Drug Interactions, Kratom Guides

Kratom & Pethidine (Demerol): A Dangerous Combination

Pethidine (Demerol) is commonly known as meperidine, a potent opioid analgesic.

Kratom is an all-natural herbal supplement used to manage pain, anxiety, and depression.

Both compounds work through opioid receptors and actually have a lot of distinct interactions you need to be aware of.

In this guide, you’ll find out all about pethidine and how it interacts with kratom.

Medically reviewed by Dr. Devin Carlson

Last updated 5 months ago by Dr. Devin Carlson

Kratom & Pethidine (Demerol): A Dangerous Combination

Does Kratom Interact With Pethidine (Demerol)?

Yes, kratom interacts with opioids like pethidine in various ways.

In terms of their effects, both kratom and pethidine are central nervous stimulants that work on the body’s opioid receptors.

This agonistic relationship — in which both compounds work towards the same effects — increases the risk of adverse effects.

Furthermore, an estimated 28% of pethidine’s metabolization is done by the CYP3A4 enzyme.

This is significant because kratom is a potent CYP3A4 inhibitor too [1]. Both are metabolized by the same enzyme, which can cause them to remain in the body too long, causing a buildup.

Pethidine is deadly in large amounts and with many other substances, so it’s crucial to be extra careful when using it with anything else. This requires a doctor’s supervision.

Pethidine Specs

Drug NamePethidine
Trade NameMeperidine, Demerol, Meperitab
ClassificationOpioid analgesic
CYP MetabolismPrimarily metabolized by CYP2B6, with contributions from CYP3A4 and CYP2C19
Interaction With KratomKratom has an inhibitory effect on pethidine’s metabolization
Risk of InteractionHigh

Is it Safe to Take Kratom With Pethidine?

No. This combination can put you at severe risk of respiratory depression, leading to death.

Kratom deaths are rare, but when they happen, they are almost always accompanied by the use of potent opioids such as pethidine [2].

Kratom’s inhibitory effects on pethidine’s metabolization can lead to a slow but steady buildup of pethidine — this can have several dangerous complications.

For example, some of pethidine’s metabolites are toxic; any buildup of those compounds could have serious consequences.

What is Pethidine?

Pethidine — commercialized under the brand name Demerol — is a synthetic opioid analgesic of the phenylpiperidine class.

It is the precursor of many different analgesics like pethidine 4-phenylpiperidines, prodines, bemidones, and even more.

Pethidine is a Schedule II drug, indicating its medical use as well as its potential for abuse and dependence. The drug usually draws comparisons with morphine as it shares many of the same characteristics.

Pethidine is delivered via hydrochloride salt in tablets, syrups, or by different types of injection.

It works similarly to all other opioid analgesics, interacting with the opioid receptors found in the central nervous system.

What is Pethidine Used For?

According to the FDA, pethidine has been approved for:

  • Preoperative medication
  • Support of anesthesia
  • Managing severe pain

Pethidine is also the primary opioid medication used in the delivery of babies [3].

Initially, the compound was thought to have a lower incidence of addiction and be superior in treating pain stemming from biliary spasm or renal colic. This was due to pethidine’s anticholinergic effects [4].

However, these assumptions were later discovered to be false. Pethidine carries the same addiction risk and has roughly the same effects as morphine [5].

In general, there’s a tendency for there to be conflicting results in the scientific literature when it comes to the similarities and differences of many opioid analgesics.

What’s the Dose of Pethidine (Demerol)?

Prescription opioids like pethidine should not be administered according to dosage information found on the internet. You must remember this is a highly addictive and dangerous substance.

Doctors need to do a risk assessment before prescribing pethidine.

There are several contraindications to assess, like the presence of asthma or gastrointestinal obstruction.

Basically, you should only be taking pethidine by prescription and according to your doctor’s instructions.

Still, the FDA provides the basic dosage guidelines and information related to contraindications, risk, and other specifics.

Generic & Brand Name Versions

The brand names of pethidine are the following:

  • Meperidine
  • Demerol
  • Meperitab

What Are the Side Effects of Pethidine (Demerol)

Like all opioid medications, pethidine has a considerable list of side effects and contraindications.

Common side effects are:

  • Nausea
  • Vomiting
  • Dizziness
  • Diaphoresis
  • Sweating
  • Weakness
  • Headaches
  • Tremors
  • Loss of coordination
  • Constipation
  • Flushing
  • Tachycardia

More severe side effects include:

  • Respiratory depression
  • Circulatory depression
  • Respiratory arrest
  • Shock
  • Cardiac arrest
  • Hypotensive effect

Additionally, there are other risks:

  • Norpethidine, a metabolite of pethidine, is toxic, making it more harmful when compared to other opioids. This also increases the risk of serotonin syndrome and seizures.
  • Interaction with CNS depressants like alcohol can seriously heighten the risk of respiratory depression.
  • There’s a high risk of physical and mental dependence.

What is Kratom?

Kratom is made from the leaves of the Mitragyna speciosa evergreen tree. It hails from Southeast Asia, where indigenous peoples and local farmers have cultivated and used it for centuries.

