Kratom acts as a mild stimulant in small amounts and a calming pain reliever in larger ones. It reliably eases pain and helps many step away from stronger opioids, with hints of better mood, cholesterol, and weight. Against this sit dependence, digestive problems, occasional liver injury, and heart effects — best used as a time-limited tool. (Full Review)

Protocol

Dose

1–5 g

Stimulant range; 5–8 g for analgesia. Typically started at 1–2 g and titrated slowly.

Timing

By effect

Energizing use in the morning; analgesic or sleep-supporting use later in the day.

Frequency

1–2×/day

Commonly split into two or three smaller doses to smooth effects and limit dependence.

Time to effect

Onset

15–45 min

Effects usually begin within 15–45 minutes of an oral dose.

Peak

~1 hour

Effects peak near one hour after dosing.

Benefits

High: Acute pain relief

Medium: Opioid withdrawal relief and substitution

Low: Mood elevation and anxiety reduction; increased energy, alertness, and focus; favorable metabolic and lipid markers

Speculative: Antioxidant and anti-inflammatory actions; sexual performance and endurance

Contraindications

Pregnancy or breastfeeding

Significant liver disease (Child-Pugh Class B or C)

Cardiac arrhythmia or prolonged QTc (>450 ms men, >470 ms women)

Seizure disorder

Active or prior substance use disorder

Concurrent CNS depressants (benzodiazepines, opioids)

Key Interactions

Alcohol and sedating antihistamines (diphenhydramine)

Strong CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir, grapefruit)

Serotonergic drugs (SSRIs, SNRIs, MAOIs, tramadol)

QTc-prolonging drugs (antipsychotics such as quetiapine, antiarrhythmics)

Loperamide, dextromethorphan

Sedating or serotonergic supplements (kava, valerian, high-dose CBD, melatonin, 5-HTP, poppy-seed)

St. John's Wort

Opioid-tapering agents (buprenorphine, methadone)

Risk & Side Effects

High: Dependence and withdrawal; gastrointestinal effects; product contamination and adulteration

Medium: Hepatotoxicity; cardiovascular effects

Low: Seizures; respiratory depression; neonatal withdrawal

Speculative: Skin hyperpigmentation; cognitive impairment with chronic heavy use

Monitoring

Marker	Target	Why
ALT	< 25 U/L (men), < 20 U/L (women)	Hepatocellular liver injury
AST	< 25 U/L	Liver-cell injury, with ALT
ALP	40–100 U/L	Cholestatic (bile-flow) injury
Total bilirubin	< 1.0 mg/dL	Impaired bile flow / jaundice
GGT	< 30 U/L	Cholestatic pattern and alcohol co-use
Lipid panel (LDL-C, HDL-C, triglycerides)	LDL-C < 100 mg/dL; HDL-C > 50 mg/dL; TG < 90 mg/dL	Metabolic effect and cardiovascular risk
QTc interval (ECG)	< 440 ms	Arrhythmia risk from QTc prolongation
CBC	Within reference range	General health and infection screen
eGFR / creatinine	eGFR > 90 mL/min/1.73 m²	Kidney clearance for elimination

Cadence: Baseline before starting; repeat liver enzymes at 4–8 weeks after starting regular use, then every 6–12 months; repeat ECG if cardiac risk factors or QTc-prolonging co-medications; reassess dependence, dose, and goals at each interval.

Qualitative Assessment

Pain and function: genuine, sustained reduction in pain and improved daily function without dose escalation
Mood and energy: stable mood and steady energy, rather than a cycle of highs followed by dysphoria between doses
Sleep quality: maintained sleep onset and continuity, not worsening insomnia
Dependence signs: absence of craving, dose creep, using to stave off withdrawal, or use interfering with obligations
Bowel and appetite: regular bowel movements and stable weight rather than constipation and unintended weight loss

Kratom for Health & Longevity

Protocol

Benefits

Risk & Side Effects

Monitoring

Qualitative Assessment