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Kratom (Mitragyna speciosa) is an evergreen tree of the coffee (Rubiaceae) family native to countries such as: Indonesia, Malaysia, Myanmar, Papua New Guinea, and Thailand.  It is best known for generating leaves that contain upwards of 40 distinct psychoactive compounds.  Pharmacological research indicates that the psychoactive constituents of kratom – most prominent being [indole alkaloids] 7-hydroxymitragynine, mitraphylline, and mitragynine – act upon a variety of neurotransmitter systems within the human brain.

The principal mechanism of kratom’s psychoactive action involves mu-opioid receptor partial agonism, and to a lesser extent, kappa-opioid receptor antagonism – relatively analogous to the drug buprenorphine.  Other [less prominent] mechanisms of kratom’s action include: kappa-opioid receptor antagonism, delta-opioid receptor antagonism, alpha-2 receptor agonism, 5-HT2A receptor antagonism, and adenosine A2A receptor antagonism.  Due to the aforestated pharmacodynamics, when ingested, most individuals report opioidergic and/or stimulatory effects.

Although not FDA approved or endorsed to treat any medical condition, kratom has become increasingly popular as an alternative intervention for the management of chronic pain and opioid dependence.  Moreover, kratom is occasionally administered as a last-resort treatment for neuropsychiatric conditions (e.g. anxiety, depression, insomnia), and due to its unregulated status as a supplement, it is commonly ingested as a recreational intoxicant.  Regardless of a person’s rationale for using kratom, it is important that all users be cognizant of potential kratom side effects and adverse reactions.

Kratom Side Effects & Adverse Reactions (List of Possibilities)

Just because kratom is “natural,” unregulated, and an herbal supplement does not mean that it’s somehow incapable of provoking side effects.  Although many individuals tolerate kratom well without side effects and/or adverse reactions, it is important to emphasize the fact that side effects and serious adverse reactions to kratom can occur.  Among the most common kratom side effects include: appetite changes, blood pressure fluctuation, constipation, nausea, and vomiting.

Understand that the total number of side effects, specific side effects, and respective severities of each side effect will be largely subject to individual variation.  Some individuals may experience zero side effects from kratom, whereas another may report extreme adverse reactions to the extent that discontinuation is warranted.  Included below is a comprehensive list of side effects that have been reported by kratom users.

Anger:  Although many individuals report that kratom decreases proneness to anger and/or preexisting feelings of anger, others will experience anger as an unwanted side effect.  The side effect of anger is likely attributable to kratom-induced neurochemical changes and/or altered CNS activation.  It is understood that certain individuals are inherently more prone to kratom-induced anger than others based upon homeostatic neurochemistry, as well as the dosage and type of kratom ingested.

Some users may experience a minor increase in anger such that it is relatively manageable, whereas others may feel extremely angry to the extent of rage after taking kratom; this has been referred to by some as “kratom rage.”  It should be noted that persons with a history of anger and/or neuropsychiatric disorders are likely most sensitive to kratom-induced neurochemical alterations and corresponding anger.  That said, even if you have no history of anger, it’s possible that the dosage and/or strain of kratom you ingested is suboptimal for your individual neurobiology.

For example, if you are naturally overstimulated and you ingest a stimulatory dose/strain of kratom, the stimulation may be excessive to the extent that every little thing makes you angry.  Assuming you want to continue using kratom without the side effect of anger, you may want to transition to a different strain and/or modify your dosage.  If the anger persists and you continue to feel short-fused with each kratom ingestion, it’s probably smart to discontinue kratom altogether.

Anxiety: In many cases, individuals will report experiencing an anxiolytic effect and corresponding relaxation from the ingestion of kratom.  That said, others may endure the exact opposite reaction, such that after taking kratom, they experience an anxiogenic effect and corresponding anxiety.  Any anxiogenic effect accompanied by accelerated thinking, discomfort in social situations, panic attacks, and various physical symptoms of anxiety such as palpitations, shaking, and sweating.

Persons with neuropsychiatric conditions, especially anxiety disorders, may be most at-risk for experiencing kratom-induced anxiety due to preexisting neurochemical abnormalities and/or sensitivities.  In any regard, it’s possible that anxiety from kratom may be transient such that it emerges in the early days of usage, but eventually subsides as a person’s physiology adjusts to its influence.  Yet another cause of anxiety as a side effect may be the type of strain and/or species of kratom ingested.

Of the three major strains, white vein kratom leaves are thought to be most energetic and stimulating, with less of an opioidergic effect, and may be more likely to provoke anxiety than green vein and red vein.  Moreover, the dose-response curve of kratom can be sensitive such that too low of a dose may yield only stimulation without sedation and corresponding anxiety.  Lastly, it’s possible that a paradoxical effect may occur in which an individual feels sedated, but experiences relaxation-induced anxiety from excessive sedation, depersonalization, and/or cognitive impairment.

Blood pressure fluctuations: Some individuals have reported fluctuations in blood pressure as a side effect of kratom.  Generally speaking, the greater the opioidergic effect of kratom, the more likely it is to induce CNS depression and corresponding drops in blood pressure.  On the other hand, the greater the stimulatory effect of kratom, the more likely it is to induce CNS activation and corresponding spikes in blood pressure.

What’s more, assuming an individual has physiologically adapted to kratom (i.e. developed tolerance), an extended duration between doses may result in mini-withdrawals whereby blood pressure shifts to the opposite of its status while under the influence.  For example, a person who experiences lower blood pressure while under the influence of kratom may experience a spike in blood pressure when its effect wears off.  It should be known that any reduction in blood pressure from kratom may lead to lightheadedness, dizziness, and/or fainting.

Additionally, any spike in blood pressure from kratom may not induce any noticeable symptoms, but could increase risk of heart attack and/or stroke.  For some individuals, kratom-induced fluctuations (reductions and/or spikes) in blood pressure may be negligible and pose no health risk.  That said, persons with a history of blood pressure abnormalities (e.g. hypertension, hypotension, etc.) and/or cardiac irregularities may find their health threatened by kratom-induced blood pressure fluctuations.  If you observe blood pressure changes and/or are worried about your blood pressure while taking kratom, it is recommended to consult a medical professional.

Body odor: A small percentage of individuals may notice unpleasant body odor as a side effect of kratom.  It’s possible that the unpleasant body odor may emit from armpits as a result of kratom-induced upregulation of sweat production.  If you’re sweating excessively while taking kratom, the accumulation of sweat throughout the body is likely going to emit a stench unless you shower/bathe more frequently than usual and/or neutralize the sweat with a deodorant.

In some cases, body odor as a side effect isn’t always associated with increased sweat production.  Some kratom users might describe body odor as “bad breath” (i.e. halitosis) or abnormally stinky urine.  For most individuals, the side effect of body odor isn’t bothersome enough to stop kratom and can be counteracted with extra hygiene efforts.

Brain fog: It is common to experience “brain fog” or cloudy thinking as a side effect of kratom.  As a result of brain fog, persons might feel slightly dissociated, almost as if they’re stuck in a dream-like state.  Some individuals won’t mind the foggy thinking, whereas others who necessitate and/or enjoy being alert and focused may seriously dislike it.

Kratom-induced brain fog is largely a byproduct of the alkaloidal constituents exerting an effect within the brain and shifting neurochemistry away from homeostatic baseline.  Generally, the stronger the opioidergic and/or sedative effect and the lesser the concurrent stimulatory effect, the more likely you’re going to report some brain fog while taking kratom.  In other words, someone using red vein kratom (known for inducing sedation) would be more likely to experience brain fog than a person using green vein kratom (known for inducing stimulation).

Moreover, the significance of a person’s brain fog while taking kratom is likely contingent upon the dosage ingested.  Using a low dose should modulate neurochemistry to a lesser extent than a high dose, thereby inducing less of a sedative effect and corresponding brain fog.  That said, brain fog may also be transient such that it emerges in the early days of using kratom but subsides with continuous regular usage.

Cognitive impairment: A common side effect of kratom is cognitive impairment.  Although certain individuals claim that kratom enhances cognition, most will exhibit a noticeable decline in their cognitive abilities while under kratom’s influence.  For example, many will report that aspects of cognition such as: attention, critical thinking, planning, memory (storage / retrieval), etc. – suffer as a result of kratom.

In some cases, the kratom-induced cognitive impairment will be minor and manageable, yet for others it may be moderate or severe to the extent that it interferes with occupational and/or academic performance.  Obviously if you’re experiencing such extreme cognitive impairment that it’s putting your employment and/or academic career at risk, you may want to pursue alternative interventions.  That said, sometimes cognitive impairment can be made manageable with a different strain of kratom and/or dosage adjustments.

The cause of cognitive impairment while using kratom is a combination of neurochemical alterations and/or downregulation of physiologic arousal.  Given the fact that red vein kratom is most sedating, it is logical to suspect that red vein users would experience most cognitive impairment [unless they exhibited an anxiety disorder].  Since white vein kratom is more stimulating, perhaps white vein users are less susceptible to cognitive impairment.

A study by Yusoff, Suhaimi, Vadivelu, et al. (2016) revealed that acute or chronic administration of mitragynine induces cognitive impairment analogous to morphine.  Specifically, mitragynine administration modified dopamine transporter and dopamine receptor-regulating factor mRNA which impaired: passive avoidance learning, object recognition learning, and memory consolidation/retrieval.  Although further research is needed in humans to confirm these effects, many anecdotal accounts report kratom-induced cognitive impairment.  (Source: https://www.ncbi.nlm.nih.gov/pubmed/25262913).

Constipation: Like most drugs with an opioidergic mechanism of action, kratom is known to cause constipation.  Although kratom acts centrally upon mu-opioid receptors, it may also agonize mu-opioid receptors in the peripheral nervous system, ultimately modifying activation of the gastrointestinal tract.  Particularly, is thought that kratom might increase non-propulsive contractions in the middle of the jejunum (small intestine) and decrease propulsive peristalsis whereby the movement of food through the gastric system is prolonged and constipation occurs.

Many individuals will notice fewer bowel movements and less of an urge to defecate while taking kratom.  If the constipation is severe, individuals may experience indigestion and/or varying degrees of stomach pain.  For some, the constipation eventually diminishes with continued regular kratom usage, whereas for others it persists as a troubling side effect.

Recommendations for coping with kratom-induced constipation include: increasing dietary fiber intake, drinking plenty of water, and engaging in physical exercise.  Other interventions for constipation may include: magnesium supplementation, transient laxative usage, and/or pharmaceuticals (e.g. methylnaltrexone).  Moreover, many individuals are able to manage their constipation simply by reducing the dose of their kratom.

Coordination deficits: Similar to most opioidergic medications, kratom can impair hand-eye coordination and fine motor skills.  The impairment of coordination largely stems from the kratom-mediated downregulation of CNS activity and corresponding induction of sedation/drowsiness.  It is also possible that dizziness, another fairly common side effect, may potentiate coordination deficits stemming from a drop in arousal.

Worthy of noting is that anyone who exhibits kratom-induced coordination deficits and operates a motor vehicle and/or heavy machinery may be putting themselves and/or others at risk for serious injury or death.  Furthermore, individuals using kratom prior to an athletic event might be at risk for a making significant number of errors.  For this reason, it is imperative that all individuals abstain from activities that require normative coordination (e.g. driving a car) while under the influence of kratom.

Depression: While some individuals anecdotally reference kratom as being an efficacious intervention for the treatment of depression, others will report depression as a side effect.  If you experience depression while taking kratom, it’s likely that your baseline neurochemistry is incompatible with the specific dose and/or type of kratom that you ingested.  Individuals with a history of neuropsychiatric conditions may be at highest risk of experiencing kratom-induced depression due to preexisting neurochemical abnormalities.

Nonetheless, depression is also associated with downregulation of CNS activity and under-arousal – each of which can be induced by kratom.  Other ways in which kratom might cause depression include: interfering with sleep and the circadian rhythm, modifying brain waves, and/or by altering neurotransmission (neurotransmitter production / receptor densities).  Additionally, some individuals may feel emotionally stable while under kratom’s influence, but when its effect wears off, depression may occur.

Should you experience depression while taking kratom, it makes logical sense to discontinue usage for the sake of your psychological health.  Some may also find that their depression is less severe and/or doesn’t occur with a different dose/strain of kratom.  If you are struggling to cope with kratom-induced depression, do not hesitate to contact a medical professional.

