Drug Interactions, Kratom Guides

Kratom & Metformin

Just over 10% of the population in the United States has diabetes. 

With metformin being the most commonly prescribed treatment for this condition, it’s not surprising that there are a lot of people using both metformin and kratom together. 

But is this combination safe? What are the risks? Will kratom interact with metformin?

Last updated 4 months ago by Dr. Devin Carlson

Kratom & Metformin

Does Kratom Interact With Metformin?

Unlikely. Metformin is one of the rare drugs that isn’t metabolized in the liver. It also shares virtually no similarities with kratom in terms of mechanism of action. Therefore, there’s a very low chance of experiencing any significant adverse reactions when taking kratom with metformin.

However, kratom should be used with caution in people who have been diagnosed with diabetes. The effects of this herb on blood pressure and blood sugar levels are unpredictable. Some reports suggest it lowers blood sugar levels; others have found it can increase blood sugar. The direction of this effect depends on the dose, the strain being used, and the state of the user’s metabolic health. 

The same level of risk applies when mixing kratom with other biguanide medications as well.  

With that said, everybody is different. Kratom could worsen the underlying symptoms of diabetes, causing the metformin to be insufficient for managing symptoms. 

Is it Safe to Take Kratom With Metformin?

While there’s always going to be some inherent risk when mixing kratom with prescription medications, it’s unlikely for metformin and kratom to result in any serious side effects. 

These medications only have a mild overlap and share little to no similarities in terms of what effects they exert on the body. 

With that said, you should always consult your doctor before taking kratom if you’ve been prescribed metformin or any prescription medication.

What is Metformin?

Metformin is classified as a biguanide, which means it helps regulate blood sugar levels in diabetic patients. Specifically, it reduces glucose production and increases glucose uptake to prevent dangerous spikes in blood sugar.

There are many other biguanides that serve as diabetes medications, many of which also inhibit the expression of the enzymes that metabolize kratom. 

Other biguanides that may interact with kratom

  • Canagliflozin (Invokana)
  • Dapagliflozin (Farxiga)
  • Saxagliptin (Onglyza)
  • Empagliflozin (Jardiance)
  • Linagliptin (Tradjenta)
  • Ertugliflozin (Steglatro & Segluromet)
  • Metformin and metformin-based drug combinations (Glucophage, Glucophage XR, Glumetza, Invokamet, Invokamet XR, Qternmet XR, Riomet, Riomet ER, Synjardy, Synjardy XR, Trijardy XR & Xigduo XR)

Metformin Details & Specifications:

Drug Name Metformin
Trade Names Glumetza, Invokana, Farxiga, Onglyza, Jardiance, Tradjenta, Steglatro, Segluromet
Classification Biguanide
CYP Metabolism Not metabolized
Interaction With Kratom Metabolic competitor
Risk of Interaction Low to Moderate

What Is Metformin Used For?

Metformin is used to regulate blood sugar levels in type 2 diabetes patients. It decreases the production of glucose in the liver and increases the uptake of glucose available in the blood [3].  This helps to limit the concentration of free glucose in the blood. 

Metformin is sometimes used with other medications and frequently prescribed alongside diet and exercise to help regulate blood sugar. 

However, it’s not recommended for patients who have kidney or liver issues.

Generic & Brand Name Versions of Metformin

While metformin is a generic drug name, there are many generic drugs that contain metformin alongside other medications. Generic names for these drugs include canagliflozin, dapagliflozin, saxagliptin, empagliflozin, linagliptin, and ertugliflozin.

Glumetza is one of the most common brand names for metformin, but there are many others.

Brand-name medications that include metformin as part of their combination of medications include Invokana, Farxiga, Fortamet, Onglyza, Jardiance, Tradjenta, Steglatro, Segluromet, Glucophage, Glucophage XR, Glumetza, Invokamet, Invokamet XR, Qternmet XR, Riomet, Riomet ER, Synjardy, Synjardy XR, Trijardy XR, and Xigduo XR.

What Are the Side Effects of Metformin?

Some users will experience nausea, low blood sugar, upset stomach, and diarrhea. 

The symptoms of low blood sugar include dizziness or confusion, and in severe cases, fainting. 

Some more severe side effects of taking metformin include lightheadedness, muscle aches, difficulty breathing, feeling cold, nausea, and irregular heartbeat. If any of these problems occur, consult your doctor or call 911 in the case of an emergency.

Some complications arise from metformin’s ability to limit enzymatic activity in the body. Most of the risks of taking the medication alone include a buildup of acid in the blood. Conditions include metabolic acidosis, diabetic ketoacidosis, and lactic acidosis. In extreme cases, these issues can be fatal.

Metformin is not recommended for children under ten years of age, and it’s sometimes not suggested for use while pregnant. You should always consult your physician about taking metformin if you’re pregnant.

What is Kratom?

