Kratom Dosage for Initial Use
Direct Recommendation
SPAQI (Society for Perioperative Assessment and Quality Improvement) explicitly recommends discontinuation of kratom and does not recommend use of this supplement at any dose. 1
Clinical Context and Safety Concerns
Regulatory and Safety Position
The FDA warns against use of kratom, and it has been placed on the US Drug Enforcement Administration's "Drugs and Chemicals of Concern" list. 1, 2
Kratom should be discontinued entirely rather than initiated, as it carries opioid- and stimulant-like properties with significant risks including withdrawal syndrome, neurologic effects including seizures, liver toxicity, and death. 1, 3, 4
Why No Safe Initial Dose Can Be Recommended
Chronic use of more than 5-15 grams per day leads to withdrawal syndrome, indicating significant addiction potential even at relatively modest doses. 1
Serious adverse effects including seizures, liver toxicity, and death have been reported, often compounded by polysubstance use and drug interactions through cytochrome P450, P-glycoprotein, and UGT enzyme modulation. 3, 4
The product lacks FDA oversight, meaning alkaloid concentrations vary widely between products, making any dosing recommendation inherently unsafe. 4, 5
Common Usage Patterns (For Information Only, Not Recommendation)
If patients disclose current use, they typically report:
1-3 grams daily consumed as powder in capsules for chronic pain, depression, or anxiety. 6
Dose-dependent effects: stimulant effects at low doses, sedative and opioid-like effects at higher doses. 6, 2
Critical Clinical Pitfalls
Patients may use kratom for opioid withdrawal self-management, creating a dangerous cycle of opioid receptor agonism without medical supervision. 3, 6
Physical and psychological dependence develops, with classic opioid withdrawal symptoms upon cessation. 3
Drug interactions are significant, particularly with medications metabolized by CYP450 enzymes, potentially causing toxicity of co-administered medications. 3
Clinical Action
Counsel patients against initiating kratom use and assist current users with cessation strategies, treating kratom dependence similarly to other opioid use disorders with appropriate medical supervision. 1, 3