Dizziness: After ingestion of kratom, it is extremely common to experience dizziness as a side effect.  In many cases, the dizziness is of minor-to-moderate severity but isn’t overly debilitating, yet in other cases it may be extreme enough to impair balance and coordination.  For certain individuals, dizziness is an adaptation-related side effect that occurs as a result of baseline neurochemistry acclimatizing to the neurochemical modulation induced by kratom.

Once neurochemistry has adjusted itself to the regular ingestion of kratom, dizziness may become less intense and/or cease completely.  It has been reported that taking too high of a kratom dose and/or re-dosing too soon can lead to significant dizziness.  Dizziness may also be caused by fluctuations in blood pressure while taking kratom.

For example, some individuals may experience orthostatic hypotension such that their blood pressure abruptly drops upon transitioning from a seated to a sanding position, leaving them temporarily dizzy.  Some individuals have had success managing their kratom-induced dizziness by reducing their dosage and/or switching strains.  That said, as long as the dizziness isn’t severe, most individuals are able to cope with it.

Drowsiness: Another popularly-reported side effect among kratom users is drowsiness.  The drowsiness may be modestly noticeable for some, yet downright overwhelming for others to the extent that it becomes nearly impossible to complete simplistic daily tasks (e.g. washing dishes) and they eventually doze off to sleep.  It is thought that drowsiness is most likely to occur as a side effect among: new users (e.g. first-time), red vein users, and/or high-dose users.

Usually the drowsiness is not considered a debilitating side effect, but may be unwanted by persons who need to maintain alertness while operating a motor vehicle and/or heavy machinery.  Drowsiness can also interfere with cognitive functions whereby it becomes difficult to complete cognitively-demanding tasks in academic and/or occupational settings.  Among new kratom users, drowsiness is sometimes nothing more than an adaptation-related side effect that diminishes with continuous regular usage.

Those who continue experiencing unwanted drowsiness often benefit from reducing their dosage and/or switching to another strain.  Taking lower doses of kratom tends to yield a greater ratio of stimulation to sedation.  Moreover, switching from a red vein kratom to a white vein kratom OR mixing in some white vein kratom with red vein – can often attenuate extreme drowsiness.

Fatigue: Kratom is known to increase inhibitory transmission and downregulate physiologic arousal, possibly causing fatigue.  Some kratom users may report psychological fatigue characterized by a reduction in mental/cognitive energy, others may report physical fatigue or tiredness throughout the body, and another subset of users may report a combination of both psychological and physical fatigue.  Should you experience fatigue as a side effect of kratom, it’s possible that with continued usage it will subside.

If you’re not a new kratom user and are experiencing fatigue, it may be related to using a high dose.  High doses of kratom are known to exert a more substantial opioidergic effect relative to stimulatory effect, ultimately increasing likelihood of fatigue.  Another possibility is that the side effect of fatigue is related to the specific strain and/or vein color of kratom that you’re ingesting.

Red vein kratom is most sedating, and therefore is more likely to cause fatigue than green vein and/or white vein.  White vein kratom is most energizing, and therefore is least likely to cause fatigue.  Simple adjustments to strain and dosing can markedly increase energy levels if fatigue has become an unwanted side effect.

Headaches: A common side effect ubiquitously associated with most drugs, including kratom, is headache and/or migraine.  Although there are many types of headache and migraine each with specific neurophysiologic nuances, they generally are a byproduct of intracranial vasoconstriction and vasodilation, respectively.  Following the ingestion of kratom, its central action upon neurotransmitter systems is sometimes enough to modulate intracranial blood vessel size and blood flow such that the user experiences headache and/or migraine.

In most cases, assuming low-to-moderate dose is ingested, the headaches or migraine will not be long-lasting nor debilitating.  Furthermore, headaches and migraines sometimes occur when an individual initially begins taking kratom and eventually subside with continued usage as the brain adapts to its psychoactive effect.  That said, everyone’s neurochemistry is different and if you continuously experience headaches and migraines from kratom, it is recommended to discontinue.

It is thought that individuals with a history of headaches, migraines, and/or other neurological complications are most likely to experience headaches and migraines while taking kratom due to preexisting susceptibility.  Some believe that white vein kratom may be more likely to provoke a headache due to its stimulatory effect and corresponding vasoconstriction, whereas red vein kratom may be more likely to provoke a migraine due to its sedating effect and corresponding vasodilation.

Nonetheless, if you experience a headache and/or migraine from kratom, it could be a sign that you’re using too high of a dose for your neurophysiology to handle.  Reducing your dosage is often most useful for dealing with kratom-induced headache and/or migraine.  Moreover, to reduce odds of a headache, always ensure that you’re staying hydrated, maintaining adequate electrolyte intake, and aren’t combining kratom with other substances.

Hot flashes:  Hot flashes are defined as unexpected sensations of warmth/heat throughout areas of the body such as the face, head, neck, and chest.  Many individuals who experience hot flashes feel as if they are uncontrollably blushing and may notice an increase in sweat production.  Although not an extremely common side effect, a subset of kratom users have reported hot flashes.

Hot flashes can occur in new kratom users and eventually subside with continued usage, but may also emerge after a moderate-term or long-term use.  The cause of kratom-induced hot flashes isn’t fully known, however, they may stem from a combination of neurochemical, hormonal, and thermoregulatory alterations.  Compared to many side effects, hot flashes are not usually regarded as debilitating and are manageable.

Insomnia: Taking a suboptimal dose and/or strain of kratom [in accordance with individual physiology], especially in the afternoon or evening, can cause insomnia.  Some kratom users will report that they lie in bed for hours unable to fall asleep after kratom, whereas others will report that kratom seems to help with sleep induction, but leads them to wake prematurely with the inability to fall back asleep.  Though some modest insomnia from kratom may not be a big deal, ongoing moderate-to-severe insomnia may yield numerous deleterious effects such as daytime cognitive deficits and fatigue.

The cause of insomnia could be related to excessive CNS activation from a stimulating kratom strain (e.g. white vein), but may also occur as a result of neurochemical alterations that interfere with maintenance of circadian rhythm homeostasis.  Persons who want to continue using kratom, but don’t want to deal with the side effect of insomnia should avoid using kratom in the late afternoon or evenings.  Moreover, modifying the dosage of kratom and/or transitioning to a different strain may also ameliorate and/or eradicate the side effect of insomnia.

Irritability: Some individuals have documented irritability as a side effect of kratom such that they become annoyed, impatient, and/or angry with others more frequently than usual.  Irritability is commonly associated with negative moods such as anxiety and depression and stems from an individual’s neurochemistry and physiologic arousal.  In certain persons, kratom may induce irritability as a result of a stimulatory effect, whereas in others kratom may induce irritability as a result of an inhibitory effect.

For example, ingesting energizing strains and/or doses may bolster excitatory neurotransmission and upregulate sympathetic tone – each of which could provoke irritability.  In this case, the obvious solution would be to refrain from further usage of stimulatory strains and/or doses and engage in exercise plus relaxation exercises to counteract the excessive arousal.  Oppositely, persons might experience irritability from ingesting sedating strains and/or doses of kratom such that inhibitory neurotransmission increases, CNS activity is depressed, and a person becomes frustrated with his/her unclear thinking, slow-wittedness, and/or cognitive deficits.

In this case, the obvious solution would be to refrain from further usage of sedating strains and/or doses while engaging in activities that increase CNS activation.  Many individuals have reported experiencing irritability between doses and/or as soon as the effect of kratom subsides, however, this is less a “side effect” and more of a withdrawal symptom.  If you always feel irritable after taking kratom no matter the type and/or dosage ingested, it is recommended to discontinue.

Itching: Kratom is known to cause itching as a side effect similar to conventional opiates/opioids.  In most cases, the itchiness that occurs after kratom ingestion is modest and is not so extreme that individuals decide to stop using kratom.  Some have speculated that the itching is due to the fact that the body is slightly allergic to kratom and releases histamine, a neurochemical implicated in allergic reactions and itchiness.

If after taking kratom you notice swelling, edema, a rash, and/or redness in addition to your itchiness – there’s a chance you may be allergic to kratom and/or the specific strain you ingested.  Any individual who suspects an allergic reaction is recommended to seek immediate medical attention.  Moreover, itching can occur among individuals with hepatic dysfunction so you may want to get your liver function checked if experiencing this side effect.

That said, the most likely cause of itching has to do with the binding of kratom alkaloids to the mu-opioid receptor 1D (MOR1D).  Agonism of MOR1D has been shown to induce itching in mice by activating GRPR (gastrin-releasing peptide receptor) in the spinal cord.  Although mice are not the same as humans, this is currently the best explanation for opioid-induced itching.  Itching can be minimized by using strains of kratom with less significant opioidergic effects (e.g. white vein) and/or by reducing the dosage.

Lightheadedness: Certain individuals will experience lightheadedness as a side effect of kratom.  In many cases, the lightheadedness goes hand-in-hand with other side effects such as coordination deficits, dizziness, drowsiness, and/or headache.  Many will perceive lightheadedness as lack of blood flow to the brain accompanied by the sensation of heaviness.  Usually a bit of lightheadedness isn’t disconcerting enough for individuals to abate further kratom ingestion, however, the lightheadedness is often noticeable and may lead some to feel as though they’re about to faint.

If you feel lightheaded after taking kratom, one potential cause is altered neurotransmission and intracranial blood flow.  Keep in mind that lightheadedness may also occur if you are dehydrated and/or fail to maintain electrolyte balance while taking kratom and/or if you are allergic to kratom.  Kratom can also induce blood pressure fluctuations, some of which may be culpable for lightheadedness.

To avoid lightheadedness while taking kratom, it is recommended to use a low dose and avoid mixing kratom with other substances.  Furthermore, if you experience lightheadedness from one particular vein type (e.g. red vein), realize that lightheadedness might be less likely to occur with another vein type (e.g. white vein).  In most cases, lying and/or sitting down after taking kratom can make lightheadedness easier to manage.

Mood swings: Since kratom exerts an effect on central neurotransmission and alters physiologic arousal, it can affect mood.  Some individuals will report mood fluctuations or “swings” while under the influence of kratom and/or once its effect wears off.  For example, some individuals may feel relatively happy and/or relaxed within the first hour of taking kratom, but anxious and/or irritable as its effect gradually wanes.

The specific effect of kratom upon your mood will likely be related to the particular type of kratom you ingest, as well as its dosage.  If you continuously experience mood swings while taking kratom, you might want to reduce your dosage and/or try using a different type of kratom.  That said, another possible cause of mood fluctuations is related to altered secretion of hormones (e.g. prolactin, testosterone, estradiol, etc.).

It should be noted that persons with neuropsychiatric conditions such as anxiety, bipolar disorder, and/or depression may be most at risk of experiencing unpredictable and/or sudden mood swings while using kratom.  That said, anyone can experience disconcerting mood changes while taking kratom.  If you find it difficult to cope with these mood swings, consult a psychologist or neuropsychiatric professional.

Nausea: Another side effect that is commonly reported among kratom users is nausea.  Nausea is defined as sickness within the stomach and/or gastrointestinal tract associated with an inclination to vomit.  Since kratom exerts an opioidergic effect, we can speculate that similar to most opioids, the side effect of nausea is caused by:  stimulation of the chemoreceptor trigger zone in the brain, increased vestibular sensitivity, and delayed gastric emptying.

Individuals who are new to using kratom and/or ingesting high doses are most likely to experience severe nausea, possibly so extreme that they end up vomiting.  To minimize likelihood of kratom-induced nausea, it is recommended to take smaller doses and/or administer strains with less significant opioidergic effects (e.g. white vein).  If reducing the kratom dosage and/or switching strains fails to alleviate nausea, antiemetic agents may be a viable intervention.

It should be noted that some nausea may also occur as a result of kratom’s taste/smell, taking kratom on an empty stomach, and/or mixing kratom with other substances.  If the taste/smell of your kratom is making you nauseous, consider mixing it with some food (e.g. yogurt).  If you’ve experienced nausea while taking kratom on an empty stomach, then try taking it with food.

