Kratom Drug Interactions: What Not to Mix

Kratom doesn't mix safely with drugs that slow your breathing or your brain. That includes alcohol, benzodiazepines like Xanax, and opioids. It can also change how your body handles some prescriptions.

Kratom isn't FDA-approved for any use, and no one has tested most of these combinations in careful studies. What we know comes from death reports, case reports and a few lab and clinical studies. For the basics, start with our overview: what is kratom.

Kratom and alcohol

Mixing kratom and alcohol isn't safe. Both slow down your central nervous system. Together they add sedation and raise the risk that your breathing slows too much.

The DEA calls taking kratom alkaloids with a central nervous system depressant a serious concern. No controlled study has tested kratom with alcohol, so there's no amount known to be safe.

Most kratom deaths involve more than one substance. Of 233 kratom-related deaths reported to US poison centers from 2015 to 2025, 184 (79%) involved other substances too.

Kratom has also been linked to liver injury, though cases are uncommon. If you drink and use kratom, tell a doctor about both, especially if you've had liver problems.

Kratom and Suboxone

Taking kratom on Suboxone isn't a safe mix to try on your own. Suboxone contains buprenorphine, an opioid medicine. Kratom's main compounds, mitragynine and 7-OH, act on the same mu-opioid receptors. Stacking them adds opioid effects, including sedation.

The bigger risk comes when someone starts Suboxone. Starting buprenorphine too soon after kratom or 7-OH can cause precipitated withdrawal: withdrawal that comes on suddenly and hard. It has been reported with concentrated 7-OH products.

Concentrated 7-OH products carry another risk: you may not know what's in them. DEA testing found 7-OH samples that also contained opioids such as fentanyl, benzodiazepines such as bromazolam, and ketamine. So a 7-OH product can bring its own interactions, on top of anything you take with it.

Licensed doctors who start buprenorphine after kratom usually wait until moderate withdrawal has begun, or use a low-dose start. In a 9-patient series of people who used 7-OH, a telehealth clinic used low-dose and standard starts. None had precipitated withdrawal.

Buprenorphine is FDA-approved for opioid use disorder, not for kratom. Doctors use it off-label for kratom dependence, and the evidence so far is case reports and small case series. Read more about medications for kratom withdrawal.

If you take Suboxone and use kratom, tell the doctor who prescribes it. Don't change your dose on your own.

Kratom and benzodiazepines (Xanax)

Kratom and benzodiazepines like Xanax (alprazolam) are a risky mix. Both cause sedation, and together they can slow breathing.

Benzodiazepines come up often in kratom deaths. In CDC data on 152 overdose deaths with kratom detected (2016 to 2017), 22.4% also involved benzodiazepines. Only 7 of the 152 had kratom alone detected.

Kratom can also raise blood levels of some medicines. In a clinical study, 2 g of kratom tea raised levels of midazolam, a benzodiazepine, by about 1.4 times. Midazolam is broken down by the CYP3A enzyme, so other drugs broken down the same way may be affected too. Ask a pharmacist whether yours is one of them.

Kratom and stimulants (Adderall)

There are no studies of kratom with Adderall. A 2026 review warns about mixing kratom with amphetamines or other stimulants. Mixing them may raise the risk of a seizure or a psychotic episode in people with a seizure disorder or psychotic illness. The reports involve several substances, so kratom's exact role isn't clear.

Kratom can speed up your heart too. In a study of 200 adults, those who used kratom regularly had higher odds of a fast heart rhythm called sinus tachycardia. If you take a stimulant for ADHD, ask the licensed doctor who prescribes it before you use kratom.

Kratom and antidepressants

Data on kratom with antidepressants like Prozac (fluoxetine) are thin. Reviews raise serotonin syndrome as a concern, but no controlled study has tested it.

In lab studies, mitragynine blocks CYP2D6, a liver enzyme that breaks down many medicines. A study in people found no effect on CYP2D6 after a single dose (see the FAQ on cough medicine below). If you take an antidepressant, check with your prescriber before using kratom.

Kratom before surgery or anesthesia

No study has looked at kratom and anesthesia. Tell your surgeon and anesthesia team that you use kratom, how much and how often.

That lets them plan for sedation, pain control and withdrawal. Stopping regular kratom use suddenly can cause kratom withdrawal, so make a plan for the days around surgery with a licensed doctor.

Warning signs

Kratom overdose can look like opioid overdose. Call 911 if someone:

• Can't be woken up or won't respond

• Has slow or stopped breathing, or trouble breathing

• Has blue lips

• Has a seizure

• Has chest pain or faints

If you have naloxone (Narcan), give it, and still call 911. In one reported case, naloxone reversed a kratom overdose, and doctors advised watching the person for 24 hours afterward in case symptoms came back.

Other signs of too much 7-OH include nausea, vomiting, agitation, confusion, sweating, a fast heart rate and high blood pressure. For a possible poisoning, call Poison Control at 1-800-222-1222 or 911.

Learn more about can you overdose on kratom.

Getting help

Doctronic doesn't treat addiction and doesn't run detox. Doctronic's medical AI chat is free and can go through what you take. A video visit with a licensed doctor is $39. The doctor can help with symptoms and refer you to addiction care.

For free, confidential referrals to addiction care, call the SAMHSA National Helpline at 1-800-662-4357 (TTY 1-800-487-4889). It's open 24 hours a day, 365 days a year.

Frequently Asked Questions

Can I take kratom with naltrexone?

No, not without your prescriber. Naltrexone blocks opioid receptors, and precipitated withdrawal has been reported in someone who used kratom and then took it. Tell the doctor who prescribes naltrexone that you use kratom.

Does kratom affect cough medicine with dextromethorphan?

Probably not much after a single dose. In a study of 12 adults, one 2 g dose of kratom tea didn't change how the body handled dextromethorphan. That's despite lab results showing mitragynine blocks the enzyme that breaks it down. Regular or larger doses haven't been tested.

Can I take kratom with a sleep aid?

It isn't a safe mix to try without asking a doctor. Sleep aids work by making you drowsy, and kratom adds to that sedation. Ask a pharmacist or licensed doctor about your specific sleep aid.

Can I take kratom with ketamine?

No, it isn't safe to try. Both can cause sedation, and no study has tested the combination. Ketamine has also turned up in 7-OH products, so you could take both without knowing it.

Should I tell my doctor I use kratom?

Yes. A doctor can only check for interactions if they know what you take. Say how much kratom you use, how often, and whether it's leaf, extract or a 7-OH product.

The Bottom Line

If you use kratom, list it with your other medicines whenever you see a doctor or pharmacist. Call 911 for slow breathing, a seizure or someone who won't wake up.