The Anti-Addiction Drug Ibogaine and the Heart: A Delicate Relation

Abstract

The plant indole alkaloid ibogaine has shown promising anti-addictive properties in animal studies. Ibogaine is also anti-addictive in humans as the drug alleviates drug craving and impedes relapse of drug use. Although not licensed as therapeutic drug and despite safety concerns, ibogaine is currently used as an anti-addiction medication in alternative medicine in dozens of clinics worldwide. In recent years, alarming reports of life-threatening complications and sudden death cases, temporally associated with the administration of ibogaine, have been accumulating. These adverse reactions were hypothesised to be associated with ibogaine’s propensity to induce cardiac arrhythmias. The aim of this review is to recapitulate the current knowledge about ibogaine’s effects on the heart and the cardiovascular system, and to assess the cardiac risks associated with the use of this drug in anti- addiction therapy. The actions of 18-methoxycoronaridine (18-MC), a less toxic ibogaine congener with anti-addictive properties, are also considered.

Toxicokinetics of ibogaine and noribogaine in a patient with prolonged multiple cardiac arrhythmias after ingestion of internet purchased ibogaine

“…Unfortunately, we did not perform genotyping in our patient. Finally, both hypokalemia and hypomagnesemia may increase the risk of TdP [3]. Even though the disturbances were minimal in our patient, we cannot be certain it did not have an impact on the manifestation of cardiac arrhythmias.…”

“…Although human studies on ibogaine are relatively scarce, recent literature has detailed the pharmacokinetic and pharmacodynamic profile of ibogaine. In the liver and gut wall, ibogaine is metabolized into biologically active noribogaine by mostly CYP2D6 and to a lesser extent by CYP2C9 and CYP 3A4 [2,3]. As a consequence, blood concentrations of ibogaine and noribogaine can be influenced by polymorphism in the CYP2D6 enzyme and co-ingestion of other medication metabolized by CYP2D6 may have clinical impact [4].…”

Remission of Severe Opioid Use Disorder with Ibogaine: A Case Report

“…First, studies have suggested that ibogaine is effective in easing opioid withdrawal, as well as in reducing cravings (Brown 2013). Although the pharmacological bases of ibogaine’s anti-addictive properties are not fully understood, ibogaine and noribogaine (ibogaine’s main metabolite) simultaneous action on a diversity of neurotransmitter transporters and receptors provides a biological plausibility for its anti-addictive effects (Antonio et al 2013; Koenig & Hilber 2015). Second, ibogaine is usually administered in a single session, not requiring ongoing administration (Brown 2013), which can be a substantial advantantage for many individuals with OUD.…”

“…Ibogaine is an alkaloid found in the Tabernanthe iboga root bark, traditionally used in initiatory rituals in West Central Africa (Brown 2013; Koenig & Hilber 2015). Since the 1960s, anecdotal evidence has suggested its potential to treat addictions without the need for ongoing administration (Alper 2001; Brown 2013; Glick et al 1991; Maisonneuve, Keller & Glick 1991).…”

“…Dozens of clinics worldwide are hence offering ibogaine for the treatment of addictions in both non-medical and medical settings (Koenig & Hilber 2015). For instance, as of Febuary 2006, it was estimated that 3414 individuals had taken ibogaine (Alper, Lotsof & Kaplan 2008).…”