A Systematic Review on the Effects and Implications of Kratom Use on Cardiotoxicity

Purpose: Mitragyna speciosa, referred to as kratom, is a plant native to Asia known for its opiate- and psychostimulant-like effects. Kratom use in the US has increased in the last fifteen years. Mitragynine, a kratom-derived alkaloid, has been shown to interfere with cardiac ion channels, leading to QTc prolongation and Torsades de Pointes. These findings are clinically relevant in the psychiatric population, where medications affecting QTc interval are commonly prescribed. This systematic review aims to bring awareness to the cardiac effects of kratom use and highlight the clinical significance for patients who are prescribed psychiatric medications. Methods: This systematic review was conducted using PubMed as the primary database. The query was specified as "All fields" with search terms: Kratom OR mitragynine OR mitragyna speciosa AND cardiac. This search yielded thirteen articles. Inclusion criteria included ability to access articles through the UNTHSC portal. Exclusion criteria included absence of search terms in the article title, abstract, and keywords. The final synthesis included five articles. Results: Two of the articles discussed the side effects of kratom, highlighting QTc prolongation. Three articles discussed the mechanism and interaction of kratom with other psychiatric medications. Conclusion: As kratom usage increases in the US, it is important to understand the mechanisms of kratom-induced cardiotoxicity. This is particularly relevant to the psychiatric population, where the use of medications known to affect QTc interval is prevalent. This systematic review highlights the need for increased awareness and research on the interactions between mitragynine and other psychiatric medications.