Kratom drug interactions: What you shouldn’t mix with kratom

You don’t have to be a regular kratom user to experience a bad interaction when you add in another substance. Even a single dose, taken alongside something as ordinary as an antidepressant or your morning coffee, can interact in ways you wouldn’t notice right away.

There are a few specific combinations that account for nearly all of the real risk. Thankfully, each has specific guidance on what’s safe, what isn’t, and what to do about it.

Is it safe to take other medications while using kratom?

There’s no single yes-or-no answer, but there is a clear pattern: a handful of combinations are dangerous enough to avoid outright, while most others call for both caution and a conversation with your doctor.

A few pairings, though, including opioids, benzodiazepines, and alcohol, go past the point of caution. They’re risks to avoid entirely, not manage carefully.

Kratom also affects your body on its own, independent of anything else you take. For a look at the bigger picture, see our guide to kratom side effects.

Why kratom interacts with so many medications

It comes down to how your liver actually processes things.

Most medications are broken down in your liver and cleared from your system at a normal rate. Mitragynine (kratom’s own natural compound) blocks and gets in the way of that process for certain medications. When that happens, a medication won’t clear out of your body as quickly as it should, and it can build up to a higher level than your prescription was ever meant to reach.

That’s the real reason the list of affected medications is so broad; a lot of different, unrelated medications happen to share the same few routes through your liver. A clinical study confirmed this effect happens at a normal, everyday kratom dose, not just in a lab.

Kratom and opioids or other opioid-based pain medications

This combination can be especially dangerous. Kratom has opioid-like effects, and taking it with prescription or illicit opioids can increase the risk of slowed or stopped breathing and overdose.

The CDC has tracked this. Data shows that kratom-related deaths often involve other substances. In about two-thirds of cases, fentanyl or a similar opioid was also present, and prescription opioids were involved in about one in five. The risk becomes especially concerning when kratom is combined with other opioids.

Similar concerns have been documented elsewhere. In Sweden, nine deaths were associated with Krypton, a product containing kratom and the opioid O-desmethyltramadol.

If you’re concerned about your own kratom use or that of a loved one, our guide to kratom overdose explains the warning signs, risks, and when to seek help.

Kratom and benzodiazepines

Benzodiazepines were the second most common substance found alongside kratom in that same national dataset, present in about 22% of those deaths. 

Kratom and benzodiazepines both slow your breathing and dull alertness, and combining them adds those effects together. Kratom’s effect on your liver enzymes can also make a benzodiazepine stay active in your body longer than usual, which stretches out the danger window instead of shortening it.

Kratom and alcohol

Alcohol may not seem like an obvious concern, but combining it with kratom can carry additional risks.

Here’s what we know.

Kratom and alcohol both slow down your central nervous system. When taken together, they slow your breathing and heart rate more than either can alone. This combination is also very unpredictable. The effect can vary from person to person, and from drink to drink.

Alcohol has also appeared in reports of kratom-associated deaths. In the CDC dataset discussed above, alcohol was detected in about 13% of cases. That doesn’t mean alcohol caused those deaths, but it underscores how often kratom is used alongside other substances. Because kratom has stimulant-like effects at low doses, you may not feel as impaired as you actually are, which can make it easier to underestimate the risks of continuing to drink.

Kratom and antidepressants

Kratom may also interact with antidepressants, particularly medications that affect serotonin, such as SSRIs and SNRIs. Combining them could increase serotonin activity and, in rare cases, contribute to serotonin syndrome, a potentially life-threatening condition. Warning signs can include confusion, agitation, high fever, a rapid heart rate, and muscle rigidity or twitching. Treat these signs as an emergency. Don’t wait to see if it passes on its own.

In one published case, a 63-year-old man taking several medications that affect serotonin developed possible serotonin syndrome while also using kratom. His symptoms included confusion, a fever of 103.2°F, and difficulty speaking. A separate case reported gastrointestinal symptoms and mild liver injury in a person who used kratom while taking amitriptyline, a tricyclic antidepressant.

MAOIs, an older and less commonly prescribed class of antidepressants, should never be combined with kratom. The risk of serotonin syndrome is highest with this pairing.

Kratom and stimulants (including caffeine)

Most people don’t think of coffee as a risk. At low doses, though, kratom itself has stimulant-like effects. Stacking it with caffeine, energy drinks, or a prescription stimulant can add cardiovascular strain, resulting in a faster heart rate and higher blood pressure than either substance produces alone.

In one documented case, an 18-year-old athlete went into a dangerous heart rhythm during football practice after drinking an energy drink mixed with 2 grams of kratom powder. He received emergency treatment and later had a defibrillator implanted to help manage the risk of future abnormal heart rhythms. This is a single case, but it shows the danger is real. The same caution applies to prescription stimulants, and you should talk to a doctor before combining the two.

Kratom and common over-the-counter medications

Research on some of these combinations is limited, so the potential risks are based on what we know about how kratom and these medications affect the body.

• Kratom by itself has occasionally been tied to liver injury, and acetaminophen (the active ingredient in Tylenol) is already a known cause of liver damage when taken in large or frequent amounts. Given what each can do to your liver on its own, it’s worth being mindful of how much acetaminophen you’re taking if you also use kratom regularly.
• If kratom already tends to upset your stomach, adding an NSAID like ibuprofen (which can irritate your stomach on its own) could make that worse.
• Certain cough and cold medicines contain dextromethorphan, an ingredient that also affects serotonin activity. Taking one alongside kratom carries a similar potential risk of serotonin syndrome, the same concern that comes up with some antidepressants.

Kratom, 7-OH, and Suboxone® (buprenorphine-naloxone)

If you’re struggling to stop using kratom or 7-OH, treatment is available. Buprenorphine-naloxone (Suboxone®) may be one option a doctor considers to help manage withdrawal symptoms and support recovery.

Starting treatment should be guided by a healthcare professional. Your doctor will consider your kratom or 7-OH use, your symptoms, and the degree of withdrawal you’re experiencing to determine when and how to start buprenorphine. 

A QuickMD doctor can evaluate your symptoms, discuss your treatment options, and help determine an appropriate next step, often the same day you reach out. Our kratom and 7-OH treatment page explains more about treatment, while our guide to kratom withdrawal symptoms can help you understand what to expect.

What to tell your doctor if you use kratom

Telling a doctor you use kratom won’t get you in trouble. It helps them treat you safely.

Tell every doctor or dentist prescribing you a new medication that you use kratom, the same way you’d mention any other supplement. It changes how your body processes many medications, and your doctor needs that information to treat you safely, not to judge you. Mention roughly how often you use kratom and how much, since more frequent, higher-dose use has a bigger effect on how your body processes medications. Don’t stop kratom abruptly right before a procedure or a new prescription without talking to a doctor first; stopping suddenly can bring on withdrawal symptoms of its own.

A QuickMD doctor can evaluate your kratom use alongside any medication questions, without judgment, and help you find a safe path forward. If you’re looking to move toward treatment, you can start by booking a visit.

When to seek emergency help

Call 911 if you or someone you’re with has any of the following:

• Trouble breathing, or slow, shallow breaths
• Confusion, a high fever, or stiff muscles (possible serotonin syndrome)
• A fast or irregular heartbeat, chest pain, or fainting
• A seizure
• Unresponsiveness