Challenges in Anesthesia Practice with Kratom


  • Anchala Jirakulsawat Faculty of Medicine Siriraj Hospital, Mahidol University
  • Papiroon Noitasaeng Faculty of Medicine Siriraj Hospital, Mahidol University
  • Nisa Noocharoen Faculty of Medicine Siriraj Hospital, Mahidol University
  • Parichad Apidechakul Faculty of Medicine Siriraj Hospital, Mahidol University
  • Phongthara Vichitvejpaisal Faculty of Medicine Siriraj Hospital, Mahidol University


Kratom, Mitragynine, Cytochrome P-450, Drug interaction, Anesthesia practice


Kratom, also known as Mitragyna speciosa, is a plant native to Southeast Asia. Its active ingredients, mitragynine and 7-hydroxymitragynine, affect the central nervous system in a manner similar to opioids; at low doses, kratom can increase work endurance and productivity, but at high doses it can have sedative effects and cause adverse reactions such as digestive and circulatory problems. Withdrawal symptoms, such as uncontrolled behavior, may occur if kratom consumption is stopped, but it is not known to lead to serious crimes. Kratom can also interfere with the liver’s metabolism of other drugs by inhibiting the cytochrome P-450 enzyme. As a result, drug interactions may occur. Despite being legalized by the Thai Traditional Medical Council, the use of kratom as alternative medicine should be monitored by healthcare professionals. Anesthesia personnel should be especially cautious with patients who have a history of kratom use as ones who have used other addictive drugs before, during, or after surgery.


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How to Cite

Jirakulsawat A, Noitasaeng P, Noocharoen N, Apidechakul P, Vichitvejpaisal P. Challenges in Anesthesia Practice with Kratom. J Royal Thai Army Nurses [Internet]. 2023 Sep. 1 [cited 2023 Nov. 29];24(2):46-52. Available from:



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