Kratom and Your Liver: Unpacking the Hidden Risks
Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia whose leaves contain compounds that can have mind-altering effects. As kratom use has increased in the United States and other Western countries, so have concerns about its safety, particularly its potential impact on liver health.
Kratom 101: The Tropical Leaf with a Complex Profile
Kratom contains numerous compounds, with mitragynine and 7-hydroxymitragynine being the primary active alkaloids. These substances interact with opioid receptors in the brain, producing stimulant effects at low doses and sedative, pain-relieving effects at higher doses.
People use kratom for various reasons, including:
-
Managing chronic pain
-
Treating opioid withdrawal symptoms
-
Recreational purposes
-
Self-treatment of anxiety or depression
-
Energy enhancement
Kratom is typically consumed as a pill, capsule, or extract, or brewed as a tea. It is not currently approved by the FDA for any medical use, and its legal status varies widely across different states and countries.
Liver Under Attack? What Science Reveals About Kratom
Clinical Research Findings
The scientific evidence regarding kratom's effect on the liver is still emerging, but several important studies have documented cases of liver injury associated with kratom use.
Dr. Victor Navarro, a leading hepatologist who has studied drug-induced liver injury, notes: "We've observed a significant increase in cases of kratom-associated liver injury in recent years. The pattern of injury typically shows features of cholestasis, sometimes with hepatocellular elements."
A 2022 systematic review published in The American Journal of Gastroenterology analyzed 53 cases of kratom-associated liver injury. The majority of these cases (approximately 80%) exhibited a cholestatic pattern of liver injury. Notably, 5.6% of the cases progressed to liver transplantation, and 9.4% experienced acute renal injury, with some requiring hemodialysis. These findings underscore the potential severity of kratom-induced hepatotoxicity and the need for heightened clinical awareness.
These findings stress the importance of monitoring liver health if using kratom.
Case Reports That Raise Alarms
Multiple case reports in medical literature document instances of liver injury following kratom consumption:
-
A 2021 case series in the Journal of Hepatology described eight patients who developed jaundice and elevated liver enzymes after using kratom products
-
A report in ACG Case Reports Journal detailed acute liver failure requiring transplantation evaluation in a previously healthy individual with no history of liver disease who consumed kratom tea
-
Several cases documented in the American Journal of Medicine showed resolution of liver injury after discontinuation of kratom use
For insights into recovery, see signs your liver is healing.
How Kratom Might Damage Your Liver
Several mechanisms may explain how kratom could cause liver injury:
-
Direct toxicity: Some alkaloids in kratom may directly damage liver cells
-
Metabolic idiosyncrasy: Individual genetic variations may affect how the liver processes kratom compounds
-
Immune-mediated reaction: Some cases suggest an adaptive immune response similar to other drug-induced liver injuries
-
Contaminants and adulterants: Kratom products may contain heavy metals, bacteria, or other substances that could harm the liver
Additionally, variable potency and lack of standardization in commercial kratom products make it difficult to establish safe dosing guidelines.
To support detoxification, explore science-backed liver detox strategies.
Who's Most at Risk?
Research suggests certain factors may increase the risk of developing liver problems from kratom:
-
Pre-existing liver conditions: Those with hepatitis, fatty liver disease, or cirrhosis may be more vulnerable
-
Medication interactions: Kratom may interact with medications that are processed by the liver
-
Dosage and duration: Higher doses and long-term use appear to increase risk
-
Product quality: Contaminated or adulterated products may pose greater risks
-
Alcohol use: Combining kratom with alcohol may compound liver stress
Combining kratom with alcohol can multiply liver strain—learn how alcohol affects the liver.
Red Flags You Shouldn't Ignore
Liver damage from kratom typically develops within 1-8 weeks of starting use. Signs and symptoms may include:
-
Jaundice: Yellowing of the skin or whites of the eyes
-
Itching: Often widespread and severe
-
Dark urine: Darker than usual urine color
-
Light-colored stools: Clay or pale-colored bowel movements
-
Abdominal pain: Particularly in the upper right quadrant
-
Fatigue: Unexplained tiredness that doesn't improve with rest
-
Nausea or vomiting: Persistent digestive symptoms
Understand these symptoms better with this guide to liver pain.
How Doctors Detect Liver Damage
If kratom-related liver injury is suspected, healthcare providers may recommend:
-
Liver function tests: Including ALT, AST, alkaline phosphatase, and bilirubin levels
-
Complete blood count: To check for signs of infection or inflammation
-
Hepatitis panel: To rule out viral causes of liver inflammation
-
Imaging studies: Ultrasound, CT, or MRI to examine liver structure
-
Liver biopsy: In some cases, to determine the pattern and extent of damage
Importantly, patients should disclose all supplement and kratom use to their healthcare providers. Many cases of kratom-related liver injury are initially misdiagnosed because patients don't mention kratom use or providers don't specifically ask about it.
Can Your Liver Heal After Kratom Damage?
The good news is that most cases of kratom-associated liver injury resolve after discontinuation of use. A 2020 follow-up study of 25 patients with kratom-induced liver injury found:
-
Recovery time: Most patients showed normalization of liver tests within 2-8 weeks after stopping kratom
-
Complete recovery: Over 90% of patients fully recovered without long-term liver damage
-
Recurrence: Reintroduction of kratom led to recurrent liver injury in several documented cases
However, in rare severe cases, kratom use has been associated with acute liver failure requiring liver transplantation.
In severe instances, liver transplantation may be required. Here’s what to know about eligibility for a liver transplant.
