Kratom Drug Interactions

We know there are those of you interested in combining kratom with other herbs or with drugs (prescription or otherwise). People like to experiment with new herbs, and we understand kratom is no different; however, it does have significant physiological effects and there is a potential for harmful kratom drug interactions. We decided to write this article exploring a range of potential kratom combinations so that those of you who might be tempted to experiment can avoid dangerous kratom drug interactions. Please note that we are not doctors, and this article doesn’t constitute medical advice. We are simply educated consumers who want to teach others how to use kratom safely and respectfully and keep this wonderful herb legal!

Kratom refers to the tree Mitragyna speciosa, its leaf, or various preparations made from the leaf. The main active compounds in the leaves are mitragynine and 7-hydroxymitragynine, although kratom leaves contain up to 40 different active compounds. In Southeast Asia, kratom leaves are chewed as both a stimulant and relaxant depending on the dose. Kratom has a curious “bi-phasic” effect that changes with the dosage: at lower amounts it produces energizing effects, and at higher amounts it produces sedating effects. Different types of kratom also can be primarily energizing (such as White Vein or Maeng Da kratom) or mainly sedating (such as Red Vein Borneo kratom). Being aware of this bi-phasic effect can help one avoid harmful kratom drug interactions that might result from overstimulation or oversedation. Now we’re going to look at specific kratom combinations in more detail. (see kratom.net for source)

Kratom and Prescription Opiates:

All the information we could find says to avoid this combination completely. While kratom is not an opiate (a drug that binds to delta opioid receptors in the brain), it has some sedative properties that may synergize with those of conventional opiates in hazardous ways. For instance, combining kratom with a prescription opiate may result in oversedation and respiratory depression (dangerously slowed or stopped breathing). Because many prescription opiates are very powerful in themselves, it is also almost impossible to calculate a safe dose that would avoid this kratom drug interaction. Be on the safe side and don’t attempt it.

We also have to say a word about adulterated kratom here. More than a few people have experienced adverse drug reactions after taking products labeled as kratom that were adulterated with powerful opiates. In at least one U.S. case, a man died after unknowingly taking a herbal mixture of kratom adulterated with fentanyl, diphenhydramine, caffeine, and morphine. Fentanyl and morphine are serious opiates, while diphenhydramine is an anti-histamine with sedative properties. None of these chemicals should be combined with kratom (nor with each other)! The best way, in our opinion, to avoid unknowingly consuming an adulterated kratom product is not to buy kratom from “head shops” and other sketchy establishments that are notorious for offering subpar and possibly adulterated products. Look to independent reviews online. Research the company you’re thinking of buying from to get an idea of their reputation. Protect yourself.

Kratom and Stimulants:

It’s also generally recommended to avoid combining kratom with other stimulants—both synthetics such as amphetamine or cocaine, and herbal products such as guarana, yohimbine, or even large amounts of coffee. Combining kratom and stimulants (especially stronger ones) may result in unpleasant symptoms such as palpitations, sweating, agitation, and anxiety. These kratom drug interactions can also include more serious effects such as increased blood pressure and lowered seizure threshold. However, more experienced kratom users may combine kratom with a small amount of coffee without ill effects, after they know how kratom affects them by itself.

Kratom and Psychedelics:

Mitragynine itself is structurally similar to certain psychedelic alkaloids, although its effects manifest as stimulating and/or sedating. Though there isn’t much reliable information out there about this combination, experiences of people who have combined psychedelics and amphetamines suggest the result may be unpleasant: due to kratom’s stimulating properties, combining kratom with psychedelics has the potential to increase anxiety and mental thought loops. While probably not physically harmful, this combination could lead to mental distress and possibly harmful behavior. On the other hand, some people have experienced positive results when using kratom as a calmative during the come-down phase of a session.

Kratom and Depressants:

For the same reason that kratom and opiates don’t mix, kratom should not be combined with central nervous system (CNS) depressants such as benzodiazepines, anti-anxiety medications, or large amounts of alcohol. This would also seem to indicate that care should be taken if kratom is combined with kava, even though some kava bars do offer this combination as a beverage. The problem with combining kratom and depressants is that it could cause the same harmful kratom drug interactions as opiate combinations. While kratom alone has a ceiling that appears to limit the sedation it can cause, when combined with depressants there is potential for a syngergistic or additive oversedation, which increases the risk of respiratory depression.

Kratom and SSRIs:

SSRIs, or Selective Serotonin Reuptake Inhibitors, are a class of anti-depressants that includes Prozac. SSRIs interact with the brain’s serotonin receptors, whereas kratom interacts with the mu-opioid receptors. This is our way of saying we’re not sure if kratom drug interactions would result from this combination, but it’s probably best to take extra care with kratom if you take SSRIs. There’s not a lot of data on this combination, and all of it is anecdotal.

Kratom and Monoamine Oxidase Inhibitors (MAOIs):

Monoamine oxidase inhibitors are a class of drugs that interact with enzymes in the stomach called monoamine oxidases, which metabolize—you guessed it—monoamine compounds. People taking monoamine drugs should not combine them with any MAOIs, as well as some foods and herbs that have MAOI properties. Serious, even fatal adverse events can occur if monoamine compounds and MAOIs are combined. While we haven’t found anything in the literature about kratom drug interactions with MAOIs, kratom leaves do contain monoamine compounds. Thus, we suggest it is safer to avoid combining kratom with any drugs, foods, or herbs that have MAOI properties, including Syrian rue, Banisteriopsis caapi, passionflower, sea bean, bay bean, etc. Some foods, such as those high in the amino acid tyramine, can also act as MAOIs.

Conclusion: Is Any Combination Safe?

Much as the list above might suggest otherwise, there are a few kratom combinations that users have generally reported to be safe and pleasant. However, this list is mostly anecdotal, so you assume your own risk for any you choose to try out!

In general, users have found kratom to synergize well with a little black tea, sugar (both of which can lessen the bitter taste of kratom), and ginger powder. Ginger can be especially nice for settling the stomach if you experience nausea when taking kratom. A mild tea made from red poppy flowers (Papaver rhoeas) or blue lily (Nymphaea caerula) synergizes well with kratom’s sedating and anxiolytic effects as well. Kratom has also been safely mixed with small quantities of alcohol, as well as smoking herbs such as tobacco. However, take care not to nod off afterward and drop lit smoking materials.

Finally, if you’ve never tried kratom or are only lightly experienced with it, we recommend first working with this herb alone to discover how it affects you. Do you find kratom more stimulating, more sedating, or a mix of both? What strains of kratom agree best with you? Then, if you wish to try some kratom combinations, you’ll have a better idea of which combinations will have pleasant effects for you.