IBOGAINE | IBOGA

Fatalities have been associated with the use of ibogaine; concomitant opioid use and comorbidities (eg, cardiovascular disease, depression, posttraumatic stress disorder, anxiety, stress, schizophrenia, epilepsy, or other imbalances in the autonomic nervous system) increase the risk of life-threatening complications including sudden cardiac death. The greatest concern about the known risks of taking iboga or ibogaine is that it decreases the heart rate (bradycardia) and prolongs the QT interval, a measurement of the time between the onset of the Q wave and the end of the T wave in the electrical cycle of the heart. Therefore, people with a history of myocardial infarction, murmurs, arrhythmias, heart surgeries or severe obesity should not take ibogaine. An electrocardiogram (ECG) is the absolute minimum test required, but a stress test and/or 24-hour monitoring with a Holter increases the possibility of detecting important abnormalities. The presence of a skilled physician (preferably a specialist in cardiology and emergency medicine) during the session, who monitors variations in heart rhythm and other vital signs, significantly increases the safety of this treatment.

Another risk factor is pulmonary embolism. This occurs when there are blood thrombi in the veins, such as those that can occur during prolonged immobility during aeroplane travel, car accidents, or blood-related diseases. When these clots circulate through the body during an ibogaine session, they can reach the lungs, where they can cause an embolism with the risk of suffocation. The risk of pulmonary embolism can be reduced by doing sports or exercise after long, sedentary trips and by avoiding initiation of treatment immediately after arrival at the destined treatment location. People with bleeding problems, chronic blood clots, or people who have recently been involved in accidents that have caused bruising and bleeding should be excluded from treatment.

Another cause of adverse effects is the interaction of iboga or ibogaine with other drugs or pharmaceuticals. Before taking ibogaine, the recipient should avoid consuming drugs for a sufficient period to ensure that the drug has been eliminated. This depends on the half-life of the drug and is different for each substance. On the other hand, foods and substances that are metabolized by the enzyme CYP2D6 (an enzyme involved in the metabolism of many drugs) should be avoided, since they could interact with ibogaine, and potentiate its effects on bradycardia and QT prolongation. There are lists of such substances available on the Internet. Quinine and grapefruit belong to this group and should be avoided before and during treatment.

Given that iboga is offered in a variety of forms, taking a material whose chemical composition and potency are unknown is another risk factor. It is important to know the exact dose and composition of what is being consumed to avoid overdose or complications.

Although some centers accept people with psychiatric disorders such as bipolar, borderline personality disorder, etc. – and certain patients do report an improvement in their condition – nothing is known about the effects of ibogaine on such disorders or the risks that it involves. It is a dangerous landscape. In general, people with psychiatric disorders such as those mentioned above, as well as those suffering from schizophrenia and a history of psychosis, must be excluded from this treatment, since ibogaine could cause the reappearance or worsening of symptoms. Similarly, the interaction of ibogaine with certain psychotropic drugs can be dangerous. An in-depth psychiatric review as well as the supervision of a psychiatrist is important before engaging in treatment in case of the existence of a psychiatric disorder or the use of certain medications.

In addition to psychiatric risks, iboga and ibogaine are powerful psychoactive practices that can induce an introspective experience that is not always easy to manage. Episodes of extreme anxiety can occur, and in more serious cases, paranoia. A skilled facilitator should be able to offer necessary support to the individual and assist with difficult episodes. Proper preparation with the guidance of a therapist can help greatly in improving self-confidence, going into the experience with an appropriate mental state and being prepared for possible difficult experiences.