DRUGS AND SUPPLEMENTS

Kratom (Mitragyna speciosa)

March 22, 2017

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Kratom (Mitragyna speciosa)

Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • 7-Hydroxymitragynine, 9-O-demethyl paynantheine, 9-O-demethyl-16-carboxy paynantheine, 9-O-demethyl-17-carboxy-16,17-dihydro paynantheine, 9,17-O-bisdemethyl paynantheine, 9,17-O-bisdemethyl-16,17-dihydro paynantheine, 16-carboxy paynantheine, 17-O-demethyl paynantheine, 17-O-demethyl-16,17-dihydro paynantheine, 17-carboxy-16,17-dihydro paynantheine, biak, biak biak, isopaynantheine, ithang, kakuam, ketum, krathom, kratom, krypton, Mitragyna speciosa, Mitragyna speciosa Korth., mitraciliatine, mitragynine, mitraphylline, paynantheine, Rubiaceae (family), speciociliatine, speciogynine, thang, thom.

  • Combination product examples: Krypton (kratom, O-desmethyltramadol).

  • Note: The cultivation, sale, and possession of Mitragyna speciosa are illegal in some countries. Unintentional death has occurred following ingestion of krypton, a combination preparation containing Mitragyna speciosa and O-desmethyltramadol.

Background

  • Mitragyna speciosa is a tree found in Southeast Asia. It acts on the central nervous system, affects brain function, is known to have pain-relieving, mood-enhancing, and cough-reducing effects, and has been used as an opium substitute.

  • It is also called kratom and has been identified as an herb of recreational drug abuse. People who use it over the long term may develop an addiction and symptoms of withdrawal when they stop using it. Many countries and states have passed laws to make Mitragyna speciosa illegal, but people may still easily obtain it over the Internet. Unintentional death has occurred following use of krypton, a combination product containing Mitragyna speciosa and O-desmethyltramadol.

  • There is not enough evidence to support the medical use of Mitragyna speciosa.

Scientific Evidence

Uses

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Grade*

No available studies qualify for inclusion in the evidence table.

*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Anxiety, attention deficit disorder, calming, chronic pain, cough, depression, diarrhea, drug addiction, drug withdrawal, increases energy, mood, narcotic (euphoric), pain relief, sexual performance.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

  • Mitragyna speciosa is currently used as an herbal drug of abuse. The leaves of Mitragyna speciosa have been chewed, smoked, or made into a tea.

  • Growing, selling, and owning Mitragyna speciosa is illegal in some countries. Unintentional death has occurred after taking a combination preparation containing Mitragyna speciosa and O-desmethyltramadol.

Children (under 18 years old)

  • There is no proven safe or effective dose for Mitragyna speciosa in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in people who are allergic or sensitive to Mitragyna species, their parts, or members of the Rubiaceae family.

Side Effects and Warnings

  • Mitragyna speciosa is illegal in some countries, and there is not enough evidence to support its medical use in humans.

  • Mitragyna speciosa may cause addiction, anorexia, changes in urination, coma, seizures or seizure-like activity, weight loss, and withdrawal symptoms.

  • Use cautiously in everyone in general, due to a lack of safety information.

  • Use cautiously in people who have liver disorders and thyroid disorders. Mitragyna speciosa may cause liver and thyroid problems.

  • Use cautiously in people who have stomach problems. Mitragyna speciosa may cause black feces, constipation, dry mouth, nausea, poisoning, and vomiting.

  • Mitragyna speciosa may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

  • Avoid using in people who have disorders of the nervous system or are taking agents that may affect the nervous system. Mitragyna speciosa may affect brain function.

  • Avoid using krypton, a combination product containing Mitragyna speciosa and O-desmethyltramadol, due to reports of unintentional death.

  • Mitragyna speciosa may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery. Avoid using with alcohol, benzodiazepines, opioids, opium-containing agents, or sedatives, due to potential oversedation or breathing problems.

  • Avoid using with caffeine, caffeine-containing agents, cocaine, stimulants, yohimbine, or related agents, due to potential overstimulation or increased blood pressure.

  • Avoid using with monoamine oxidase inhibitors (MAOIs), such as Syrian rue (Peganum harmala), ayahuasca (Banisteriopsis caapi), and passionflower (Passiflora incarnata), or certain other antidepressants, due to potentially serious reactions.

  • Avoid using in large doses.

  • Avoid in children and in pregnant or breastfeeding women, due to a lack of available evidence.

  • Avoid in people who are allergic or sensitive to Mitragyna species, their parts, or members of the Rubiaceae family.

Pregnancy and Breastfeeding

  • There is currently a lack of scientific evidence on the use of Mitragyna speciosa during pregnancy or breastfeeding.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

  • Mitragyna speciosa may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

  • Mitragyna speciosa may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.

