Short answer
Most regular kratom users experience at least some side effects.
Common side effects include: nausea, constipation, dry mouth, sweating, itching, sleep disruption, appetite change, mood changes, and brain fog.
Serious adverse events have been reported, including liver injury, seizures, severe sedation, dependence, withdrawal, and deaths involving kratom. Most severe reports involve higher doses, concentrated products, 7-OH products, or other substances.
Long-term safety data in humans remains limited. Most evidence comes from surveys, case reports, poison-center data, animal studies, and short-term observational work, not large long-term controlled trials.
Short-term effects
Common short-term side effects.
Commonly reported side effects include:
Nausea: Often dose-related and more common with extracts or higher doses.
Constipation: Related to mu-opioid activity.
Dry mouth: Common with regular use.
Sweating: Can occur during use or between doses.
Itching: May occur through opioid-related pathways.
Sleep changes: Some people feel stimulated and cannot sleep; others feel sedated.
Appetite changes: Some users report reduced appetite.
Brain fog: Slowed thinking, forgetfulness, or reduced concentration can occur with chronic use.
Mood changes: Some people report irritability, anxiety, or low mood, especially between doses.
Many of these improve when dose is reduced or the product is stopped.
Less common
Less common but documented side effects.
Less common but reported problems include:
- Palpitations or fast heart rate.
- Tremor.
- Confusion or disorientation.
- Severe vomiting.
- Seizures.
- Hyponatremia.
- Liver injury.
- Severe sedation.
- Worsening anxiety or panic.
- Psychotic symptoms in some case reports.
These effects are more concerning when they occur after high-dose use, concentrated extracts, 7-OH products, or combinations with other substances.
Liver
Kratom and the liver.
Kratom-related liver injury is reported in the medical literature. LiverTox describes rare acute liver injury that usually appears within 1 to 8 weeks after starting regular kratom powder or tablets. The pattern is typically cholestatic or mixed, meaning bilirubin and alkaline phosphatase may rise and jaundice can occur.
Warning symptoms include:
- Yellowing of the skin or eyes.
- Dark urine.
- Pale or clay-colored stools.
- Severe itching.
- Fatigue.
- Nausea.
- Right upper-abdominal discomfort.
Most reported cases improve after kratom is stopped. Severe cases have occurred, so jaundice or dark urine should not be watched at home.
For deeper detail, see our page on kratom and the liver.
Dependence
Dependence and withdrawal.
Kratom can cause tolerance, physical dependence, and withdrawal.
Dependence is more likely with:
- Daily use.
- Multiple doses per day.
- Higher total dose.
- Extracts or shots.
- Concentrated 7-OH products.
- Prior opioid use disorder.
- Use to self-treat withdrawal, pain, anxiety, or depression.
Withdrawal can include body aches, restless legs, sweating, chills, insomnia, anxiety, low mood, cravings, and stomach upset. Most physical symptoms improve over about a week, but sleep, mood, and cravings can last longer.
See how to quit kratom for the full timeline and quitting options.
Respiratory and overdose
Respiratory depression and overdose risk.
Kratom’s respiratory-risk profile is not identical to classical full-agonist opioids, but it should not be described as overdose-proof or respiratory-safe.
Preclinical data suggest that mitragynine and related compounds may differ from classical opioids in some signaling pathways, including beta-arrestin recruitment. That may help explain why respiratory depression is less predictable with kratom leaf than with morphine, heroin, fentanyl, or oxycodone.
But this does not prove safety in humans. Sedation, respiratory effects, seizures, and deaths have been reported, especially with:
- Concentrated 7-OH products.
- High doses.
- Alcohol.
- Benzodiazepines.
- Opioids.
- Gabapentin or pregabalin.
- Sleep medications.
- Other sedatives.
For more detail, see can you overdose on kratom.
Pregnancy
Pregnancy.
Kratom use in pregnancy has been associated with neonatal withdrawal symptoms in case reports. There is no established safe dose of kratom in pregnancy.
Pregnant patients with opioid-type dependence should speak with an obstetrician, maternal-fetal medicine clinician, or addiction medicine clinician. Buprenorphine is much better studied than kratom in pregnancy, but pregnancy treatment should be managed by clinicians who treat pregnant patients.
MyStreetHealth does not directly treat pregnant patients.
Long-term
Long-term effects: what we actually know.
The honest answer is that long-term human safety data are limited.
What appears clear:
- Some people use kratom regularly and remain functional.
- Some people develop dependence and withdrawal.
- Serious adverse events are reported but do not appear to be the typical experience of every kratom user.
- Risk is higher with extracts, 7-OH products, very high doses, and polysubstance use.
- Concentrated 7-OH products are too new for reliable long-term safety conclusions.
Long-term liver, cardiovascular, cognitive, hormonal, and psychiatric effects are not well characterized in controlled studies.
7-OH
7-OH products are a separate safety conversation.
Natural kratom leaf and concentrated 7-OH products should not be treated as the same risk category.
7-OH occurs naturally in trace amounts in the kratom plant, but FDA warnings focus on products with added or enhanced 7-OH. These may be sold as tablets, shots, drinks, gummies, or high-potency extracts. FDA has warned consumers to avoid these products because of risks including addiction, withdrawal, and serious harm.
If someone is using occasional kratom leaf, that is one conversation. If someone is using daily 7-OH tablets or shots, that is a different and higher-risk clinical situation.
What to do
What to do if you are worried.
Stop the product and seek medical advice if you have:
- Jaundice.
- Dark urine.
- Severe itching.
- Confusion.
- Severe sedation.
- Slow or shallow breathing.
- Seizure.
- Chest pain.
- Severe vomiting or dehydration.
If you are dependent, do not assume you have to quit alone. Tapering, supportive care, and medication treatment may all be options depending on the situation.
Treatment
Treatment for kratom and 7-OH dependence is available online.
MyStreetHealth treats kratom and 7-OH dependence through secure telehealth visits in Virginia, West Virginia, Maryland, Washington DC, and Ohio. Same-day visits are often available when the schedule permits. No insurance is required.
Medical note
Kratom and 7-OH products vary widely in strength, purity, labeling accuracy, and legal status. This page is educational and does not replace medical care. Seek urgent medical advice for jaundice, severe vomiting or dehydration, chest pain, confusion, fainting, seizure, severe sedation, slowed breathing, pregnancy, or use with alcohol, benzodiazepines, opioids, gabapentin, pregabalin, or other sedatives.