Does kratom cause liver toxicity?

There is emerging evidence of kratom (tea, powder, tablets) ingestion leading to liver toxicity and injury in rare cases. Kratom-induced liver injury is usually cholestatic (notable reduced/stopped bile flow) or mixed – a combination of cholestatic and hepatocellular (notable death and inflammation of liver cells). People often recover from this liver injury after stopping kratom use and receiving emergency supportive treatment. Corticosteroids, sometimes in combination with N-acetylcysteine (which is also used to treat other drug-induced liver toxicities), have been given for kratom-induced hepatotoxicity, but there is no evidence that these agents actually improve recovery. In previous cases, it took anywhere from 1 to 8 weeks for symptoms of liver injury to start showing (e.g. fatigue, nausea, itching, dark urine, jaundice).^[1] In a more recent case series of 11 people (mostly male, ages 25–70), severe liver injury symptoms that required hospitalization started showing after 5 to 28 days of kratom use. In 3 of those 11 cases, the kratom product was available for analysis and was found to contain 0.8–2.0 mg of mitragynine per gram.^[2] LiverTox a website that provides information related to liver injury rates Kratom as a likely cause of clinically apparent liver injury, although cases are rare.^[1] More research is needed to determine whether certain doses, usage patterns, concomitant substance use, or preexisting conditions predispose a person to developing liver toxicity with kratom.