Moreover, rather than engaging in physical activity after taking kratom, some have suggested that relaxing by lying down can reduce likelihood of nausea.  In the rare case that you’re allergic to kratom, you may feel nausea and vomit no matter what strain you use.  Anyone who constantly feels nauseous from kratom is encouraged to listen to their body’s reaction, refrain from further usage, and seek medical attention.  In most cases, kratom-induced nausea abates within 10 to 72 hours of administration.

Psychosis: Although rare, the adverse reaction of drug-induced psychosis has been observed in a small percentage of kratom users.  Psychosis is defined as loss of connection with reality, often accompanied by delusions (strong beliefs with no basis in reality) and hallucinations (sensory perceptions with no basis in reality (e.g. hearing voices)).  Individuals at highest risk of experiencing kratom-mediated psychosis are persons with preexisting neuropsychiatric disorders and/or who mix kratom with other substances.

Anyone diagnosed with a preexisting neuropsychiatric disorder (e.g. schizophrenia) will be more sensitive to the neurochemical changes induced by kratom, possibly leading to psychosis, especially if abused.  Furthermore, mixing kratom with another substance, especially an illicit drug, may yield synergistic effects upon neurotransmitter systems within the brain to such an extent that psychosis occurs.  Some have speculated that likelihood of kratom-induced psychosis increases at higher doses and/or if multiple strains of kratom are mixed.

Pupil constriction: A side effect that nearly every user of kratom will experience is pupil constriction.  If you were to observe your pupil diameter prior to taking kratom, and then reassessed pupil diameter after kratom has taken effect, you’d notice significant pupillary constriction.  Constriction of pupils is caused predominantly by the opioidergic effect generated by kratom and the corresponding activation of the parasympathetic nervous system.

Generally speaking, the greater the opioidergic effect derived from your kratom, the more noticeable the pupillary constriction is likely to be.  Many users of kratom and other opioids have reported slightly poorer night vision, which is largely due to constricted pupils – allowing less light to enter the eye.  That said, pupil constriction from kratom isn’t considered a problematic side effect for most.

If you dislike the slight reduction in night vision due to pupillary constriction, simply avoid using kratom in the evening.  In the event that you’re worried the pupillary constriction is a sign of an eye and/or visual problem, it is recommended to consult an ophthalmologist.  For individuals concerned with this side effect, it may be possible to ameliorate pupil constriction by using a lower dosage of kratom and/or transitioning to a more stimulating strain.

Rapid thinking: Some individuals will experience acceleration of thoughts or “rapid thinking” as a side effect of kratom.  In some cases, accelerated thinking will be associated with mood enhancement, quick-wittedness, and social pleasure – making for an enjoyable stimulatory experience.  In other cases, accelerated thinking may be associated with severe anxiety, unwanted fearful thoughts, panic, and muscle tension – making for an unpleasant stimulatory experience.

In any regard, rapid thinking is most likely to occur as a kratom side effect among individuals who ingest energizing (i.e. stimulating) strains of kratom (e.g. white vein).  It is also possible that acceleration of thinking may occur as a side effect if ingested at a low dose due to the fact that, in accordance with dose-response documentation, lower doses deliver stimulation without a potent opioidergic effect.  Moreover, if kratom is mixed with another stimulant (e.g. caffeine), users may experience a synergistic stimulatory effect that leads to quicker thinking.

It should also be noted that persons with a family or personal history of mania or hypomania may be prone to rapid thinking as a side effect of kratom.  Understand that rapid thinking is unlikely to occur with sedating strains of kratom (e.g. red vein) and at higher doses.  If you find the rapid thinking that occurs while taking kratom to be disturbing, and experience it no matter the dose and type of kratom you use – it is recommended to abstain from further kratom usage.

Respiratory depression: Hypoventilation, also referred to as respiratory depression, is defined as insufficient ventilation in the process of gas exchange whereby individuals exhibit increased concentrations of carbon dioxide (hypercapnia) and respiratory acidosis.  Although no cases of severe respiratory depression have been documented in the literature among kratom users, it’s necessary to acknowledge that respiratory depression might occur as an adverse reaction.  Many kratom advocates wrongfully assume that because no cases of respiratory depression have been documented, that it somehow cannot occur – this is a mistake.

We know that kratom functions as a mu-opioid receptor agonist analogous to many other opiates, each of which can induce respiratory depression.  Although kratom exerts a stimulatory effect which likely protects against respiratory depression resulting from CNS suppression, using sedating strains at high doses can override the stimulatory effects such that respiratory depression might occur.  In addition to high dose kratom users being at risk of respiratory depression, individuals who mix kratom with other CNS depressants (e.g. alcohol, benzodiazepines, etc.) may be at highest risk.

In the event that respiratory depression occurs, it can lead to shortness of breath, carbon dioxide toxicity, and brain damage.  In extreme cases, respiratory depression may be a precursor to death via respiratory failure (such as might occur in an overdose).  If you and/or someone you know is experiencing respiratory depression from kratom, it is recommended to seek immediate medical attention.  First-line treatment options for respiratory depression likely include: opioid receptor antagonists (e.g. naloxone) and/or respiratory stimulants.

Seizures: A relatively rare adverse reaction that a subset of kratom users have reported is seizure, or sudden convulsing due to abnormal excitatory electrical discharge in the brain.  The cause of kratom-induced seizure is hypothesized to stem from its opioidergic action, specifically its agonism of mu-opioid receptors.  Evidence from a study by Saboory, Derchansky, Ismaili, et al. (2007) discovered that excessive stimulation of mu-opioid receptors via high-dose morphine lead to neuroexcitation followed by seizures.

Comparatively, lower doses of morphine yielded normative stimulation of mu-opioid receptors and appeared to protect against neuroexcitation.  Although kratom is certainly not the same drug as morphine, it acts predominantly upon the mu-opioid receptor to facilitate an opioidergic effect.  Assuming a large enough dose of kratom is ingested, it’s reasonable to suspect that mu-opioid receptors become overstimulated enough to induce neuroexcitation followed by seizure.

Most suspect that individuals with a family/personal history of epilepsy, seizures, and/or related neurological complications are at greatest risk of experiencing kratom-induced seizures.  Furthermore, anyone ingesting abnormally high doses of kratom, especially highly-potent opioidergic strains (e.g. red vein), will be at increased risk of seizure.  To minimize likelihood of seizure from kratom, it is recommended to rule out neurological complications prior to usage, and if considered safe, use the minimal effective amount and avoid co-administration of substances.  (Source: https://www.ncbi.nlm.nih.gov/pubmed/18042875).

Sexual dysfunction: While a subset of persons will report improved sexual drive and/or performance upon commencement of kratom, others will experience sexual dysfunction.  There are many reasons as to why kratom may induce the side effect of sexual dysfunction including: reduced physiologic arousal [due to CNS depression], specific neurochemical changes within the brain, and altered hormone production.  Assuming you’re using a strain of kratom that’s sedating, the sedation alone is likely to impair sexual drive and/or performance.

Another possibility is that kratom-induced modulation of neurotransmission within pleasure/reward pathways of the pain make individuals less interested in sex.  Among short-term kratom users, sedation and neurochemical changes are likely most culpable for the reduction in sexual drive.  In longer-term kratom users, decreased sex drive is likely a byproduct of significant changes in hormone production.

Research suggests that opioidergic substances act upon opioid receptors in the hypothalamus to alter gonadal function.  Altered gonadal function leads to reduced production of gonadotrophin releasing hormone and downstream drop-offs in luteinizing hormone and follicle stimulating hormone from the pituitary gland, and of testosterone or estradiol from the gonads.  Moreover, opioids can sometimes increase prolactin levels which decreases testosterone production.

As a result, kratom users commonly report decreased sexual interest or drive, anorgasmia (inability to orgasm), and/or erectile dysfunction.  Among those who find the decreased sex drive to be problematic, you may want to consult a medical professional, check your hormone levels, and if out of normative ranges – you may want to utilize hormone-replacement therapy.  That said, sometimes switching to a different strain of kratom and/or adjusting its dosage is sufficient enough to ameliorate sexual dysfunction.

Skin discoloration: Some reports emphasize that skin discoloration may occur as an adverse reaction to kratom, especially among long-term users.  Most suggesting kratom can cause skin discoloration claim that the discoloration is usually most noticeable in the face, specifically the cheeks.  Given the fact that changes in skin pigmentation tend to only occur in a small percentage of individuals after a long-term of regular kratom usage, it’s possible that they are not actually caused by kratom.

Most speculate that skin discoloration occurs naturally in kratom users the same as it would in non-kratom users, leading many to mistakenly assume that kratom is the underlying cause.  That said, while we should be highly skeptical of claims that kratom can induce skin discoloration, it’s reasonable to acknowledge the possibility that kratom may cause skin changes.  A subset of persons hypothesize that long-term, high-dose kratom administration might alter melanin production in the skin, thus explaining the discoloration.

Others believe that chronic administration of kratom may induce hepatic dysfunction in which individuals experience jaundice or yellow darkening of the skin.  Additional possibilities that may explain skin discoloration include significant long-term changes in hormone production (due to opioidergic effects) and/or immunosuppression.  Yet another possibility is that an individual may be allergic to kratom and/or develop an allergy over time, ultimately triggering a skin rash.  In the event that your skin becomes discolored while using kratom, abstain from further usage and consult a dermatologist for evaluation.

Sleep disturbances: While some individuals claim that kratom enhances their sleep duration and quality, others will report disturbed sleep and corresponding declines in total sleep time and/or quality.  For example, certain individuals have reported broken sleep associated frequently waking in the middle of the night.  Others might experience insomnia after using kratom whereby they are unable to fall asleep and/or stay asleep throughout the night.

Kratom may disrupt sleep if administered in the form of an energizing strain (e.g. white vein) and/or at a lower dose (providing less of a sedating effect).  It’s also possible that kratom disrupts sleep by modulating neurophysiology in such a way that it interferes with normative circadian rhythm processes (e.g. melatonin production) and/or sleep stages/cycles.  Regardless of the specific sleep disturbance(s) you experience, any disturbance may leave you feeling fatigued and/or cognitively impaired upon waking.

To minimize likelihood of sleep disturbances while taking kratom, it is recommended to avoid using kratom in the late afternoon and/or early evening.  Some individuals may find that switching to a different strain of kratom and/or modifying their current dosage corrects their sleep disturbances.  Obviously if your sleep continues to suffer, regardless of altering time of administration, dosage, and/or strain – it is recommended to cease usage and consult a sleep specialist to correct your suboptimal sleep.

Sweating: Though not experienced by all kratom users, some individuals have noticed substantial increases in sweat production while under its influence.  Even if you’re satisfied with the therapeutic effect of kratom, you may be frustrated with the side effect of increased sweating.  Excessive sweating or hyperhidrosis can be embarrassing in an occupational or social setting.

Some individuals have claimed that the sweating is especially prominent throughout the night such that they wake up to soaked, malodorous bedsheets.  Others end up doing more laundry than usual because they continuously drench their clothing in sweat.  Though the exact causes of kratom-induced sweating aren’t fully understood, it’s likely that: the autonomic nervous system, neurochemistry, and/or thermoregulatory centers are implicated.

Research has shown that mu-opioid receptor activation induces hyperthermia or increases in body temperature, whereas kappa-opioid receptor activation induces hypothermia.  Kratom acts as a mu-opioid receptor agonist and kappa-opioid receptor antagonist, the combination of which could yield a noticeable increase in temperature.  This body temperature increase may lead to increased sweat production by the body as a cooling mechanism.

Excessive sweating may also be related to increased sympathetic tone from ingestion of a stimulating strain of kratom.  Possible ways to reduce the kratom-induced sweating include: reducing the dose and/or switching the strain.  Keep in mind that excessive sweating could also signify an allergic reaction to kratom, especially if accompanied by other symptoms such as shortness of breath and/or hives.

Temperature changes: A predictable side effect that occurs in nearly all kratom users is fluctuation of body temperature.  The extent to which body temperature fluctuates as a result of kratom will be contingent upon the specific type and dosage of kratom ingested.  Individuals who use low doses of kratom probably won’t sense any substantial changes in body temperature whereas persons who ingest higher doses may notice significant shifts in body temperature after kratom takes effect.

According to research by Rawls and Benamar (2011), mu-opioid receptors can induce hyperthermia when activated, whereas kappa-opioid receptors can induce hypothermia when activated.  The simultaneous activation of mu-opioid receptors and inactivation of kappa-opioid receptors may lead to significant increases in body temperature among kratom users, especially if ingested at a high dose.  For some, the increases may be so significant that they’re perceived as a fever.

