In brief
Kratom is a psychoactive substance and its use may harm your health - that is the first sentence of the mandatory consumer information, and that is how we approach it too. This article summarises what the literature and the mandatory information say about the risks: dependence, adverse effects, dangerous combinations, driving and situations in which help is needed. It is not medical advice and does not replace a doctor; if you use kratom and have health problems, contact a doctor or the contacts listed below.
Dependence and withdrawal
The mandatory information states that long-term use of high doses may lead to dependence. The literature confirms this: regular daily users in South-East Asia and in Western surveys report tolerance (the same amount stops having the same manifestation), craving and withdrawal symptoms on cessation - irritability, restlessness, muscle aches, insomnia, sweating, runny nose, diarrhoea. The symptoms are described as milder than with classic opioids, but unpleasant and lasting several days.
That is exactly why the instructions for use include the rule not to use every day and to keep a three-day break (see Kratom dosing). If you find you cannot keep the break, that is a signal not worth ignoring - see "When to seek help".
Adverse effects described in the literature
Most often reported are nausea and vomiting, constipation, dizziness, sweating, dry mouth, itching, loss of appetite and drowsiness. Seizures, heart rhythm disorders and liver injury are described more rarely; most serious cases in the literature involved high doses, long-term use, combination with other substances or products of unknown composition (7-hydroxymitragynine concentrates, counterfeits). The mandatory information adds that the long-term effects on human health are not sufficiently described, especially for any use other than oral use of the dried plant.
Dangerous combinations
The mandatory information prohibits using kratom together with other psychoactive substances, alcohol, nicotine and medicines. The literature describes specific reasons:
- alcohol, benzodiazepines, opioids, sleeping pills - additive depressant effect on breathing and consciousness; most reported deaths associated with kratom involved combinations;
- antidepressants and other medicines metabolised by the CYP2D6 and CYP3A4 enzymes - mitragynine inhibits these enzymes and may raise drug levels and change their effect;
- stimulants including high doses of caffeine - strain on the circulatory system;
- other substances with opioid action - increased risk of respiratory depression.
If you take any medicines, the only safe course is to consult a doctor or pharmacist before using kratom at all.
Driving, work and drug tests
The mandatory information prohibits use when driving, immediately before it and less than 8 hours before driving or activities requiring attention - and you must not drive even after that time if you feel under the influence. Legally, driving under the influence of a psychoactive substance is punishable regardless of whether the substance is legally sold.
A frequent question is whether kratom "shows up in a drug test". Common screening tests for standard groups of substances do not detect mitragynine; specific laboratory methods, however, do. This changes nothing about the driving ban - it is about safety, not about the risk of detection.
Who should not use kratom at all
- persons under 18 (legal ban on sale and provision),
- pregnant and breastfeeding women,
- persons with a mental illness,
- persons with kidney, liver, heart and vascular disease,
- persons taking medicines, until they consult a doctor,
- persons with a history of dependence on opioids or other substances.
Products of unknown composition
A significant share of the serious cases in the literature concerns products whose composition was unknown: 7-OH concentrates, "extra strong" blends, powder without a lab report or batch number. That is why every product of ours has a certificate of analysis with alkaloid content, heavy metals and microbiology. We describe the forms we do not offer, and why, in Kratom capsules, tablets and 7-OH.
When to seek help
If you notice tolerance, craving or withdrawal symptoms on cessation, contact a general practitioner or an addiction outpatient clinic; a network of clinics and counselling centres is available in every region. National addiction helplines can also be used anonymously and free of charge. It is not a failure - it is the same procedure as with any other addictive substance.
Frequently asked questions
Is kratom addictive?
With long-term regular use, yes - both the mandatory information and the literature say so. Following the instructions, especially the three-day break, reduces the risk.
Can I drive after kratom?
Not earlier than 8 hours after use and never if you feel under the influence. Driving under the influence is punishable regardless of the legality of the substance.
Does kratom show up in a drug test?
Usually not in common screening tests, yes in a specific laboratory analysis. This has no effect on the driving ban.
Can I combine kratom with alcohol?
No. The mandatory information prohibits it and the literature describes an additive depressant effect on breathing.
Kratom and antidepressants?
Mitragynine affects the enzymes by which many medicines are broken down. Do not use kratom without consulting a doctor.
References
- WHO Expert Committee on Drug Dependence (2021). Pre-review report: Kratom (Mitragyna speciosa).
- Singh D. et al. (2014). Kratom dependence, withdrawal symptoms and craving in regular users. Drug and Alcohol Dependence, 139, 132-137.
- Grundmann O. (2017). Patterns of kratom use and health impact in the US - results from an online survey. Drug and Alcohol Dependence, 176, 63-70.
- Kamble S. H. et al. (2020). Pharmacokinetics of eleven kratom alkaloids following an oral dose of either traditional or commercial kratom products. Planta Medica - CYP2D6/CYP3A4 inhibition.
- Decree No. 448/2025 Coll. - mandatory consumer information for psychomodulatory substances.
