April 2026: Kratom-Associated Liver Injury-Kratom-associated Liver Injury

Video Transcription

Video Summary

The Hepatotoxicity SIG April seminar focused on kratom-induced liver injury. Dr. Jawad Ahmad reviewed kratom (Mitragyna speciosa), a Southeast Asian plant sold widely in teas, powders, and capsules, with stimulant effects at low doses and opioid-like sedative effects at higher doses via mitragynine and 7-hydroxymitragynine. He highlighted rising U.S. use (survey estimates near 2 million past-year users in 2021) and a recent surge in poison-center reports, including increasing co-exposure with kava. Regulatory history was discussed: kratom remains unscheduled federally, though the FDA continues to warn of serious adverse events; a 2016 DEA attempt to schedule it was withdrawn after major public backlash, and future action may target concentrated extracts.<br /><br />Clinically, published cases and a PRISMA review show kratom liver injury typically occurs after weeks of use, often in younger men, with predominantly cholestatic or mixed patterns and marked jaundice; most recover, but severe cases including transplant have been reported. Dr. Ahmad summarized 11 well-characterized DILIN cases showing similar latency and mixed/cholestatic injury, with product testing confirming kratom alkaloids and highlighting broader supplement mislabeling concerns.<br /><br />Dr. David Kleiner presented biopsy findings: portal inflammation with eosinophils, prominent bile duct injury sometimes resembling primary biliary cholangitis, and canalicular/hepatocellular cholestasis—patterns that can overlap with other drug injuries (e.g., amoxicillin-clavulanate), underscoring the need for clinical correlation.

Keywords

kratom-induced liver injury

Mitragyna speciosa

mitragynine

7-hydroxymitragynine

drug-induced liver injury (DILI)

cholestatic hepatitis

DILIN case series

FDA/DEA kratom regulation

liver biopsy bile duct injury