Furthermore, animal studies show that administration of opioidergic substances significantly increases body temperature.  Anyone who notices a temperature increase may also experience hot flashes and/or increased sweat production.  Those who dislike the side effect of elevated body temperature may find it helpful to reduce the amount of kratom used.  (Source: https://www.ncbi.nlm.nih.gov/pubmed/21622235).

Tiredness: It is common to experience tiredness as a side effect of kratom such that you may find it difficult to summon the energy necessary for the completion of energy-intensive physical or cognitive tasks.  In some cases, tiredness is a transient side effect that occurs among novice kratom users and subsides as neurophysiology adapts to its regular administration.  In other cases, tiredness may be more related to individuals using a sedating strain of kratom and/or an abnormally large dose.

Sedating strains and/or large doses tend to stimulate mu-opioid receptors which depresses CNS activity, leaving you feeling lethargic and less energized.  The tiredness may be so overwhelming that you just want to relax on the couch and/or drift off to sleep.  Anyone who dislikes the tiredness as a side effect of kratom can simply reduce their dose (lower doses tend to be more stimulating) and/or transition to an energizing strain (e.g. white vein).

Tremor: Although uncommon, tremor has been reported as an adverse reaction to kratom.  In some cases, tremor may be related to ingestion of a stimulating strain of kratom, leading to overactivation of the sympathetic nervous system and corresponding convulsions and/or shakes.  Tremor could also be caused by ingesting an abnormally high dose of kratom.

Abnormally high doses of kratom are thought to excessively agonize mu-opioid receptors and generate downstream neuroexcitation.  This downstream neuroexcitation is associated with seizures and could certainly lead to onset of tremor and/or shakiness.  In addition to stimulatory strains and/or doses, as well as abnormally high doses, tremor could also occur as a result of mixing kratom with other substances.

Kratom can interact and/or synergize with other substances, possibly yielding excessive stimulation or neuroexcitation whereby users end up with tremor.  Some suspect that tremor may emerge as a side effect among persons who are allergic to kratom and/or from ingesting kratom that had been sprayed with pesticides.  Anyone with a history of neurological disorders and/or tremor is likely at greatest risk of experiencing convulsions or shakiness while taking kratom.

Urinary retention: Some individuals will experience increased urinary retention as a side effect of kratom characterized by difficulty urinating despite having a full bladder.  It is hypothesized that increased urinary retention as a side effect of kratom stems from mu-opioid receptor agonism and downstream modulation of autonomic nervous system (ANS) activation.  This leads to decreased sensation of bladder fullness (via partial inhibition of nerve innervations to the bladder) and bladder outlet resistance (via altered sphincter tone of the urinary bladder).

Assuming you’re getting some sort of therapeutic value from kratom, slightly increased urinary retention may be regarded as a minor issue.  To minimize likelihood of urinary retention as a side effect, it is recommended to decrease your dosage of kratom and/or utilize a more stimulating strain.  Certain individuals with unremitting kratom-induced urinary retention claim that consumption of caffeine increases urinary output and offsets the retention.

Before you add caffeine or any other stimulant to your kratom in attempt to attenuate urinary retention, confirm that it’s safe with a medical professional.  If the urinary retention is extreme and you are unable to urinate, it is recommended to cease usage of kratom.

Visual abnormalities / disturbances: It is fairly common to experience visual abnormalities and/or disturbances while under the influence of kratom.  In fact, the visual side effects of kratom are often considered more prominent than those associated with other opioidergic substances.  Examples of visual side effects that have been reported by kratom users include: blurred vision, double vision, eye floaters, impaired visual acuity, internal hallucinations, and poor night vision.

Most that have experienced visual abnormalities as a side effect of kratom agree that they are often dose-dependent such that the greater the dosage ingested, the more noticeable and/or numerous the visual abnormalities.  Due to the fact that the opioidergic effect of kratom induces pupillary constriction, it is possible that constricted pupils contribute to some of the aforestated visual side effects such as poorer night vision.  Additionally, because kratom modulates multiple neurotransmitter systems, it’s likely that this modulation – particularly in areas of the brain implicated in vision (e.g. visual cortex) – yields visual side effects.

Other potential causes of visual side effects associated with kratom include:  cerebral blood flow changes (possibly in regions of the brain involved in visual processing) and CNS depression (reducing attentiveness to visual stimuli).  Some have hypothesized that at high doses, kratom antagonizes NMDA receptors and may induce slight disconnection from perception of visual inputs and/or stimuli.  Furthermore, extremely high doses of kratom have reportedly generated non-geometric imagery somewhat analogous to visual hypnagogic hallucinations.

Despite the fact that visual abnormalities are commonly associated with kratom ingestion, some kratom users may panic and assume that kratom is somehow damaging the eyes.  If you suspect eye damage [from kratom], it is recommended to consult an ophthalmologist for a comprehensive examination.  Moreover, anyone experiencing visual disturbances should abstain from operating a motor vehicle and heavy machinery, and/or activities that require normative visual function/processing.

Vomiting: An extremely unpleasant adverse reaction to kratom that a subset of users experience is vomiting.  Like other opioidergic substances, kratom induces nausea and corresponding vomiting primarily by stimulating the chemoreceptor trigger zone, an area of the brain [within the medulla oblongata] implicated in detecting substances that don’t belong in the blood.  Adjacent to the chemoreceptor trigger zone is the medullary vomiting center (VC), and if a noxious substance is detected in the blood, the chemoreceptor trigger zone signals to the vomiting center to provoke vomiting.

While some users will assume that vomiting is an allergic reaction to kratom, it’s generally a common reaction and indicative of normative brain function.  Other possible causes of kratom-induced vomiting include: increased vestibular sensitivity and/or altered gastric function.  In most cases, individuals who vomit upon commencement of kratom will find that the vomiting abates within 1-week of continued administration.

If you experience vomiting while taking kratom, you may benefit from reducing your dosage and/or switching to a different strain.  To prevent vomiting, some kratom users find it helpful to co-administer an antiemetic.  That said, if vomiting is extreme and/or persists, discontinue kratom and seek emergency medical attention – as this may indicate toxicity or an allergy.

Weight changes: Another lesser discussed side effect of kratom is change in body weight.  Some individuals report that kratom causes weight loss, whereas others have suggested that it causes weight gain.  Among those who experience weight loss while taking kratom, the weight loss is often related to decreased appetite.  Appetite reduction on kratom may be attributable to kratom’s influence upon:  CNS activation, hormone secretion, neurochemistry, and/or gut microbiota.

It’s also possible that other kratom side effects like constipation, nausea, and/or vomiting make food consumption less appealing.  A reduction in appetite on kratom, regardless of the specific underlying cause(s) may lead to caloric restriction and weight loss.  It is also worth mentioning that certain strains and/or doses of kratom provide stimulation which may increase physical activity levels and caloric expenditure for weight loss.

That said, over a long-term, most kratom users are likely to experience some weight gain.  Research by Mysels and Sullivan (2010) reports that both acute and chronic opioid administration is associated with glycemic dysregulation and weight gain.  The weight gain is likely related to increased sugar cravings and/or preference for hyperpalatable foods stemming from agonism of mu-opioid receptors at the nucleus accumbens shell, hypothalamus, and paraventricular nucleus.

Moreover, many individuals feel fatigued and/or sedated after taking kratom, ultimately minimizing physical activity and decreasing caloric expenditure – possibly explaining some weight gain.  Over a long-term, kratom may significantly affect concentrations of sex hormones, leading to an unappealing body composition.  Anyone experiencing significant unfavorable weight changes may want to adjust their dose, switch to a different strain, and/or cease kratom altogether.  (Source: https://www.ncbi.nlm.nih.gov/pubmed/21269006).

Weird dreams:  After taking kratom, some individuals will experience unexpectedly bizarre or strange dreams.  Dreams may seem exceptionally vivid, more entertaining, emotionally-charged, and possibly nightmarish.  The weird dreams that occur while using kratom are primarily related to its influence on neurochemistry.

Kratom modulates an array of neurotransmitter systems, each of which might alter your perception of dreams during sleep.  It’s possible that the neurotransmitter modulation induced by kratom may affect the duration of sleep stages/cycles.  Most kratom users do not have a problem dealing with the side effect of weird dreams and some may even enjoy them.

Nonetheless, if you want to reduce the likelihood that you’ll experience weird dreams on kratom, it is recommended to avoid using kratom in the afternoon or evening.  The later in the day you ingest kratom, the more likely it will affect your dreams and sleep.  Additionally, it is thought that the lower the dose of kratom administered, the less significant its modulation of neurochemistry and corresponding perception of atypical dreams.

Note: Kratom side effects and/or adverse reactions are not limited to the above listing.  If you experience a side effect that was not mentioned in this list, be sure to mention it in the comments section below.  Should you have any questions about side effects and/or adverse reactions you’re experiencing while taking kratom, be sure to consult a medical professional.

Variables that influence Kratom side effects

When contemplating the side effects you’re likely to experience from kratom, it’s necessary to reflect upon variables that are known to influence side effect occurrence.  Variables that influence the specific kratom side effects that you experience, as well as their respective severities include:  the specific kratom batch/leaf ingested, the dosage, co-administered agents, cumulative duration of usage, genetics, and medical conditions.  It is the cumulative influence of these variables that explains why a subset of kratom users experience few or negligible side effects, yet others experience a host of debilitating side effects or adverse reactions.

  1. Kratom constituents

The constituents of kratom that matter most in terms of influencing side effects include: alkaloids, additives, and/or contaminants.  The precise quantities of alkaloidal constituents dictate the specific neurochemical and physiologic effects induced by kratom, and predictably, have the most substantial impact on the side effects that you are likely to experience.  To a lesser extent, additives (i.e. added ingredients) and contaminants (e.g. pesticides) may be present within kratom in sufficient quantities as to provoke side effects.  In any regard, it is the specific quantities of kratom constituents that explain why you find certain strains and/or batches of kratom tolerable, yet others completely intolerable.

