Kratom and Ketamine Therapy | Tovani Health
Mitragyna speciosa (Kratom) — Botanical mu-opioid agonist with serotonergic activity
Verdict at Tovani Health
Evaluate individually; kratom combines opioid-like and serotonergic effects that complicate KAP planning.
Kratom alongside ketamine requires individual evaluation. Kratom's primary alkaloids agonize mu-opioid receptors AND have serotonergic activity, so it stacks with ketamine on both the respiratory-depression axis and the (small) serotonin-syndrome axis. We do not categorically decline patients on kratom, but we evaluate use patterns carefully and may ask for a taper.
If you take Mitragyna speciosa regularly and are considering at-home ketamine therapy, the combination is depends on your specific situation. This page covers the brief pharmacologic context and what we do at intake.
How Mitragyna speciosa interacts with ketamine
Kratom's primary active alkaloids (mitragynine and 7-hydroxymitragynine) are partial mu-opioid agonists with serotonergic activity. Product potency varies dramatically between sources. Long-term use produces tolerance and dependence similar to opioids.
What we do at intake
Disclose dose, frequency, brand, and how long you have been using. Kratom is unregulated and product strength is inconsistent, which adds to the planning challenge. We discuss tapering before starting KAP for daily users.
Bottom line
Kratom alongside ketamine requires individual evaluation. Kratom's primary alkaloids agonize mu-opioid receptors AND have serotonergic activity, so it stacks with ketamine on both the respiratory-depression axis and the (small) serotonin-syndrome axis. We do not categorically decline patients on kratom, but we evaluate use patterns carefully and may ask for a taper.
Frequently Asked Questions
I use kratom for anxiety. Will I be turned away from KAP?
Not automatically. We discuss your use pattern and may recommend a taper plan as part of your eligibility conversation.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Mitragyna speciosa (Kratom) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Ketamine as an adjuvant to opioids for cancer pain. Bell RF, Eccleston C, Kalso EA.. Cochrane Database of Systematic Reviews. 2017. PMID: 28657160
Cochrane systematic review evaluating ketamine added to opioid therapy for cancer pain.
- Attenuation of Antidepressant Effects of Ketamine by Opioid Receptor Antagonism. Williams NR, Heifets BD, Blasey C, et al.. American Journal of Psychiatry. 2018. PMID: 30153752
Landmark study showing pretreatment with naltrexone (opioid receptor antagonist) blocks the antidepressant effect of ketamine.
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 16, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.