Does Kratom have major side effects on the liver, kidneys, or coagulation systems?

Major Side Effects of Kratom on Liver, Kidneys, and Coagulation Systems

Kratom is associated with significant hepatotoxicity, including cholestatic liver injury, and should be avoided due to its potential for causing serious adverse effects on multiple organ systems. 1, 2

Liver Effects

• Kratom use has been documented to cause drug-induced liver injury (DILI), primarily presenting as cholestatic hepatitis with significant elevation of liver enzymes 2, 3
• Cases of severe jaundice with life-threatening liver failure requiring plasma exchange have been reported with kratom use 4
• Histologic examination of liver biopsies from kratom users has shown granulomatous hepatitis with prominent duct injury, sometimes mimicking anti-mitochondrial antibody-negative primary biliary cholangitis 3
• Total bilirubin levels in kratom-induced liver injury can reach extremely high levels (reported cases with values up to 28.9 mg/dL and even 70.6 mg/dL) 2, 4
• Kratom-induced liver injury may present with mixed cholestatic and hepatocellular patterns on laboratory testing 3

Kidney Effects

• Kratom use has been associated with acute kidney injury as part of multiorgan dysfunction 5
• Some cases have required hemodialysis for management of kratom-induced renal failure 5
• Similar to other medications with significant hepatic metabolism, renal function should be monitored in kratom users, especially those with pre-existing kidney disease 1

Coagulation System Effects

• While specific coagulation abnormalities are not extensively documented, kratom has been associated with multiorgan dysfunction that can affect coagulation pathways 5
• In severe cases of kratom-induced liver failure, coagulation abnormalities may develop as a consequence of impaired hepatic synthetic function 4

Other Serious Adverse Effects

• Cardiovascular effects: Kratom can cause hypertension, tachycardia, and cardiomyopathy 5
• Neurological effects: Reported complications include agitation, hallucinations, cognitive impairment, seizures, and even coma 5
• Musculoskeletal effects: Rhabdomyolysis has been reported as a less common but potentially lethal effect of kratom overdose 5
• Other reported effects include respiratory depression and sudden cardiac death 5

Clinical Implications

• The FDA and medical societies do not recommend kratom use due to its potential for causing serious adverse effects 1, 6
• Kratom is not approved for medical use in the United States 2
• Healthcare providers should specifically ask about kratom use when evaluating patients with unexplained liver injury, as patients may not volunteer this information 3
• There is no specific antidote for kratom toxicity; treatment is primarily supportive 4
• Discontinuation of kratom is the primary intervention for kratom-induced organ toxicity 2, 3

Monitoring Recommendations

• Baseline liver function tests should be obtained before starting any herbal supplement with potential hepatotoxicity 7
• Regular monitoring of liver function is advisable for kratom users, particularly in the first few weeks of use 7
• If significant elevation of liver enzymes occurs during kratom use, the supplement should be discontinued immediately 7, 2

Kratom has emerged as a concerning cause of drug-induced liver injury in the United States, with the potential for severe and even life-threatening hepatotoxicity. Given the lack of FDA approval, inadequate testing, and documented serious adverse effects, kratom should be avoided, especially in patients with pre-existing liver or kidney disease 1, 2, 6.