Kratom is a medicinal herb used throughout traditional medicine for thousands of years. It comes from the Mitragyna speciosa tree, which is primarily grown in Southeast Asia. Consumable kratom is typically powder that consists of ground leaves from the kratom tree.

What’s Kratom Used For?

One of the most common uses for kratom is as a pain reliever [4]. Kratom interacts with the body in a similar way to opioids, so it intercepts pain signals traveling to the brain and limits perceived pain.

Another common use for kratom is to help people addicted to opiates wean themselves off. Once the user is exclusively using kratom, they can then wean themselves off the herb more easily. This is the same technique used in substitution therapy using methadone or buprenorphine — only it’s much easier to quit kratom than it is these prescription drugs. 

Kratom has a variety of uses beyond pain relief and addiction treatment, depending on the strain that is ingested. 

Some strains have a sedative effect that is used as a muscle relaxer and sleep aid. Others provide a boost in energy, making them useful as nootropics for boosting concentration and focus.

What’s The Dose of Kratom?

Most users ingest between 2 and 12 grams of dried kratom powder

Anything under 2 grams is considered a low dose (best for energizing effects). 

Doses between 2 and 6 grams is considered a moderate dose (good energizing effects as well as some pain relief). 

Doses over 6 grams is considered a high dose (best for pain and anxiety relief).

Never consume more than 12 grams of dried powder unless you’re very experienced with using kratom and know exactly how this dose is going to affect your body individually. 

Related: Kratom Dosage Calculator.

What are the Side Effects of Kratom?

There are some side effects associated with taking kratom. Most side effects are associated with larger doses or constant use without taking breaks.

Nausea and GI issues — including constipation — are some of the most common side effects, especially with new users who take too much. If you’re taking large doses, you might experience lethargy and sluggishness from the sedative effects.

Dizziness is another common side effect, as kratom can make you dehydrated or lower your blood pressure slightly.

Finally, some users experience anxiety when taking stimulating doses or strains.

What are the Different Types of Kratom?

There are four main strain categories of kratom, easily distinguishable by their color. Each color has different effects and is harvested in a unique way.

A) White-Vein Kratom

White-vein kratom is harvested early in the plant’s maturity before the leaves’ color is able to form fully. White-vein kratom strains tend to be more stimulative and may provide euphoria in some users.

B) Red-Vein Kratom

Red-vein kratom is believed to be harvested very late in the plant’s maturity, long after the leaves have gotten their green color and have begun to change to a darker red. Red-vein kratom tends to be best for pain relief and its sedative properties.

C) Green-Vein Kratom

Green-vein kratom is harvested in the middle of the plant’s maturity when the leaves have a rich green color to them. Green-vein kratom is often said to have a blend of effects from white-vein and red-vein varieties, so it’s used as a hybrid for a well-balanced experience.

D) Yellow-Vein Kratom

Yellow-vein kratom is among the rarest. Some people believe that the yellow color comes from a fermenting process. Others maintain that it’s a unique drying process that provides a yellow color. Some trust that it’s a blend of red and white, and still others say that very young or very old leaves will have a yellow hue.

Yellow-vein kratom offers the best chance of euphoria. It can improve focus and concentration, provide relief from pain, and act as a calming herb to soothe anxiety and stress.

5 kratom (Mitragyna speciosa) leaves over white background

Key Takeaways: Is it Safe to Mix Kratom & Metformin?

Metformin is a biguanide used to regulate blood sugar in type 2 diabetes patients. While it doesn’t specifically compete with kratom when it comes to drug metabolism, it may affect the underlying pathology involved with diabetes — which is counterintuitive to the effects of metformin. 

Always speak to your doctor about using kratom if you’ve been prescribed any medications or have a diagnosed medical condition. 

References

  1. Krausova, L., Stejskalova, L., Wang, H., Vrzal, R., Dvorak, Z., Mani, S., & Pavek, P. (2011). Metformin suppresses pregnane X receptor (PXR)-regulated transactivation of CYP3A4 gene. Biochemical pharmacology, 82(11), 1771-1780.
  2. Kamble, S. H., Sharma, A., King, T. I., León, F., McCurdy, C. R., & Avery, B. A. (2019). Metabolite profiling and identification of enzymes responsible for the metabolism of mitragynine, the major alkaloid of Mitragyna speciosa (kratom). Xenobiotica, 49(11), 1279-1288.
  3. Hundal, R. S., Krssak, M., Dufour, S., Laurent, D., Lebon, V., Chandramouli, V., … & Shulman, G. I. (2000). Mechanism by which metformin reduces glucose production in type 2 diabetes. Diabetes, 49(12), 2063-2069.
  4. Eastlack, S. C., Cornett, E. M., & Kaye, A. D. (2020). Kratom—Pharmacology, clinical implications, and outlook: a comprehensive review. Pain and therapy, 9(1), 55-69.