Iboga and Ibogaine: Cultural History, Research and Cardiac Risks

Cardiac risk first. Ibogaine can cause dangerous heart rhythm problems and has been linked to sudden deaths. A toxicology review found case reports in which ibogaine caused ventricular tachyarrhythmias and a prolonged QT interval (an electrical delay in the heartbeat) in people without a known heart condition or family history. It also reported 27 fatalities after ibogaine ingestion. [1] If someone has taken ibogaine and has fainting, chest pain, a racing or irregular heartbeat, seizures or trouble breathing, call 911 (US) or local emergency services. In the US, Poison Help is 1-800-222-1222. See poisoning: what to do first.

Iboga and ibogaine

Iboga is the common name of Tabernanthe iboga, an understory shrub of the lowland tropical forests of the Congo Basin. Its root bark contains several alkaloids, of which ibogaine is the best known. [2] Ibogaine is a psychoactive indole alkaloid. It is unlicensed as a medicine in the UK but used by some people to try to relieve drug or alcohol use. [3] The body converts it mainly with the CYP2D6 enzyme into noribogaine, which stays in the body for days; both affect several brain systems, including NMDA, opioid and sigma-2 receptor sites. [1] NIDA places ibogaine in its "other" group of drugs that work differently from classic psychedelics. [4]

Cultural history

The Bwiti religious tradition of Gabon, Equatorial Guinea and southern Cameroon uses iboga. [2] A Chacruna article describes iboga as a cultural keystone species integral to Bwiti, practiced in Gabon and to a lesser extent in other Central African countries. [5] This page does not describe ceremonies. The same sources raise conservation concerns: demand, deforestation and political and economic conditions have led to questions about whether current harvesting is sustainable, and there are no official data on harvesting or trade. [5][2] See Indigenous traditions, ethics and conservation.

Clinical research

Evidence labels: insufficient evidence, preclinical, evidence of harm.

• Veterans with brain injury: insufficient evidence. An open-label study (no control group) of 30 special operations veterans gave ibogaine together with magnesium, which may reduce the cardiac concern, alongside other treatments. Scores for disability, PTSD, depression and anxiety improved after one month, and there were no unexpected or serious adverse events. The authors say controlled trials are needed. [6]
• Addiction treatment: insufficient evidence. Reviews describe ibogaine as an unlicensed treatment for addiction used outside approved care. [1] We did not find a completed randomized trial in the sources we read: Proper evidence not found for proven benefit.
• Neurotoxicity: preclinical. Rat studies showed damage to cerebellar cells at higher doses, and its relevance to people is unclear. [1]

Significant cardiac and other risks

• QT prolongation. NIDA notes that an analysis of studies from 2015 to 2020 associated ibogaine use with long QT syndrome. [4]
• Deaths. A forensic review of 19 deaths between 1.5 and 76 hours after ibogaine found that existing medical problems, mainly cardiovascular, or other substances explained or contributed to the death in 12 of 14 cases with enough data. It named seizures linked to alcohol or benzodiazepine withdrawal and the uninformed use of plant-based forms as other risk factors. [7]
• Poison service data. Over ten years, the UK National Poisons Information Service received enquiries about seven patients; all had symptoms, six showed heart toxicity, and the features included cardiac arrest, torsades de pointes and QT prolongation. [3]
• Medicine interactions. Differences in CYP2D6 can change blood levels of ibogaine and its main product, which matters when other medicines use the same enzyme. [1] See medication interactions.
• Who is at highest risk. The reviewers warn that deaths are more likely in people with existing heart conditions and those taking other medicines. [1] No one should take ibogaine to self-treat; speak with a clinician about addiction help: substance use support and urgent help.

Legal status

Not legal advice; laws change. Ibogaine is on the US federal Schedule I list. [8] It is described as not licensed in the UK. [3] Other countries: not verified here.