In Malaysia, mitragynine (the most abundant psychoactive alkaloid of kratom extracts) has been included in the Dangerous Poison Act 1953 since 2003. Following reports about the addictive potential and various possible toxicities associated with kratom use, several countries have categorized kratom as a controlled substance. However, these products’ psychoactive content is unknown.
Unlike in Southeast Asia, where fresh kratom leaves are used to produce kratom decoctions (kratom tea or juice), kratom in the West is largely ingested as a dried leaf powder ( Hassan et al., 2013 Singh et al., 2016 Leong Bin Abdullah et al., 2020 Domnic et al., 2021).Ī wide variety of kratom products are currently sold online in the form of resin, dried leaves, or raw leaf extracts. Kratom has also been used in the West for its dose-dependent stimulant and sedative-like psychoactive effects. For the past decade, kratom has become popular in the West (the United States and Europe), where it is mainly used for its broad antidepressant, anxiolytic, and analgesic properties as a safe substitute for prescription drugs and for illicit opioid or heroin use. Moreover, the plant has also been traditionally used in these areas as an aphrodisiac. This traditional use has relied on kratom to symptomatically relieve muscle pain, cough, fever, and diabetes mellitus. Its leaves are dark green in color and oval in shape, and they have been traditionally consumed by rural inhabitants of Southern Thailand and Northern Peninsular Malaysia for centuries. Mitragyna speciosa (Korth.) or kratom is an indigenous medicinal plant in the Rubiaceae family that can be widely found in its natural habitat of Southeast Asia, particularly in Thailand, Malaysia, and Indonesia. Given the available data, we deduced that all cardiac eventualities reported in the literature could have been compounded by polysubstance use and unresolved underlying medical illnesses.Ĭonclusion: Although kratom use has been associated with death and cardiotoxicity, especially at higher doses and when associated with other psychoactive drugs, the dearth of data and methodological limitations reported in existing studies do not allow a definitive conclusion, and further studies are still necessary to address this issue. Meanwhile, coroner and autopsy reports indicated that kratom’s cardiovascular sequelae encompass coronary atherosclerosis, myocardial infarction, hypertensive cardiovascular disease, left ventricular hypertrophy, cardiac arrhythmia, cardiomegaly, cardiomyopathy, focal band necrosis in the myocardium, and myocarditis. Similarly, analyses of national poison data showed that kratom’s most common adverse acute cardiovascular effects include tachycardia and hypertension. A few case reports also highlighted that kratom consumption is associated with ventricular arrhythmia and cardiopulmonary arrest, but this association could have ensued when kratom was co-administered with another substance. However, this latter study did show that regular kratom use could induce an increased QTc interval in a dose-dependent manner. Results: Our findings revealed that, although in vitro studies have found kratom preparations’ most abundant alkaloid- mitragynine-to cause a prolonged QTc interval and an increased risk of torsades de pointes, a clinical study examining humans’ regular consumption of kratom did not report such a risk. We then analyzed the literature’s discussion of adverse cardiovascular effects, toxicity, and mortality related to kratom use. Methods: An electronic search was conducted to identify all research articles published in English from 1950 to 2021 using the major research databases, such as Google Scholar, Web of Science, PubMed, Scopus, Mendeley, EMBASE, Cochrane Library, and Medline. Accordingly, the current narrative review aimed to provide a detailed account of kratom’s adverse cardiovascular effects and cardiotoxicity risk, based on in vitro studies, poison center reports, coroner and autopsy reports, clinical case reports, and clinical studies. Despite its potential therapeutic value, kratom use has been linked to many occurrences of multiorgan toxicity and cardiotoxicity. Background: Kratom or Mitragyna speciosa (Korth.) has received overwhelming attention recently due to its alleged pain-relieving effects.
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