approved uses; here are some of the most common:

Actinomycosis

This antibiotic is effective for the treatment of mild infection or cutaneous infection [16] and as step-down therapy following parenteral treatment of severe systemic actinomycosis, a chronic bacterial infection that commonly affects the face and neck.

Anthrax

Amoxicillin is used for mild forms of anthrax [17] and can be used for inhalational post-exposure prophylaxis. It is also helpful for anthrax involving skin but not other organ systems. Public health officials should be consulted for event-specific recommendations.

Bronchiectasis

Bronchiectasis is a chronic lung condition in which irreversible dilation of airways occurs. Amoxicillin compounded with clavulanic acid can help mild exacerbations of bronchiectasis, especially in children [18].

Chlamydia trachomatis

Erythromycin is the preferred agent for the treatment of Chlamydia in pregnant individuals. However, there have been compliance problems due to its gastrointestinal side effects. On the other hand, amoxicillin is considered one of the safest antibiotics during pregnancy (category B) and shows fewer gastrointestinal reactions relative to erythromycin.

Because of these reasons, amoxicillin may be used as an alternative to treat Chlamydia infections during pregnancy [19].

Endocarditis

Endocarditis is inflammation of the innermost layer of the heart. Amoxicillin is used as prophylaxis before any dental or invasive respiratory tract procedures in high-risk individuals, i.e., patients with cardiac conditions who may develop severe endocarditis [20].

Helicobacter Pylori

Helicobacter pylori (AKA H. pylori) is a bacteria that can cause peptic ulcers in the stomach. Amoxicillin is a significant component of the treatment regimen for eradicating H. pylori [21].

Lyme Disease

Lyme disease is caused by Borrelia burgdorferi. Amoxicillin is commonly used to manage the mild form of the disease [22]. It is used to treat Lyme disease rash, a.k.a. Erythema migrans. It may also help the joint infection without neurologic manifestations and the mild heart conditions in Lymes disease.

Otitis Media

Otitis media refers to the middle ear infection caused by Streptococcus pneumoniae and other pathogens. Amoxicillin is very effective against Streptococcus and commonly prescribed as treatment for acute otitis media in children and adults alike [23].

Pneumonia

Amoxicillin is an empirical therapy for uncomplicated pneumonia [24]. It may be an oral step-down therapy following treatment with intravenous drugs.

Bacterial Rhinosinusitis

Rhinosinusitis is an infection of the mucosa of the nose and sinuses. Amoxicillin is effective in the treatment of acute bacterial rhinosinusitis [25].

Skin & Soft Tissue Infection

Amoxicillin can treat superficial skin infections due to Streptococcus spp., e.g., erysipelas [26].

Streptococcal pharyngitis

In most cases, pharyngitis has a viral etiology. Thus, antibiotics are not warranted. However, when caused by a bacteria, amoxicillin is the drug of choice for pharyngitis [27].

Urinary Tract Infections (UTI)

Amoxicillin may be used in pregnant females who develop symptomatic UTIs [28]. It is one of the safest antibiotics for pregnant individuals due to the least teratogenicity. In non-pregnant females and males, it is not used as the first-line drug.

What Is The Dose Of Amoxicillin?

The appropriate dose of amoxicillin varies from 500-1000 mg, 2 to 3 times a day [29] — or as prescribed by your doctor. It is common to found this drug compounded with clavulanic acid; this is because clavulanic acid can stop bacteria from destroying amoxicillin and increase its effectiveness.

What Are The Side Effects Of Amoxicillin?

Lethal side effects are rare following average doses of this drug. The adverse effects following the administration of amoxicillin are as follows:

Antibiotic-Associated Diarrhea

Gastrointestinal effects range from antibiotic-associated diarrhea to nausea and vomiting. As the antibiotic disrupts indigenous gut symbiotic bacteria, the invasion of the gut by virulent bacteria becomes easy. The mean time for the onset of antibiotic-associated diarrhea is 3 to 18 days [30].

Hypersensitivity Reactions

Hypersensitivity (allergic) reactions range from skin rash to rare cases of anaphylaxis. Anaphylaxis is the most severe form of allergic reaction. The mechanism of these adverse reactions is not dose-related but immunologic. Allergic reactions can occur within minutes to hours. Anaphylaxis may become fatal if proper treatment is not started immediately [31].

Other Side Effects

Other reactions are less common and mild than the aforementioned adverse effects [21]. These include:

• Agitation
• Confusion
• Dizziness
• Headache
• Hepatitis
• Oral or genital candidiasis
• Vulvovaginal Infection

What Is Kratom?

Kratom (Mitragyna speciosa) is a tree from Southeast Asia that has been used as traditional herbal medicine in Vietnam, Thailand, Indonesia, among other countries.

The leaves of this tree are swallowed in powdered form or in tea. It’s used for various health applications, including chronic pain and opioid withdrawal [32].

The active ingredients of kratom are mitragynine and 7-hydroxymitragynine — but there are more than a dozen other active alkaloids in the plant.

Mitragynine and 7-hydroxymitragynine act as partial agonists at μ-opioid receptors and interact with various other neuroreceptors like dopamine, norepinephrine, and serotonin [33].

If a drug acts on a receptor and produces a partial effect, it is known as a partial agonist at the receptor.

What Is Kratom Used For?

Kratom has been used in Southeast Asia to relieve fatigue, elevate mood, and alleviate sleep disorders. In the Western world, it’s used as an alternative to coffee for energy and prescription opioids for managing chronic pain [34].

Related: Top Traditional Uses of Kratom & The Science That Backs it Up.

What Are The Side Effects Of Kratom?

When taken within the dosage guidelines, experiencing the side effects of kratom is rare. However, adverse reactions may occur when taken in large quantities and without tolerance breaks [35]. The most common side effect of taking too much kratom is nausea.

Side effects of kratom may include:

• Constipation
• Headaches
• Heart palpitations
• High blood pressure
• Nausea/vomiting
• Sedation

Also see: How Much Kratom Is Too Much?

What Are The Different Types Of Kratom?

Kratom comes in many different forms (called strains). Each kratom strain is different, but we can break them down into four main types:

• Green Vein Kratom — the most balanced and well-rounded kratom strain.
• Red Vein Kratom — calming, euphoric, and analgesic strains of kratom.
• White Vein Kratom — stimulating and energizing kratom strains.
• Yellow Vein Kratom — a fermented blend of red and white kratom. Effects can vary widely.

Key Takeaways: Mixing Kratom & Amoxicillin

Kratom and amoxicillin may interact indirectly with each other. Amoxicillin reduces the bioavailability of kratom by interfering with absorption (and vice versa). Thus, the antibiotic’s effects may be hindered if both drugs are taken together.

If you must take both these drugs together, it is essential to take kratom at least 2 hours after taking amoxicillin, as the half-life of amoxicillin is approximately 1 hour [36].

Nevertheless, it is best to consult your primary care physician before combining these two drugs.