Liver Injury Associated With Kratom ( Mitragyna speciosa ): A Systematic Review.
Xavier Alexander Calicdan, Anika Kopczynski, Edwin Medina et al.
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In 30 seconds
This PRISMA 2020 systematic review examined published evidence on kratom (Mitragyna speciosa) use and liver toxicity. It included 31 studies describing 32 cases of kratom-associated liver injury, most from single-patient reports. Injury was temporally associated with kratom use and commonly involved jaundice and elevated liver enzymes, with predominantly cholestatic patterns. Liver enzymes and function improved after kratom cessation in most cases; in 4 cases, liver function failed to improve and progressed to transplantation. Exposure details and formal causality assessments were often incomplete, limiting interpretation.
Key findings
- The review included 31 studies comprising 32 cases of kratom-associated liver injury.
- Liver injury was predominantly cholestatic and commonly presented with jaundice and elevated liver enzymes.
- In most cases, liver enzymes and function improved after kratom cessation.
- In 4 cases, liver function did not improve and progressed to liver transplantation.
Why it matters
The reports indicate that kratom use may be associated with clinically significant liver injury, including cases progressing to transplantation. Because kratom is used for pain, anxiety, and opioid withdrawal, awareness of this potential adverse effect may inform assessment of liver injury and exposure history. The evidence remains difficult to interpret because reports often lacked complete exposure details and consistent causality assessment.
What to keep in mind
Evidence was largely based on single-patient case reports; kratom dose, form, frequency, and duration were inconsistently reported, and formal causality assessments varied.