  • Mitragyna speciosa may also interact with agents that may affect the nervous system, agents that may affect the liver, agents that may promote urination, agents that may treat stomach disorders, caffeine-containing agents, cocaine, monoamine oxidase inhibitors (MAOIs), opioids, pain relievers, stimulants, thyroid hormones, weight loss agents, and yohimbine.

Interactions with Herbs and Dietary Supplements

  • Mitragyna speciosa may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

  • Mitragyna speciosa may increase the amount of drowsiness caused by some herbs or supplements.

  • Mitragyna speciosa may also interact with ayahuasca (Banisteriopsis caapi), coca (Erythroxylum coca), herbs and supplements that may affect the nervous system, herbs and supplements that may affect the thyroid, herbs and supplements that may affect the liver, herbs and supplements that may contain caffeine, herbs and supplements that may increase urination, herbs and supplements that may treat stomach problems, monoamine oxidase inhibitors (MAOIs), opium poppy (Papaver somniferum), pain relievers, passionflower (Passiflora incarnata), stimulants, Syrian rue (Peganum harmala), weight loss herbs and supplements, and yohimbe.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Adkins, JE, Boyer, EW, and McCurdy, CR. Mitragyna speciosa, a psychoactive tree from Southeast Asia with opioid activity. Curr.Top.Med.Chem. 2011;11(9):1165-1175. View Abstract

  2. Arndt, T, Claussen, U, Gussregen, B, et al. Kratom alkaloids and O-desmethyltramadol in urine of a "Krypton" herbal mixture consumer. Forensic Sci.Int. 5-20-2011;208(1-3):47-52. View Abstract

  3. Holler, JM, Vorce, SP, McDonough-Bender, PC, et al. A drug toxicity death involving propylhexedrine and mitragynine. J.Anal.Toxicol. 2011;35(1):54-59. View Abstract

  4. Kapp, FG, Maurer, HH, Auwarter, V, et al. Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa). J.Med.Toxicol. 2011;7(3):227-231. View Abstract

  5. Kong, WM, Chik, Z, Ramachandra, M, et al. Evaluation of the effects of Mitragyna speciosa alkaloid extract on cytochrome P450 enzymes using a high throughput assay. Molecules. 2011;16(9):7344-7356. View Abstract

  6. Kronstrand, R, Roman, M, Thelander, G, et al. Unintentional fatal intoxications with mitragynine and O-desmethyltramadol from the herbal blend Krypton. J.Anal.Toxicol. 2011;35(4):242-247. View Abstract

  7. McWhirter, L and Morris, S. A case report of inpatient detoxification after kratom (Mitragyna speciosa) dependence. Eur.Addict.Res. 2010;16(4):229-231. View Abstract

  8. Philipp, AA, Meyer, MR, Wissenbach, DK, et al. Monitoring of kratom or Krypton intake in urine using GC-MS in clinical and forensic toxicology. Anal.Bioanal.Chem. 2011;400(1):127-135. View Abstract

  9. Philipp, AA, Wissenbach, DK, Weber, AA, et al. Metabolism studies of the Kratom alkaloids mitraciliatine and isopaynantheine, diastereomers of the main alkaloids mitragynine and paynantheine, in rat and human urine using liquid chromatography-linear ion trap-mass spectrometry. J.Chromatogr.B Analyt.Technol.Biomed.Life Sci. 5-1-2011;879(15-16):1049-1055. View Abstract

  10. Philipp, AA, Wissenbach, DK, Weber, AA, et al. Metabolism studies of the Kratom alkaloid speciociliatine, a diastereomer of the main alkaloid mitragynine, in rat and human urine using liquid chromatography-linear ion trap mass spectrometry. Anal.Bioanal.Chem. 2011;399(8):2747-2753. View Abstract

  11. Rosenbaum, CD, Carreiro, SP, and Babu, KM. Here today, gone tomorrow...and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J.Med.Toxicol. 2012;8(1):15-32. View Abstract

  12. Schmidt, MM, Sharma, A, Schifano, F, et al. "Legal highs" on the net-Evaluation of UK-based Websites, products and product information. Forensic Sci.Int. 3-20-2011;206(1-3):92-97. View Abstract

  13. Sheleg, SV and Collins, GB. A coincidence of addiction to "Kratom" and severe primary hypothyroidism. J.Addict.Med. 2011;5(4):300-301. View Abstract

  14. Vicknasingam, B, Narayanan, S, Beng, GT, et al. The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy. Int.J.Drug Policy 2010;21(4):283-288. View Abstract

  15. Ward, J, Rosenbaum, C, Hernon, C, et al. Herbal medicines for the management of opioid addiction: safe and effective alternatives to conventional pharmacotherapy? CNS.Drugs 12-1-2011;25(12):999-1007. View Abstract

Copyright © 2013 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

Updated:  

March 22, 2017