  • Alkaloids: The specific effect of kratom upon a user’s physiology is influenced principally by its 40+ alkaloidal constituents. Examples of several prominent psychoactive alkaloids within kratom include: 7-hydroxymitragynine, mitraphylline, and mitragynine.  Quantities of the aforestated psychoactive alkaloids, as well as the many other alkaloids, can differ significantly depending on the specific strain, batch/leaf, cultivation details, and supplier of kratom.  It is the quantities of these alkaloids that predict the effect of kratom upon physiology and the resulting side effects.
    • Strain: In addition to general types of kratom based on vein color, there are highly specific strains of kratom, each of which will vary in terms of alkaloid content. Even if two strains are classified as “red vein,” alkaloid content will be slightly different, ultimately yielding slightly different physiologic effects and perhaps noticeably different side effects.  For example, both Red Thai kratom and Red Maeng Da kratom are “red vein,” however, each will contain strain-specific quantities of alkaloids.  Red Maeng Da kratom is thought to exert a slightly greater opioidergic effect, slightly less stimulation, and slightly greater mood enhancement – than Red Thai kratom.  Examples of other kratom strains include: Bali, Borneo, Indo, Malaysian.  Understand that the alkaloid content within strain of kratom you ingest might explain the side effects you’re experiencing.
    • Types: Most kratom resources suggest there are 3 general types of kratom based on vein color including: red vein, white vein, and green vein. Red vein kratom is said to yield sedating effects, white vein kratom is said to yield stimulatory effects, and green vein kratom is said to yield a relatively balanced combination of sedation with stimulation.  Logically, we would hypothesize that the vein color of a kratom leaf influences its alkaloid content and corresponding physiologic effect.  Researchers have suggested that red vein kratom contains high levels of the alkaloid 7-hydroxymitragynine, whereas white vein kratom contains low levels of 7-hydroxymitragynine.  Most would suspect that white vein kratom may also contain more stimulatory alkaloids than red vein kratom.  As a result, most will notice slight variation in physiologic effect and side effects in accordance with the vein color of kratom ingested.
    • Source (Supplier / Vendor): Alkaloid content can also differ based upon the supplier or vendor of kratom. Hypothetically, even if multiple kratom vendors were selling the same specific strain of kratom, there would likely be slight variation in alkaloid content due to differences in cultivation.  For example, one company may cultivate Maeng Da kratom in optimal conditions as to maximize the concentration of certain alkaloids, whereas another may cultivate Maeng Da kratom in suboptimal conditions such that certain alkaloids may be lacking and/or the batch is of lower quality.  Ingesting Maeng Da kratom from the first hypothetical company may facilitate a slightly more potent physiologic effect and slightly different side effects than ingesting the same strain kratom from the second hypothetical company – primarily due to slight differences in alkaloidal constituent.  It’s also possible that kratom may vary among suppliers/vendors based on storage conditions (e.g. temperature, sunlight, humidity, etc.) and duration of storage prior to consumer purchase.
    • Batch / Leaf: A standardized kratom extract ensures that you’re getting a relatively similar, nearly-identical herbal supplement from batch-to-batch, however, because there’s no legal obligation for vendors/suppliers of kratom to sell standardized extracts, it’s possible that the Maeng Da kratom you purchased 6 months ago from hypothetical “Company K” may differ in alkaloid content from the Maeng Da kratom you purchased 1 week ago from the same company.  The difference in alkaloid content from batch-to-batch, largely attributable to lack of standardization, may lead you to experience batch-specific side effects.  What you might assume to be a “bad batch” of kratom might be better explained by differences in alkaloids – resulting from lack of standardization.  Unless you’re personally testing the alkaloidal constituents within each batch of kratom you ingest – you won’t know the extent to which they’re differing from batch-to-batch.  To a lesser/negligible extent, it’s also possible that there may be slight intra-batch variation in alkaloid contents from leaf-to-leaf – possibly due to one leaf getting more sunlight than other, etc.  Although alkaloids probably won’t differ much from batch-to-batch and leaf-to-leaf, any differences would explain batch-specific or leaf-specific side effects.
  • Additives: If you’re experiencing side effects from kratom, you may want to evaluate whether there are any additives in your product. Certain kratom suppliers add ingredients to their kratom to improve its taste, scent, and/or enhance its psychoactive effect.  If there are any additives in your kratom, it’s possible that these may directly cause side effects or potentiate kratom-induced side effects.  For example, kratom marketed under the name “Krypton” reportedly is laced with caffeine and O-desmethyltramadol (a metabolite of the opioid analgesic drug tramadol) and ultimately lead to users experiencing noticeably different side effects than standalone kratom.  Another possibility is that you may be allergic to kratom additives, thus explaining adverse reactions and/or side effects that you experience.  Still, it’s also necessary to consider that certain additives may attenuate certain side effects caused by kratom.  For example, someone who ingests red vein kratom laced with caffeine may be less prone to experiencing side effects such as drowsiness and/or fatigue due to the stimulatory effect of caffeine.  Always be cognizant of additives within your kratom and understand that they may prompt side effects.
  • Contaminants: While the likelihood of purchasing contaminated kratom is thought to be extremely low, most consumers have no way of knowing whether their kratom is devoid of contaminants unless they were to send in their kratom for expensive testing. It’s possible that in rare cases, kratom could end up contaminated during the growth, harvest, shipping, and/or handling process.  Contaminants could take many forms including: bacteria, fertilizer, pesticides, viruses, and others.  In the event that you purchase a kratom product with contaminants, you may experience severe adverse reactions and possibly permanent long-term complications associated with biotoxicity and neurotoxicity.  Most kratom retailers protect themselves legally by emphasizing that their kratom is “not intended for human consumption.”  If you have a severe adverse reaction to kratom, it’s possible that contaminants were to blame.
  1. Dosage of kratom

The average dosage of kratom you take will have a significant influence on the side effects that you experience.  In general, persons who use low doses of kratom should experience fewer and/or less severe side effects than persons who use higher doses of kratom.  This is because lower doses of kratom provide fewer alkaloids to modulate physiology than high doses, ultimately minimizing likelihood and/or severity of side effects.

Comparatively, high doses of kratom provide a greater number of alkaloids to exert a more substantial effect on physiology than low doses whereby likelihood and/or severity of side effects increase.  Moreover, kratom has a unique dose-response curve such that it is generally more stimulating at lower doses and opioidergic/sedating at higher doses.  With this knowledge, one might speculate that stimulatory-type side effects are more noticeable at lower doses and opioidergic/sedative-type side effects are more common at higher doses.

  • Low doses: Low doses of kratom are generally classified as falling within the range of 0 to 4 grams. The lower the dosage of kratom ingested, the less noticeable and/or likely side effects are to occur.  Someone who ingests a micro-dose kratom at 0.5 grams may experience zero unwanted side effects due to the fact that there aren’t enough alkaloids within such a small dose to substantially modulate physiology and provoke side effects.  It is also known that kratom typically exhibits a unique dose-response curve such that low doses tend to yield greater stimulation than high doses.  For this reason, some might expect that low doses may increase likelihood of stimulatory-type side effects such as: anxiety, anger, irritability, and/or restlessness.
  • Moderate doses: Moderate doses of kratom are generally classified as falling within the range of 4 to 6 grams. Persons who use moderate dosages of kratom will be ingesting a greater number of alkaloids than individuals who use low doses of kratom and therefore should be more susceptible to side effects.  In other words, someone who consistently ingests 5 grams of kratom should experience a greater physiologic effect, and might endure more side effects, than if he/she were to consistently ingest 0.5 grams.  Furthermore, moderate doses of kratom tend to provide a blend of stimulation and sedation.  At the higher end of the moderate dosing range, opioidergic/sedative-type side effects may be more prevalent than at the lower end, whereas stimulatory-type side effects may be more prevalent at the lower end of the moderate dosing range.
  • High doses: High doses of kratom are generally classified as exceeding 6 grams of dried leaf. Individuals using high doses of kratom will be ingesting a greater number of alkaloids than moderate-dose and low-dose users.  The greater number of alkaloids ingested by high-dose users will exert a more substantial effect upon the user’s physiology and should induce more severe side effects and/or a greater number of side effects than at lower doses.  Moreover, high doses of kratom tend to facilitate a potent opioidergic/analgesic/sedative effect with little to no stimulation.  For this reason, high-dose users should expect opioidergic-type side effects (e.g. brain fog, cognitive deficits, constipation, depression, etc.) than lower-dose users.

It should be noted that the relationship between kratom dosing and side effects will be highly individualized based on things like: body composition and genes implicated in hepatic metabolism of alkaloids.  For example, a petite person with a certain CYP2D6 allelic expression may react to a moderate dose of kratom the same way a large person with a different CYP2D6 allelic expression.  The takeaway is that, generally speaking, the larger the dosage of kratom ingested – the greater a person’s susceptibility to side effects.

  1. Frequency of ingestion

The frequency at which you ingest kratom may also influence the side effects that you experience.  If we were to take three individuals and assign them to respectively receive kratom frequently, semi-frequently, and infrequently – most would agree that if each single dose of kratom were the same, the person who received kratom most frequently would be most prone to side effects due to ingestion of the largest quantity of kratom in the shortest duration of time.  In other words, someone receiving 5 mg of kratom once every 6 hours (frequently) would have ingested more total kratom than a person receiving 5 mg of kratom daily (semi-frequently) or 5 mg of kratom weekly (infrequently).

Although we cannot assume that frequency of kratom administration always correlates with dosing, it’s reasonable to suspect that frequent users ingest larger daily doses of kratom than less frequent users.  In many cases, larger doses due to increased dosing frequency will yield a greater number of side effects due to the fact that an individual will need to absorb, metabolize, and excrete a greater quantity of alkaloids in a shorter duration.  That said, not all highly frequent kratom users necessarily use high doses and thus may actually be protected against certain side effects that occur in less frequent kratom users.

  • High-frequency: A high-frequency kratom user would be considered anyone who ingests kratom multiple times per day. As a result of ingesting kratom multiple times per day, high-frequency users may develop tolerance quicker and/or ingest a greater quantity of kratom (i.e. larger daily dose) than infrequent users.  The greater the quantity of kratom ingested, the more significant its physiologic effect and corresponding odds of experiencing side effects.  That said, if a high-frequency user administers low quantity of kratom per day (e.g. 0.5 mg once every 5 hours), it’s possible that side effects will remain minimal.
  • Moderate-frequency: A moderate-frequency kratom user would be considered anyone who ingests kratom between once per day to several times per week. Moderate-frequency users may be less likely to ingest as much total kratom per day than high-frequency users, and as a result, may be less at risk of experiencing side effects.  That said, some moderate-frequency users might resort to ingesting large single doses of kratom (e.g. 10 mg/dose) which would increase risk of side effects.
  • Infrequent: An infrequent kratom user would be considered anyone who ingests kratom once a week or even less often such as once every other week or once per month. Many persons who use kratom infrequently opt to ingest small doses due to a low preexisting physiologic tolerance as compared to moderate and high-frequency users.  That said, if an infrequent kratom user decides to use a high dose, he/she may end up with severe side effects partly due to lack of physiologic adaptation or tolerance that emerges with more frequent usage.

What about intra-day frequency with the same total daily dose?

If we are to assume that the total daily dose of kratom remained constant, but frequency of administration changed, it’s likely that side effects would be partly contingent upon administration frequency.  Administration 6 mg kratom once every 12 hours may differ in side effect induction from other protocols [with the same cumulative daily dose] such as:  4 mg once every 8 hours, 3 mg once every 6 hours, 2 mg once every 4 hours, or 1 mg once ever 2 hours.  Most strains of kratom are thought to deliver an effect that lasts between 2 and 4 hours, possibly indicating that the greater the amount of kratom you ingest within a 4-hour period, the more likely you are to experience side effects.

That said, it is necessary to also consider individual variation in hepatic metabolism of kratom alkaloids based on CYP2D6, CYP2C9, and CYP3A4 genes.  Some individuals may rapidly metabolize the alkaloids and experience no increase in side effects with increased frequency of kratom administration, whereas others may struggle to handle frequent dosages due to the fact that their metabolism of kratom alkaloids is prolonged.  Overall, there’s likely an optimal dosing frequency for each kratom user based on metabolism and specific strain of kratom ingested whereby likelihood of side effects can be minimized.

  1. Term of administration

The cumulative duration or term over which you’ve been administering kratom might also dictate the side effects that you experience.  This is because the cumulative duration of kratom administration generally influences the degree to which a person’s physiology has adapted or changed [over particular timeframe] in response to kratom.  Furthermore, the cumulative duration of kratom administration often affects a user’s dosing decisions.  Someone who’s been using kratom for a short-term may decide to initiate treatment with a low dose due to his/her lack of tolerance, whereas someone who’s been using kratom for a long-term may administer a high dose due to his/her high tolerance.  As a result, you may experience predictable differences in side effects based on the cumulative duration over which you’ve administered kratom.

  • Short-term: Those who’ve been using kratom for a short-term (1 day to 1 month) are at increased risk of experiencing adaptation-related side effects, or side effects stemming from insufficient physiologic acclimation to a drug. Common adaptation-related side effects that emerge among kratom users include:  balance/coordination deficits, constipation, headache, lightheadedness, nausea, and vomiting.  In many cases, while adaptation-related side effects may be severe and/or numerous over a short-term, they diminish and/or abate with longer-term [regular] kratom administration.  Nevertheless, in addition to being at increased risk of experiencing adaptation-related side effects, new kratom users may be more likely to commit dosing errors and/or administer too high of a starting dose for their physiology to safely handle, ultimately triggering adverse reactions and/or more side effects than expected over a short-term.  That said, not all new kratom users recklessly initiate treatment with a large dose.  Others may cautiously initiate treatment with a small dose such that short-term side effects are negligible.
  • Moderate-term: Those who’ve used kratom for a moderate-term (e.g. 1 to 6 months) are likely to have successfully endured most adaptation-related side effects and should no longer experience them. For example, a person who experiences nausea and/or vomiting over a short-term of administration may notice that all emetic side effects abate within the first few weeks of regular usage.  Additionally, most moderate-term users will have optimized their kratom dosage/strain to minimize side effects, and may have devised strategies for managing lingering unwanted side effects – ultimately making kratom more tolerable than it was over a short-term.  As a result, many moderate-term users will experience less numerous and/or severe side effects than some short-term users.  That said, a subset of moderate-term users may become tolerant to their current kratom dosage and titrate their dosage upwards or switch to a more potent strain.  Any upward titration in dosing and/or switching to a more potent strain may induce severe and/or numerous side effects in moderate-term users.
  • Long-term: Those who’ve used kratom for a long-term (e.g. 6+ months) should be well-adapted to the physiologic effect exerted by kratom’s alkaloidal constituents. For this reason, assuming a long-term user remains at a constant or fixed dose of kratom without switching strains, he/she may experience few unwanted side effects than short-term and/or moderate-term users.  Furthermore, one might speculate that most long-term users experience few unwanted side effects, because if they did, they probably would’ve discontinued kratom over a short-term.  That said, any substance, including kratom, may induce increasingly deleterious cumulative physiologic changes when administered regularly over a longer-term – as compared short-terms and/or moderate-terms.  As a result, some long-term users may notice the onset of side effects (i.e. “long-term effects”) that never occurred over a short-term or moderate-term.  The onset of long-term side effects may be a sign that the user’s physiology has shifted profoundly away from homeostasis.  It should also be noted that many long-term users will have long developed tolerance to standard doses of kratom, possibly leading a subset of long-term users to increase their dosage and/or use a more potent strain whereby side effects are more likely to occur.