Using Kratom? Smart Strategies to Protect Your Liver
For those who choose to use kratom despite potential risks:
-
Consult healthcare providers: Discuss kratom use with your doctor, especially if you have pre-existing conditions
-
Regular monitoring: Consider periodic liver function tests if you use kratom regularly. E.g - Use at-home liver tests to track health
-
Quality sourcing: If using kratom, choose products that have been independently tested for contaminants
-
Avoid mixing: Don't combine kratom with alcohol or medications that affect liver function
-
Know the warning signs: Seek immediate medical attention if you develop symptoms of liver problems
-
Consider alternatives: Discuss FDA-approved options for pain management or other conditions with your healthcare provider
-
Support your liver: Consider vitamins for liver repair and reduce salt intake
Special Cases Requiring Extra Caution
Already Struggling: Kratom with Pre-existing Liver Disease
Those with pre-existing liver disease should exercise extreme caution with kratom. The compromised liver may have difficulty processing kratom's active compounds, potentially leading to:
-
More severe reactions
-
Faster development of symptoms
-
Prolonged recovery time
-
Greater risk of liver failure
Dangerous Combinations: When Medications and Kratom Collide
Kratom may interact with many medications by affecting liver enzymes that metabolize drugs. This can lead to:
-
Increased or decreased drug levels
-
Enhanced side effects
-
Reduced effectiveness of medications
-
Greater liver stress from processing multiple compounds
The Legal Gray Zone of Kratom
Currently, kratom exists in a regulatory gray area:
-
Not approved by the FDA for any medical use
-
Classified as a "drug of concern" by the DEA
-
Legal status varies by state and country
-
Not subject to consistent quality control standards
The FDA has issued multiple warnings about kratom, including specific concerns about liver injury. The agency continues to review evidence regarding kratom's safety profile.
The Bottom Line
The link between kratom use and liver damage is becoming increasingly evident, but not everyone who uses kratom will experience liver issues. Still, understanding the risk is essential.
Factors like your health history, how much and how long you use kratom, and the type of product all play a role. While more research is needed, doctors and researchers, including those at the NIH, are urging caution as evidence of kratom-related liver injury grows.
If you're using kratom and notice symptoms like fatigue, jaundice, or dark urine, stop using it and seek medical attention right away. Early action can make a big difference.
Healthcare providers are also being encouraged to ask about kratom use when evaluating liver problems, even if patients don’t mention it first. Awareness can lead to quicker diagnosis and better outcomes.
Monitor your symptoms, consider safer alternatives, and use tools like at-home liver health testing to stay proactive.
Worried about how kratom might be affecting your liver? Ribbon Checkup's at-home liver health test can help you monitor key liver function markers between doctor visits—giving you peace of mind and early insights.
Related Resources
-
How To Monitor Liver Health with At Home Test?
A guide to using at-home tools for early liver issue detection and ongoing monitoring.
-
Signs Your Liver Is Healing: What to Expect and How to Support Recovery
Learn the key signs of liver recovery and supportive lifestyle tips post-kratom use.
-
Can High Liver Enzymes Be Dangerous?
Explore the implications of elevated liver enzymes and how to manage them safely.
References
Ahmad, J., Odin, J. A., Hayashi, P. H., Fontana, R. J., Conjeevaram, H., Avula, B., … Navarro, V. J. (2021). Liver injury associated with kratom, a popular opioid-like product: Experience from the U.S. drug induced liver injury network and a review of the literature. Drug and Alcohol Dependence, 218, 108426. https://doi.org/10.1016/j.drugalcdep.2020.108426
Ahmad, J., Odin, J. A., Hayashi, P. H., Fontana, R. J., Hari Conjeevaram, Bharathi Avula, … Navarro, V. J. (2020). Liver injury associated with kratom, a popular opioid-like product: Experience from the U.S. drug induced liver injury network and a review of the literature. Drug and Alcohol Dependence, 218, 108426–108426. https://doi.org/10.1016/j.drugalcdep.2020.108426
Botejue, M., Walia, G., Shahin, O., Sharma, J., & Zackria, R. (2021). Kratom-Induced Liver Injury: A Case Series and Clinical Implications. Cureus. https://doi.org/10.7759/cureus.14679
Jentsch, M. J., & Pippin, M. M. (2023, August 28). Kratom. Retrieved May 19, 2025, from Nih.gov website: https://www.ncbi.nlm.nih.gov/books/NBK585120/
Khan, M. Z., Saleh, M. A., Alkhayyat, M., Roberts, D. E., & Lindenmeyer, C. C. (2021). Multiorgan Dysfunction Related to Kratom Ingestion. ACG Case Reports Journal, 8(8), e00647. https://doi.org/10.14309/crj.0000000000000647
Kratom. (2020, April 3). Retrieved May 19, 2025, from Nih.gov website: https://www.ncbi.nlm.nih.gov/books/NBK548231/
Kratom: Botanical with opiate-like effects increasingly blamed for liver injury | MDedge. (2018). Retrieved May 19, 2025, from Mdedge.com website: https://www.mdedge.com/familymedicine/article/212164/gastroenterology/kratom-botanical-opiate-effects-increasingly-blamed
Kratom: Unsafe and ineffective. (2025). Retrieved May 19, 2025, from Mayo Clinic website: https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/kratom/art-20402171
Office. (2024). FDA and Kratom. Retrieved May 19, 2025, from U.S. Food and Drug Administration website: https://www.fda.gov/news-events/public-health-focus/fda-and-kratom
