Abstract
INTRODUCTION: Mitragyna speciosa (Korth.) Havil. (Rubiaceae), commonly known as kratom, is a tropical tree native to Southeast Asia, traditionally used for its diverse ethnopharmacological activities, including analgesic and anxiolytic effects. Kratom's unique pharmacological profile allows it to function as a stimulant at low doses and produces opioid-like effects at high doses, making it a potential alternative for pain management and mitigation of opioid use disorder. AREAS COVERED: Google Scholar and PubMed, along with FAERS database, were systematically searched to evaluate the clinical applications of kratom by examining its drug interactions, which can significantly impact the pharmacokinetics and pharmacodynamics of concomitant medications. By examining current evidence, this review aims to highlight the importance of establishing safe clinical practices and protocols for healthcare providers and patients. EXPERT OPINION: Evaluating drug interactions in kratom usage is clinically imperative because kratom's bioactive alkaloids can interact with the pharmacokinetic and pharmacodynamic processes of concurrent medications, potentially resulting in adverse effects or compromised therapeutic outcomes. This review presents an expert opinion on the clinical relevance of kratom's interactions with drugs, aiming to inform clinical practice, highlight ethical and regulatory considerations, and propose future research directions to improve the understanding of kratom's pharmacological profile and enhance user safety.