Note:  It is important to note that not all side effects are contingent upon duration of kratom usage.  Some side effects may emerge after your first dose of kratom and persist indefinitely throughout your entire term duration of usage, even if long-term.  Furthermore, influence of the aforementioned durations (short-term, moderate-term, long-term) on side effect occurrence were discussed with the assumption of regular (relatively frequent) kratom usage.  In the event that a person uses kratom infrequently (e.g. once every 6 months), the cumulative duration of usage may not be a very influential factor in terms of side effect occurrence.  This is because infrequent usage of kratom allows for reversion of physiology back to pre-kratom homeostasis between doses.

  1. Administration details

Specific details associated with the administration of kratom might also influence the prevalence and/or severity of side effects that users experience.  Examples of administration details that could potentially influence kratom side effects include: timing of administration, food intake/hydration, format/preparation of kratom, and rate of administration.  In other words, someone who slowly sips kratom tea in the morning after a large [protein-rich] breakfast may experience fewer severe side effects than if he/she rapidly ingests encapsulated kratom in the afternoon on an empty stomach.  Although administration details may not influence side effects in all users, they might have a significant influence on side effect severity/occurrence in others.

  • Time of ingestion: The specific time(s) of day at which you generally administer kratom may affect how your body reacts to its ingestion.  Some individuals will notice that they experience significantly fewer and/or less severe side effects when taking kratom in the morning or early afternoon compared to at night.  Others may have the exact opposite experience such that side effects tend to be less numerous and/or severe at night compared to morning or afternoon.  Moreover, another subset of persons may notice slight differences in side effects depending on whether they take kratom extremely early in the morning compared to mid-morning or late-morning.  In most cases, time of kratom ingestion influences side effect occurrence/severity based on a person’s circadian biology, and influences perception of side effects based on time-specific activities.  For example, in the evening, most individuals feel naturally drowsier and tired due to the fact that circadian biology is increasing production of certain neurotransmitters and hormones.  If a person were to ingest a sedating strain/dose of kratom, it may act synergistically with circadian biology such that a side effect such as drowsiness is amplified.  Oppositely, if a sedating strain/dose of kratom were ingested in the morning or early afternoon, it might be antagonistic to circadian biology such that drowsiness is less intense than the evening.  Additionally, it’s necessary to note that a person’s perception of kratom side effects may be altered by time-specific activities.  For example, a person who ingests a sedating strain/dose of kratom prior to a cognitively-demanding day job (e.g. 7 AM to 3 PM) may yield significantly more frustration with the side effects of brain fog and cognitive dysfunction – than if ingested in the evening.  Although the brain fog and cognitive dysfunction may actually be less severe during the workday than in the evening, an individual may become so frustrated with his/her decline in work performance under the influence of kratom that he/she perceives the cognitive dysfunction as being more severe during the daytime.
  • Food intake/hydration: In most cases, whether a drug is ingested on a full or empty stomach can influence its pharmacokinetics such that the speed of absorption, metabolism, distribution, and/or elimination are altered.  As a result, certain drugs are quicker to reach peak plasma concentrations when taken on an empty stomach than when taken with food – and vice-versa.  In some cases, the specific type of macronutrient consumed (e.g. carbs, fats, proteins) with the drug can influence its pharmacokinetics.  For example, certain drugs exhibit superior absorption when ingested after a high-protein meal than if ingested after other macronutrients and/or on an empty stomach.  It is also necessary to mention that consuming food prior to ingestion of a drug affects the production of neurotransmitters and hormones – each of which might influence how you respond to a particular drug.  Furthermore, the degree to which you are hydrated can influence drug pharmacokinetics such that someone who’s dehydrated may exhibit markedly different pharmacokinetic parameters than a person who’s optimally hydrated or overhydrated.  While many individuals will experience no noticeable differences in kratom’s effect or side effects based on food intake and/or hydration – others will.  Some will notice that kratom’s effect is significantly more potent if taken on an empty stomach compared to taken with food.  Because of the greater potency [reported by a subset of users] on an empty stomach, it’s possible that number and/or severity of side effects increases due to kratom exerting a more substantial physiologic effect.  Furthermore, certain side effects associated with ingesting kratom on an empty stomach may be potentiated by mild anxiety, irritability, and/or depression that some individuals experience when they’re hungry and haven’t eaten.  That said, other side effects such as constipation may be less likely to occur on an empty stomach.  Understand that the duration between your previous meal and kratom ingestion, as well as the duration between kratom ingestion and your subsequent meal – might influence side effects.  Lastly, understand that the specific macronutrient (and possibly micronutrient) composition of that food that you consume, as well as your degree of hydration, could influence your kratom side effects.
  • Format: The format in which kratom is purchased may also influence the side effects that users experience.  Kratom is generally purchased in the form of dried leaves or finely-ground powder.  Some individuals may not notice any difference in side effects (specific side effects, number of side effects, severity of side effects) with one format of kratom (e.g. dried leaves) as compared to another (e.g. powder), whereas others may notice format-specific differences in side effects and/or overall tolerability.
    • Dried leaves: Dried kratom leaves are commonly used to brew kratom tea because they are easy to steep in boiling water and won’t yield much sediment. Although kratom powder can also be used to make tea, it is generally messier and challenging to filter.  If finely-ground powder is used to brew tea, it becomes nearly impossible to filter out all the granules and the tea may contain a lot of sediment.  Excessive sediment can be irritating to the gastrointestinal tract for some individuals and provoke gastrointestinal-related side effects such as nausea, stomach aches, and/or vomiting.  Because sediment is generally lower in kratom tea brewed with dried leaves, it may be less likely to provoke GI-related side effects and might be easier to tolerate.  That said, if dried leaves are not used to brew kratom tea and instead are ingested unaltered, users may experience significant gastrointestinal irritation due to digestion of unaltered leaves.  However, less efficient digestion of unaltered leaves may yield a less significant physiologic effect, and as a result, certain side effects associated with the physiologic impact of kratom may be less severe.
    • Powder: Ground kratom powder is among the most popular formats of kratom purchased. Powder forms of kratom are generally easier than non-powder forms (e.g. full-leaf) for the body to absorb and metabolize.  Furthermore, the greater the fineness of the kratom powder, the more efficiently the body should absorb and metabolize it.  In other words, ingestion of an ultra-fine kratom powder will be easier for the body to use than ingesting a normatively-ground kratom powder.  That said, some individuals will claim that using powder to make kratom tea yields excessive sediment in the tea, which in turn leads to gastrointestinal irritation and/or related-side effects.  Additionally, many individuals who use ultra-finely-ground kratom powder might experience a more potent physiologic effect than they would with other formats, and because of the more potent physiologic effects, side effect severity/occurrence increases.
  • Mode of ingestion: The modality by which you administer kratom can also influence the side effects that you experience. Modality of kratom administration will influence its pharmacokinetics and pharmacodynamics and corresponding physiologic effect.  Because kratom is more efficiently utilized when ingested orally compared to smoking, someone who administers kratom orally in the form of an encapsulation should experience a more robust physiologic effect – and probably more side effects than if smoked.  That said, certain modes of administration are known to yield mode-specific side effects.  For example, you may be more prone to lung/throat irritation if you smoked kratom compared to drinking kratom tea.  Below is a list of administration modalities discussed in regards to how they may influence kratom side effects.
    • Kratom tea: Kratom is brewed in the form of a tea by steeping kratom leaves or powder in boiling water. The alkaloidal constituents of kratom leaves infuse with the boiling water, and when ingested, the alkaloids modulate the consumers’ physiology.  Drinking kratom tea should yield a more robust physiologic effect than non-oral modes of kratom ingestion, and because of the more robust effect, certain side effects may be more prevalent.  That said, as was already mentioned, the amount of sediment within the tea may dictate whether a subset of persons experience more/less gastrointestinal side effects.
    • “Toss-and-wash”: Another popular method of kratom administration involves “tossing” the powder in one’s mouth and “washing” the powder with a beverage quickly thereafter. For example, a person implementing the toss-and-wash mode of administration empty a spoonful of kratom powder in his/her mouth followed by a subsequent liquid chaser (e.g. fruit juice).  Some individuals may experience certain side effects with the toss-and-wash method as a result of smell/taste amplification.  The smell and taste of kratom are generally amplified when tossed into the mouth unaltered in powder form, which if deemed unpleasant, may induce side effects such as nausea or vomiting.  This method may also increase likelihood of burning throat and/or gastrointestinal irritation if an insufficient quantity of fluid (e.g. water) is used to wash down the powder.
    • Encapsulation: Many kratom vendors sell encapsulated kratom or a fixed-quantity of kratom powder formatted within a degradable capsule. Encapsulated kratom is ingested similar to most prescription medications such that it is placed within the mouth and swallowed with water (or a preferred beverage).  The only substantial difference between encapsulated kratom and non-encapsulated kratom powder ingested via “toss-and-wash” is that the taste and smell of the encapsulation will be less noticeable.  A less noticeable taste/smell associated with encapsulated kratom may be less likely to provoke nausea and/or vomiting among persons who find its taste and/or smell to be unpleasant.  Besides reducing side effects stemming from a subjectively perceived unpleasant smell/taste, encapsulate kratom should exert a similar physiologic effect as non-encapsulated powdered kratom, and overall, side effects won’t be much different.
    • Mixing: Some individuals using non-encapsulated kratom prefer to blend it with another beverage and/or food before ingestion. For example, mixing kratom in with fruits and vegetables in the form of a smoothie may be an easy way to administer kratom for persons who find its taste/smell to be unpleasant.  Others may prefer to mix kratom in with yogurt, oatmeal, pasta sauce, salsa, etc. to offset the taste/smell.  In any regard, mixing kratom with another substance may influence the side effects that a person experiences.  Someone who finds kratom’s taste/smell to be revolting may experience significantly fewer side effects (e.g. nausea, digestive irritation, etc.) if they mask kratom’s taste/smell by mixing it into a food or drink prior to ingestion.  It’s also possible that mixing kratom with certain substances yields different side effects than with others.  For example, blending kratom with a high-fiber food may exacerbate gastrointestinal irritation compared to blending kratom with Greek yogurt.  Moreover, as was already mentioned, mixing kratom with foods/beverages can alter its pharmacokinetics, which in turn, could influence the side effects that you experience.
    • Atypical modes: Less common modes of kratom ingestion include smoking and intranasal insufflation. Smoking said to be a highly-inefficient way to administer kratom due to the fact that a large quantity of kratom is required to attain a buzz.  Individuals who smoke kratom may experience fewer side effects than oral ingestion due to the less potent effect of kratom on physiology when smoked, but will be at greater risk of experiencing smoking-related side effects such as lung irritation.  Intranasal insufflation or “snorting” of kratom is thought to yield virtually zero significant physiologic effect.  Persons who snort kratom may experience delayed swallowing of kratom such that intranasal kratom may fall into the mouth and exert a modest physiologic effect.  Other than intranasal irritation/bleeding and/or respiratory-related issues, intranasal kratom users probably won’t experience many side effects because the effect of alkaloids on physiology will be negligible.
  • Rate of ingestion: The rate at which kratom is ingested will influence its pharmacokinetics, and possibly the side effects that a person experiences. In most cases, kratom is ingested rapidly such that an individual “tosses-and-washes” kratom powder and/or swallows an encapsulation.  Among persons who prepare kratom tea and/or mix kratom in with food, rate of ingestion may be prolonged.  For example, someone may slowly eat a vat of kratom-blended yogurt over a duration of 20 minutes OR slowly sip his/her kratom tea over a duration of 30 to 60 minutes.  It’s possible that severity and/or occurrence of certain side effects changes, in a subset of persons, based on the rate of kratom ingestion.  For some individuals, a slower rate of kratom ingestion may significantly reduce side effects due to the fact that the body isn’t absorbing and/or metabolizing a large quantity of kratom all-at-once.  Hypothetically, someone might notice that side effects are less debilitating when they slowly sip kratom tea compared to rapid consumption.
  1. Individual factors

A host of individual factors may influence the specific side effects that you experience, as well as their respective severities.  Individual factors that warrant contemplation in terms of influencing kratom side effects include: body composition, co-administered substances, genetics, medical conditions, and neurochemistry.  Other individual factors such as sleep, stress, and amount of physical exercise may modulate biology in such a way that kratom side effects become more or less severe.  It is these individual-specific factors that explain why 2 individuals may administer their first dose of kratom simultaneously, at equivalent doses/strains, each on an equally-empty stomach – yet one user may report markedly different side effects than the other.

