Ibogaine Contraindications can be roughly broken up into the following areas:

This list is not exhaustive and you should check all your medications and conditions with your ibogaine provider, who should be able to guide you. Or phone our advisers at Ibogaine Hotline.

1. Heart – Anything effecting the heart needs careful consideration
   1. Ibogaine causes bradycardia, hypotension, and prolongation of the QT interval.
   2. Other QT prolonging drugs  put the patient at greater risk for lethal cardiac arrhythmias.
   3. All other medications that prolong the QT interval should be assessed.
   4. Some people have a prolonged QT / QTc – Your EKG / ECG will show you.
   5. It is important that your QTc is less than 430ms for a man and less than 450ms for a woman. Anything higher than this is considered a prolonged QT.
   6. Ideally for a full flood dose (a large dose) a QTc of less than 400 is preferred.
   7. During administration blood pressure, pulse, blood oxygen and QT / QTc must all be monitored.
   8. Stop all ibogaine if QTc goes above 500 and get ready to use the difibrillator if it goes above 600.
   9. Heart rates below 60 bmp will need consideration.
   10. Anti-Arrhythmic Medications and the conditions requiring them are of concern.
   11. Check carefully ALL medication. Many things effect the heart like antibiotics and the birth control pill.
2. Contraindications – Many drugs are a bad mix with ibogaine. Anything you take in combination with ibogaine will need to be checked for the following:
   1. Ibogaine is O-demethylated to noribogaine primarily by cytochrome P4502D6 (CYP2D6) enzymes. CYP2D6 is an important enzyme metabolising approximately 30% of drugs. Make sure there are no other drugs using this enzyme.
   2. No hERG channel blockade drugs .
   3. Drugs metabolized by P450-11-D6 metabolism can lengthen the QT interval.
   4. P450 hepatic metabolism directly related to prolonged QT interval on ECG. So anything effecting this should be looked at
   5. Calcium Channel Blockers or Beta Blockers need to be considered carefully
   6. No Centrally Acting Medication. Central-acting agents effect the heart.
   7. Psych Meds
      1. Anything that raises serotonin in the body including antidepressants and most psych meds are bad mixes with ibogaine. The exception being benzodiazipines.
      2. Examples of medications that increase the level of serotonin in the body include: SSRIs, SNRIs, NRIs, MAOIs, buspirone (anxiety tx), trazodone (depression & insomnia tx), certain migraine medications, certain pain medications (fentanyl, meperidine, pentazocine and tramadol), dextromethorphan (cough suppressant), certain anti-nausea medications (granisetron, metoclopramide, ondansetron), cocaine, ayahuasca, MDMA, and some dietary supplements like St. John’s Wort. Passionflower a mild MAOI.
      3. All psychiatric medication is centrally acting and should be tapered and stopped prior to treatment. Consult your doctor.
      4. Patients who are taking long-acting psychiatric medications like a once a month shot, or who cannot stay off of their medications for 5 days, should be considered poor candidates.
      5. If patient is stable, psychiatric medications can be re-started 24 hours after treatment.
   8. Steroids
      1. Corticosteroids are known to prolong the QT interval and present increased an increased risk for arrhythmia.
      2. Anabolic steroids orally taken can cause liver malfunction. Pay special attention to liver function tests.
      3. Users of anabolic steroids need a prostate-specific antigen (PSA) test in addition to metabolism tests. Pay attention to haemoglobin and hematocrit. A high blood cell count means risk as thrombosis, blood clots, heart attack, also tend to have strong anxiety after treatment due to high blood pressure
3. Drugs of abuse which pose major complications
   1. Opiates (Heroin, Methadone, Subutex, Codiene, etc)
      1. Ibogaine makes opiates STRONGER. High risk of overdose. Take care that timings between doses are correct. Especially dangerous with long acting opiates.
      2. Over dose post ibogaine treatment is a common cause of death due to the deep reset that ibogaine provides
      3. Ideally off of all long acting opiates like subutex, bupernorphine, methadone and suboxone 3 months, minimum 3 weeks (but be prepared that PAWs and withdrawal symptoms may return)
      4. Not a good mix with Tramadol or Fentanyl. Swap to another short acting opiate
      5. Ibogaine taken about 10 hours after last short acting opiate.
   2. Benzodiazepines (Valium, Diazepam, Xanax, Clonazepam, etc)
      1. Ibogaine DOES NOT help with physical benzo withdrawal and can even make it worse.
      2. Do not stop taking benzos during your ibogaine flood. You must stabilize at a certain dose beforehand.
      3. Biggest cause of death following ibogaine ingestion is Grand Mal Seizures caused by benzo withdrawal
   3. Alcohol
      1. Alcohol should be stopped 3 days before if a moderate drinker. A week before for heavy drinkers.
      2. Alcoholics requiring detox can do a rapid detox in a week in most cases and then take ibogaine 7 to 10 days after the last drink
      3. Liver enzymes must be less than 2 – 2.5 x normal
      4. Liver conditions need consideration but in most cases are ok
   4. Stimulants (Crack, Cocaine, Amphethamines, etc)
      1. Stimulants effect the heart and are very dangerous with ibogaine
      2. Potential heart attack and torsades de pointes risks.
      3. Patients who have been using stimulants chronically may have higher instance of arrhythmia’s due to hyper excitable heart. Particular attention should be paid to the cardiac status throughout the treatment process.
      4. All crack and cocaine must be stopped a week before ibogaine treatment.
      5. Crack and cocaine are known to prolong the QT and block the hERG channel – very dangerous with ibogaine
      6. Amphetamines, Ritalin and Adderall should be stopped 5 days before.
      7. Amphetamines have been shown to prolong the QT interval and affect CYP2D6 metabolism
4. Avoid the following Food & Supplements
   1. No grapefruit, Earl Grey Tea, No bergamot
   2. No Kava kava
   3. No Kratom (Strange ECG’s reported from heavy kratom users)
   4. No MAOI’s. Many herbal supplements are MAOI’s this includes passionflower and ayahuasca vine.
   5. Caffiene
      1. Caffeine has also been shown to lower potassium which is important for heart function and can contribute to QT prolongation.
         