Like coffee, kratom is filled with potent alkaloids; these are naturally occurring compounds that often have psychoactive effects on the body.

Kratom works by interacting with the opiate receptors in the brain and spinal cord.

What is Kratom Used for?

Kratom is used for many purposes, and the effects are dose-dependent. Kratom acts as a stimulant in low doses, providing focus and physical and mental energy. It acts as a sedative and is a strong pain-reliever in large amounts.

Kratom is used for the following:

When it comes to treatments, kratom possesses potent analgesic and anxiolytic benefits — making it popular with those who suffer from chronic pain or anxiety.

Kratom is also promising as a weight-loss supplement, along with other things.

Kratom leaves, powder, capsules and extract.

What’s the Dose of Kratom?

You’ll have to experiment a little to find what’s right for you, but it’s always best to start low and work your way up; no sense in taking more than you need. Still, it’s good to have a general idea of what’s considered a low or high amount.

Here are the generalized kratom dosages:

  1. Low dose (1–5 g): this range best promotes kratom’s stimulant, mind-based effects.
  2. Medium dose (5–10 g): analgesic and anxiolytic properties become more evident.
  3. High dose (10–15 g): heavy doses are best for sedative, analgesic, and anxiolytic effects. Do not consume this amount of kratom if you’re unsure how your body will handle it.

As you can see, it’s quite important to have a solid grasp of the amount of dosing if you want to control what effects you feel.

Remember to be mindful of how your body reacts to kratom; you might be sensitive to it.

Related: How Long Should I Wait Between Kratom Doses?

What Are the Side Effects of Kratom?

Kratom can cause the following side effects:

  • Nausea and vomiting
  • Lethargy
  • Dizziness
  • Constipation
  • Brain fog
  • Anxiety

Additionally, it bears repeating that kratom can be addictive. However, this risk is minimal if you use kratom responsibly.

As with other substances, never use kratom when you’re pregnant or mixed with drugs or alcohol.

What Are the Different Types of Kratom?

There’s much confusion out there about the different strains of kratom. But don’t worry — we’re here to set it all straight.

The main thing you need to know is that they all have the same suite of benefits, but different strains are better at producing certain effects.

The different kratom strains are named after the color of the kratom leaf’s vein and, often, the location it’s grown in.

A) White Vein Kratom

If you are someone who’s looking to replace their morning dose of coffee with something a little more energetic — try white vein kratom.

This strain is associated with the stimulant, nootropic benefits you can generally produce with a low dose.

B) Red Vein Kratom

The red-veined kratom strains are sort of the opposite of the white-veined strains. Instead of the stimulant, mind-based effects, you get the analgesic and anxiolytic benefits.

This means these strains are best avoided unless you’re ready to relax or need substantial pain relief. Many people now prefer to switch over to kratom instead of risking the adverse effects of pharmacological antidepressants and painkillers.

C) Green Vein Kratom

If we think about the kratom spectrum, green vein kratom is right in the middle. This is because it has a great balance of the benefits found in both white and red-veined strains.

The basic question is this: do you want a targeted experience or a more generalized one? If your answer is the latter, green vein kratom is your best bet.

D) Yellow Vein Kratom

Yellow vein kratom is probably the least remarkable out of all the kratom strains — tough, we know.

Yellow vein strains have no distinguishing features except that it is the mildest. Besides that, users often report it’s similar to green vein kratom.

Yellow vein kratom is popular with first-timers and those who are sensitive to kratom.

Key Takeaways: Is it Safe to Mix Kratom & Pethidine (Demerol)?

Absolutely not. You should never mix kratom and pethidine.

These compounds are known to have a dangerous interaction, as kratom consumption can heighten the already considerable risks of pethidine.

The only occasion where it might make sense to use kratom and pethidine is in the context of a drug substitution program, but never do this without a doctor’s supervision. The risks are still too high.

In conclusion, it’s best to avoid this combination under any circumstance.

References Used

  1. Ramírez, J., Innocenti, F., Schuetz, E. G., Flockhart, D. A., Relling, M. V., Santucci, R., & Ratain, M. J. (2004). CYP2B6, CYP3A4, and CYP2C19 are responsible for the in vitro N-demethylation of meperidine in human liver microsomes. Drug metabolism and disposition, 32(9), 930-936.
  2. Corkery, J. M., Streete, P., Claridge, H., Goodair, C., Papanti, D., Orsolini, L., … & Hendricks, A. (2019). Characteristics of deaths associated with kratom use. Journal of psychopharmacology, 33(9), 1102-1123.
  3. Bricker, L., & Lavender, T. (2002). Parenteral opioids for labor pain relief: a systematic review. American journal of obstetrics and gynecology, 186(5), S94-S109.
  4. Latta, K. S., Ginsberg, B., & Barkin, R. L. (2002). Meperidine: a critical review. American journal of therapeutics, 9(1), 53-68.
  5. Unlugenc, H., Vardar, M. A., & Tetiker, S. (2008). A comparative study of the analgesic effect of patient-controlled morphine, pethidine, and tramadol for postoperative pain management after abdominal hysterectomy. Anesthesia & Analgesia, 106(1), 309-312.