  • Age: A person’s age may influence the pharmacokinetics of kratom such that elderly individuals might exhibit markedly different absorption, metabolism, and/or distribution of kratom alkaloids compared to younger persons. In general, elderly persons are more likely to exhibit declines in organ function as compared to younger adults, which might increase risk of side effects and/or adverse reactions.  Perhaps the older a person is, the more side effects he/she will experience on kratom.  It should also be stated that teenagers who use kratom may be more at-risk of experiencing side effects due to incomplete CNS or brain development.  While it remains unclear as to whether age influences kratom side effects, it’s reasonable to hypothesize that a person’s age increases/decreases risk of certain side effects.
  • Body size/composition: A person’s body size and composition may influence side effects experienced from kratom. In general, the larger an individual [in terms of height and weight], the greater the dose of a drug he/she will find tolerable.  While this is not always the case, the physiologic effect of 10 mg kratom is likely to be more substantial in a person who’s 5-feet tall and weighs 100-lbs. than a person who’s 7-feet tall and weighs 300 lbs.  Therefore, it is reasonable to speculate that a smaller-sized individual will experience a greater number of side effects than a larger-sized individual if each receives the same dose of kratom.  That said, body composition [in terms of fat and muscle percentage] may also influence the pharmacokinetics of kratom and side effects.  In other words, someone who’s 6-feet tall at 200 lbs. with a lot of lean mass and low body fat may experience significantly different side effects than a different person who’s 6-feet tall at 200 lbs. with a lot of fat and little muscle.
  • Co-administered substances: Anyone who co-administers a substance with kratom and/or while under the influence of kratom may experience different side effects than if kratom were taken as a standalone agent. It is known that various substances (dietary supplements, medications, alcohol, illicit drugs) may affect both the pharmacokinetics and/or pharmacodynamic effects of kratom such that side effects increase or decrease in severity.  From a pharmacokinetic perspective, any co-administered substance that induces or inhibits the hepatic enzymes CYP2D6, CYP2C9, and/or CYP3A4 – may alter the metabolism of kratom alkaloids.  For example, CYP2D6 inhibitors (e.g. bupropion, fluoxetine, quinidine, et al.) may prolong the metabolism of kratom alkaloids such that duration of effect is longer and/or more substantial, possibly triggering an increased number of side effects.  Oppositely, CYP2D6 inducers (e.g. dexamethasone, glutethimide, rifampicin, et al.) may expedite the metabolism of kratom alkaloids such that duration of effect is shorter and/or side effects are less severe.  Other substances may interact with kratom’s pharmacodynamics such that they act upon similar neurotransmitter systems (e.g. opioid receptors, NMDA, adenosine).  Depending on the specific pharmacodynamics, certain drugs may directly potentiate the effect of kratom alkaloids within the brain – possibly triggering toxicity and/or an adverse reaction, whereas other drugs may antagonize the effect of kratom alkaloids – possibly reducing the effect of kratom and corresponding side effects.  Keep in mind that certain co-administered substances may not directly interact with kratom’s pharmacodynamics, but may still synergistically enhance or antagonistically offset its physiologic effect such that its side effects change.  Lastly, it should be mentioned that individuals may suspect that kratom is culpable for side effects that are more likely attributable to co-administered substances or an interaction effect.
  • Genetics: A person’s genetics/epigenetics can influence kratom side effects. Perhaps the most significant genes to consider in regards to influencing pharmacokinetic-related side effects include:  CYP2D6, CYP2C9, and CYP3A4 – each of which encode for hepatic enzymes implicated in the metabolism of kratom alkaloids.  Individuals with atypical genetic expression of CYP2D6, CYP2C9, CYP3A4, et al. will metabolize kratom alkaloids at a faster or slower rate than average whereby proneness to certain side effects may increase or decrease.  Additionally, atypical expression of genes regulating neurotransmitter systems that are influenced by kratom alkaloids may increase or decrease proneness to certain side effects.  It’s also reasonable to think that a person’s entire genome and current epigenetic expression may make them more or less susceptible to kratom-induced side effects.
  • Medical conditions: A person’s medical conditions may influence the side effects that they experience from taking kratom. In the event that you have no diagnosable medical conditions, you may be less likely to experience side effects than someone with a medical condition.  On the other hand, if you have a diagnosable medical condition, you may be at increased risk of experiencing side effects on kratom for multiple reasons.  Certain medical conditions such as hepatic dysfunction and/or renal impairment may interfere with your body’s ability to absorb, metabolize, and/or excrete kratom alkaloids, potentially triggering an adverse reaction – even with a low dose.  Other medical conditions such as gastrointestinal disorders, hypertension, hypotension, and/or neuropsychiatric disorders may be exacerbated by kratom – leading individuals with these conditions to report severe side effects.  Moreover, persons with preexisting medical conditions often treat the conditions with pharmaceutical drugs, some of which may interact with kratom to increase side effect severity/occurrence.
  • Neurochemistry: A person’s neurochemistry is largely influenced by his/her genes and environment (e.g. air quality, food intake, hydration, stress, toxins, etc.). Drug ingestion can alter neurochemistry away from genetically-mediated homeostasis, possibly for an extended duration (depending on dosing, term of administration, etc.).  A head injury such as concussion may also have a significant effect upon neurochemistry.  In any regard, baseline neurochemistry can predict how a person responds to kratom, as well as the side effects that are experienced.
  • Sleep, stress, exercise: Other lifestyle-related factors such as sleep quality/quantity, stress level, and exercise might influence the severity of kratom side effects. For example, a person who is sleep deprived may experience significantly more drowsiness after using a sedating strain of kratom than if he/she were regularly getting enough sleep.  Another example could be that a person who is highly stressed has a panic attack after ingesting a stimulating strain of kratom – due to the synergistic effect of the preexisting stress and stimulating kratom on the sympathetic nervous system.  Moreover, someone who’s exercising regularly may exhibit slightly different kratom pharmacokinetics than a person who is sedentary, ultimately experiencing altered side effect severity.
  • Sex: Whether someone is male or female may also influence the side effects they experience on kratom. It is known that, in some cases, drugs exhibit markedly different pharmacokinetics in males compared to females.  Sex-specific differences in pharmacokinetics may yield sex-specific differences in particular side effects and/or severities.  Furthermore, concentrations of specific sex hormones differ in men as compared to women, which might also influence side effects.  For example, the opioidergic effect of kratom may have a more noticeable effect on testosterone in men, which in turn, might increase likelihood of sexual dysfunction in men – as compared to women.  On the other hand, women may be more prone to a completely different kratom side effect (e.g. hot flashes) than men.  Moreover, since the average female is smaller sized than the average male, side effects of kratom may be more severe for females than males if administered at an equal dose.

Kratom: Do the therapeutic benefits outweigh the side effects?

If you’re using kratom, it may be useful to conduct a cost-benefit analysis and evaluate whether, in your experience, the degree of therapeutic benefit attained from kratom outweighs unwanted side effects that it induces.  As has been discussed, responses to kratom are subject to significant variation based on the specific user such that, in some cases, perceived therapeutic benefit will outweigh side effects, yet in other cases, side effects will outweigh therapeutic benefit.  In general, responses to kratom can be categorized as one of the following permutations:  benefit/side effects; and benefit/no side effects; no benefit (with or without side effects) – each of which is discussed below.

Benefit without side effects:  A fortunate subset of kratom users will exhibit utopian responses to kratom whereby substantial therapeutic benefit (e.g. anxiety reduction, mood enhancement, pain relief, et al.) is attained without the occurrence noticeable and/or unwanted side effects.  While it is relatively rare to experience zero noticeable side effects [at standard kratom dosages], it’s less rare to experience zero unwanted or debilitating side effects.  Assuming you’d consider yourself to be among the utopian responders (experiencing benefit without side effects), it makes logical sense to continue kratom usage – you’re reaping nothing but benefit and have no tolerability issues.  That said, some individuals may fit within the “benefit without side effects” category, yet may exhibit slightly less utopian responses such that the degree of benefit derived from kratom is marginal.  Individuals who derive just marginal benefit from kratom may be smart to discontinue on the basis that it doesn’t provide adequate benefit relative to its cost.

No benefit: A less fortunate subset of kratom users will exhibit dystopian responses to kratom whereby zero therapeutic benefit is attained – and numerous debilitating side effects occur.  While it is somewhat rare to experience zero therapeutic benefit from kratom, especially if you’ve tried multiple strains and/or dosing protocols, it can happen.  Assuming you consider yourself to be a dystopian responder (experiencing zero benefit with severe side effects), it’s a no-brainer decision to cease further kratom usage.  Another subset of individuals may experience no benefit from kratom, but also no unwanted side effects.  While experiencing no unwanted side effects is perceived as favorable, it would be illogical to continue using kratom if you’re not reaping any benefit.

Benefit plus side effects: A bulk of kratom users will experience a unique combination of therapeutic benefit(s) plus side effects.  For example, kratom may significantly reduce chronic pain (therapeutic benefit), but might also provoke nausea and constipation (side effects).  That said, among persons who experience a combination of therapeutic benefit with side effects, the degree of benefit and the significance of side effects will vary – such that a subset of persons in the “benefit plus side effects” category will be best suited for continued kratom usage, whereas others will be better suited for kratom discontinuation.

  • Major benefit / severe side effects: Persons who experience major benefit, yet simultaneously end up with severe side effects probably won’t want to continue with kratom administration. For example, if you’re getting substantial pain relief from kratom but are constantly vomiting – you probably won’t be able to justify continued usage.  Another example may be that you find kratom efficacious for your migraines, yet it induces such significant cognitive dysfunction that your occupational performance suffers to the extent that you are at risk of losing your job.
  • Major benefit / moderate side effects: Some persons who experience major benefit plus moderately-severe side effects from kratom will opt to continue administration, whereas others may discontinue. For example, a person with chronic pain may derive such marked pain relief from kratom that he/she is willing to put up with incessant nausea and weight gain as side effects.  On the other hand, someone with significant anxiety may derive a substantial anxiolytic effect from kratom, but side effects such as coordination deficits and drowsiness may impair his/her ability to safely operate a motor vehicle or participate in athletic events – leading to the decision of discontinuation.
  • Major benefit / minimal side effects: In the event that you experience major benefit from kratom with minimal side effects, there’s a good chance that you’ll want to continue usage. For example, if an individual is effectively managing his/her opiate withdrawal symptoms with kratom and/or treating opiate dependence , experiencing an occasional unwanted headache or dizziness as side effects probably won’t deter him/her from continued administration.  This permutation is as close to a utopian (all benefit with no side effects) response as it gets.
  • Moderate benefit / severe side effects: If you’re reaping moderate benefit from kratom, but are experiencing severe side effects, it’ll probably be difficult to continue with administration. Anyone who experiences truly severe side effects from kratom will likely cease further administration due to intolerability.  That said, someone who has a medical condition that is inadequately addressed with conventional pharmacology may be willing to put up with severe kratom side effects even for moderate benefit.  For example, a person with chronic pain who experiences sufficient pain relief to stay productive may be willing to deal with severe side effects.
  • Moderate benefit / moderate side effects: If a person reaps a moderate degree of benefit from kratom and side effects are of moderate severity, it may be unclear as to whether the person should continue or discontinue. On one hand, kratom is providing a noticeable degree of benefit, yet on another hand, the side effects are somewhat disconcerting.  A person experiencing moderate benefit with moderate side effects may want to reflect upon how the benefit and side effects affect occupational/academic performance, social relationships, etc.  If a moderately-severe side effect has a detrimental impact on your social relationships, you may want to stop kratom – regardless of the moderate benefit.  Oppositely, if a moderate benefit (e.g. mood enhancement) improves your social relationships, you may want to continue kratom – regardless of the moderate side effects.
  • Moderate benefit / minimal side effects: Someone who experiences moderate benefit from kratom with minimal side effects is likely to continue kratom usage. Typically, unless the cost of kratom is too high for a person’s budget, he/she will continue using if moderate benefit is attained and side effects are minimal.  Minimal side effects are often easy to manage and shouldn’t really interfere with any aspect of a person’s life.
  • Modest benefit / severe side effects: Another scenario might be that a person experiences modest benefit from kratom with severe side effects. In this scenario, it’s relatively commonsense that that smartest move is to discontinue kratom.  Hypothetically, if you were taking kratom to help with pain, barely felt any pain relief, and were vomiting after each kratom dose – you shouldn’t hesitate to cease further usage.
  • Modest benefit / moderate side effects: If you’re experiencing just modest benefit from kratom, yet are dealing with moderately-severe side effects, it’s probably smart to discontinue. In this scenario, not only are side effects interfering with aspects of your daily functioning or wellbeing, but you’re spending money on a drug that isn’t providing much benefit – ultimately a net negative or drain on your life.  Cutting ties with kratom and evaluating alternative treatments is recommended.
  • Modest benefit / minimal side effects: The combination of modest benefit and minimal side effects generally indicates that kratom isn’t having much of an effect upon physiology. This outcome may be observed among individuals who ingest extremely low doses and/or low-potency strains of kratom.  Some individuals may like the modest benefit coupled with minimal side effects – and may continue using, whereas others may perceive the modest benefit as too minimal to justify further use of kratom.

If you happen to be a person who experiences a combination of therapeutic benefit(s) plus side effects from kratom, it may be difficult to accurately gauge whether you should continue using or cease administration.  Among the most effective ways to assess whether kratom’s therapeutic effect outweighs its side effects by maintaining a daily journal.  Maintenance of a daily journal while using kratom will help you get a big picture perspective in regards to kratom’s therapeutic efficacy and/or side effects – over an extended period of time (e.g. weeks, months, years).

In daily journal entries, you may want to document things like: kratom specifics (dosage/strain), therapeutic benefits (specific benefits and degree of each benefit), and side effects (specific side effects and severity of each side effect).  You may also want to keep tabs on things like your: body weight, cognitive performance, dietary habits, and mood while using kratom.  Moreover, if you ever experience an adverse reaction and/or a side effect that requires medical attention, and a medical professional wants to know details regarding your kratom usage, you can simply share some of your journal entries rather than attempting to recall the details from memory.

In any regard, after an extended period of regular journaling, it should become somewhat obvious as to whether kratom is a good fit for your physiology.  If your day-to-day entries over a period of months/years suggest that you’re benefitting immensely from kratom and you’re able to maintain a stable dose without side effects, it should be obvious that kratom is a great fit.  Oppositely, if your day-to-day entries over a period of months/years suggest that you’re not deriving much benefit from kratom and/or are struggling with side effects or tolerance, it should be obvious that kratom is a poor fit.

Possible ways to reduce Kratom side effects

If you’re taking kratom and are experiencing side effects, you may want to consider implementing some side effect mitigation strategies.  Examples of strategies to mitigate side effects of kratom include: adjusting the dosage, switching strains, co-supplementation, and tweaking the administration specifics.  That said, before implementing any of the side effect mitigation strategies listed below, it is necessary to consult a medical professional to confirm safety and hypothesized efficacy in accordance with your medical status/history and/or medication regimen.  Moreover, it is necessary to realize that the usefulness of side effect mitigation strategies will be subject to individual variation such that some individuals will find them helpful and others won’t.

  1. Adjust dosage: One way to reduce the severity and/or number of side effects that you experience while taking kratom is to adjust the dosage. In most cases, persons who experience severe side effects would benefit from reducing the amount of kratom they take on a per-dose OR per-day basis. In other words, if you’re taking 2 grams of kratom 3 times per day and are struggling with side effects, you may want to scale back to just 1 gram of kratom 3 times per day or even 0.5 grams of kratom 3 times per day and then reassess whether side effects improve.  That said, while reducing the dosage of kratom should decrease its physiologic effect and corresponding side effects, a subset of individuals may struggle with side effects that only occur at low or moderate doses, and hence, may actually benefit from slightly increasing their kratom dosage.  For example, kratom is generally more stimulatory at low doses and may provoke an unwanted side effect such as anxiety.  However, when the dosage is slightly increased, the stimulatory effect may be overridden by an opioidergic effect such that anxiety abates.
  2. Switch strains, veins, sources: There are many different types and strains of kratom available for purchase. If you’ve tried modifying the dosage of your current strain, but are still dealing with troubling side effects, you may want to switch to another. For example, if you’ve tried Borneo kratom and experience side effects, you may want to give a few other types of kratom a try (e.g. Indo, Maeng Da, Malaysian, Thai, et al.) and determine whether your side effects improve.  Moreover, if you already tried a red vein type kratom with debilitating side effects, you may want to try a green vein or white vein; or vice-versa.  Lastly, if you’ve been purchasing kratom from one specific company or supplier, you may want to try kratom from another to determine whether the quality of your kratom is superior with a different supplier.
  3. Alter administration specifics: If you’ve tried adjusting the dosage and switched strains/veins/sourcing for your kratom, but are still experiencing some side effects, you may want to alter the specifics of your administration. Specifics of administration that might influence side effects include: timing, taking kratom with food vs. without, frequency (e.g. once per day vs. twice vs. thrice), and modality (e.g. tea, encapsulations, “toss-and-wash,” mixing with food/beverages, etc.). Assuming you’re currently taking a single large dose of kratom in the early morning on a full stomach using the “toss-and-wash” method – but are experiencing side effects, you may want to modify some of the aforestated administration variables to determine whether side effects might improve.  For example, you could divide your single large dose into 2 or 3 smaller doses administered at 4-hour intervals.  Additionally, you could try taking kratom in the afternoon/evening [instead of morning], on an empty stomach [instead of full stomach], and/or in the form of kratom tea [instead of tossing-and-washing the powder].
  4. Discontinue substances: If you’re experiencing unwanted kratom side effects, yet are administering other supplements and/or medications regularly along with kratom and/or on the same day as taking kratom, one way to minimize your side effects is to discontinue unnecessary substances. Many supplements can interact with kratom and/or potentiate its psychopharmacological action such that side effects might become debilitating. By discontinuing unnecessary substances, you eliminate potential interaction-related effects.  Keep in mind that if you’re using a pharmaceutical medication, you should not be taking kratom without a doctor’s approval.  In any regard, if you’re using substances that aren’t deemed medically-necessary by a doctor, you may realize that their discontinuation alleviates your kratom side effects.
  5. Adding substances: Another means by which kratom side effects can be reduced is through the strategic administration of additional substances. Specifically, this strategy involves making note of your most debilitating and/or troubling kratom side effects, and then administering substances that are known to attenuate them. For example, someone who experiences nausea each time he/she ingests kratom may benefit from co-administration of an antiemetic agent.  Other hypothetical examples of co-administering substances to reduce kratom side effects might include: administration of an antihistamine to mitigate itchiness; administration of a peripheral mu-opioid receptor antagonist to ameliorate constipation; or administration of a headache relief drug to manage kratom-induced headache.  That said, prior to adding any substances to your regimen for the attenuation of kratom side effects, it is recommended to consult a medical professional.  A medical professional will be best equipped to help you select substances that are both efficacious for treating particular unwanted side effect(s) and safe [such that they won’t interact with kratom nor jeopardize your health].
  6. Continue using: If you’re a relatively new kratom user and are experiencing unwanted side effects, it’s possible that some side effects are adaptation-related. In other words, because your physiology hasn’t fully adapted to the regular influence of kratom, you’re experiencing more numerous and/or severe side effects than if your physiology was adequately adapted to kratom’s effect. Examples of common adaptation-related side effects documented among users of kratom include: dizziness, headache, nausea, stomach aches, vomiting, etc.  Assuming some of your side effects are adaptation-related, continued regular administration of kratom should help your physiology adapt to its effects whereby certain side effects may diminish or cease altogether.  That said, if you’re experiencing severe adverse reactions and/or have already been using kratom for an extended duration without improvement in unwanted side effects, you may want to discontinue administration.
  7. Gradual titration: If you’re a new kratom user, another way to minimize likelihood of side effects is to start with a small dose and gradually titrate it upwards over an extended duration [as opposed to immediately ingesting moderate and/or large dose]. By initiating kratom usage with a small dose (e.g. 0.5 grams) and gradually increasing it (over a period of days and/or weeks), you give your physiology a chance to adapt to the effect kratom at a slow pace, thereby minimizing odds of severe adaptation-related side effects or adverse reactions from lack of physiologic adjustment. In some cases, persons who don’t gradually titrate their dosing experience a backlash of severe side effects due to the fact that the CNS was unequipped to tolerate the psychoactive effect of kratom.  Gradual titration is also useful for helping individuals find the “minimal effective dose” of kratom – or the lowest quantity necessary to attain therapeutic benefit.  Once you’ve identified the minimally effective dose of kratom via gradual titration, it is recommended to avoid exceeding this dose.  By sticking with the minimal effective dose, you ensure that kratom isn’t altering your physiology more than needed for benefit, which should keep side effect intensity to a minimum.

Note: If you’ve exhausted all of the aforementioned side effect mitigation strategies, yet are still experiencing unwanted or debilitating side effects from kratom, it should be obvious that kratom isn’t a good fit for your physiology – hence the recommendation to discontinue.

Have you experienced Kratom side effects?

If you’ve used and/or are currently using kratom, feel free to document any side effects and/or adverse reactions that you’ve experienced in the comments section below.  In your personal experience, which kratom side effects have you found to be most debilitating and/or problematic?  On a numeric scale ranging from 1 to 10 (with “1” being least severe and “10” being most severe), what would you rate the severity of these kratom side effects?

Have you figured out any ways to manage, treat, and/or attenuate your most troubling side effects?  To help others get a better understanding of your situation, provide some additional details such as: the average dosage of kratom you ingest (e.g. 3 grams), the vein color/strain you use and supplier (e.g. Red Maeng Da from [hypothetical] “Company K”) how frequently you use kratom (e.g. thrice daily), and your cumulative duration of usage (e.g. 3 months).  If you’re aware of your allelic expression for isoenzymes implicated in metabolism of kratom alkaloids such as CYP2D6, CYP2C9, CYP3A4 – feel free to make note of them as well and/or speculate as to how they may influence your specific kratom side effects.

Also mention whether you’re using any additional substances (e.g. alcohol, medications, supplements, illicit drugs, etc.). along with kratom or on the same days as kratom.  If you are using additional substances with kratom, have you considered that the side effects you’re attributing to kratom may be more accurately attributed to another substance OR possibly a substance-kratom interaction.  If you happen to be a regular, long-term kratom user, have you noticed any change in specific side effect occurrence and/or severity over time?

Moreover, if you’ve tried multiple types, strains, or sources from kratom – how did side effects differ from each?  Did you find that you’re able to tolerate one particular strain better than another – or were they all relatively equal?  Should you know of any helpful tactics for managing kratom side effects, be sure to share them in your comment – it might help someone else.

Lastly, realize that while kratom may be therapeutically beneficial for many, some individuals may find it intolerable.  Always listen to your body and realize that no substance, including kratom, is utopian.  If you find the side effects to be disconcerting, there’s no reason to continue using it – there are numerous pharmaceutical, supplemental, and non-pharmacologic alternatives.

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