      2. Stop caffeine 5 days before
5. Diuretics
   1. Do not take anything that might make you loose electrolytes like diuretics.
   2. Do not do fasts or purges of any kind in the 3 weeks leading up to ibogaine treatment
   3. Electrolytes are extremely important for a safe ibogaine treatment, so drink lots of coconut water / electrolyte packs.
6. Double Check All Medicines & Half Lifes
   1. Even some antibiotics and contraceptive pills are a bad mix with ibogaine, so it is really important that you double check everything here.
   2. Calculate Half-Lives at least four to seven times the listed half-life of the medication.
7. Pre-Existing Health Conditions That Require Consideration (but may still be able to take ibogaine under medical supervision)
   1. Prolonged QT
   2. Heart problems (past or present) Such as coronary artery sclerosis, hypertension, myocardial infarct, cardiac hypertrophy, and dilated cardiomyopathy
   3. Hepatitis, liver cirrhosis and steatosis (may still be able to take it)
   4. Circulatory problems
   5. Bradycardia and hypotension
   6. Abscesses
   7. Bi-polar – May have mania for a few weeks after then feel better

   8. Irregular heart rhythms (Arrhythmias)
      o Atrio ventricular heart blocks
      o Any history of ventricular arrhythmias
      o Atrial Fibrillation (clot risk. quivering or irregular heart beat)

   9. Childhood congenital heart defects

   10. Heart attack (Myocardial Infarction)

   11. Coronary Vasospasm – which is a constriction of the coronary artery

   12. Murmur
       o Use echocardiogram (type of ultrasound) to rule out significant Valvular Heart Disease

   13. Valve Stenosis (Valve that doesn’t open properly because it is too narrow)

   14. Regurgitation (Leaking Heart Valve)

   15. Prolapse (Stretchy Valves)

   16. History of Pericarditis (Inflammation of the Pericardium – fibrous sack around heart)

   17. History of Endocarditis (Inflammation of the inside lining of the heart chamber)

   18. Get an echocardiogram for any of the above.

   19. Family history of heart attack/sudden cardiac death before 50 years of age

   20. Major heart/vascular/pulmonary surgery i.e. transplant, Coronary Artery Bypass Grafting, artificial heart valves, surgeries for Coronary Heart Disease, other surgeries.

   21. Internal or External Pacemaker

   22. History of blood clots
       o Stroke or transient ischemic attack (a mini-stroke) should only be accepted with sufficient time since event and pre-clearance.
       o Pulmonary embolism (blood clot in lung)or deep vein thrombosis should only be considered if these previous issues have been sufficiently resolved.Abnormal Heart Rate/Rhythm
       o Resting heart rate of ≥120 beats per minute or higher; or ≤50 beats per minute

   23. High/Low blood pressure (Hypertension /Hypotension)
       o 170/105 or higher or 90/60 or lower, while not taking blood pressure medication.
       o Ideal blood pressure is Systolic (top number) lower than 120 and Diastolic (bottom number) ideal under 80

   24. Other cardiac disease risk factors
       Including: Hypertension, hypotension, diabetes, nicotine use, high cholesterol, peripheral vascular disease, chest pain/shortness of breath with or without exertion, frequent indigestion, and unexplained fainting.

   25. Certain psychiatric conditions
       Without proper therapeutic support, ibogaine may exacerbate or re-traumatize patients with some conditions. But these could be potentially still be treated too.
       o Bipolar disorder (mania following use of ibogaine)
       o Post traumatic stress disorder (including sexual or violent trauma)
       o Borderline personality disorder (unstable moods)
       o Beck depression inventory score ≥24
       o Suicide attempts, ideations and/or intents

   26. No accessible veins for IV port access
       In this situation a central line should be inserted prior to treatment. Although other options exist for emergency meds, a central line is the only way to provide fluids, which are primary to several emergency interventions

   27. Irregular Thyroid

       1. Hypothyroid (not enough thyroid hormone – slow metabolism) leads to increased bradycardia,

       2. while hyperthyroid (too much thyroid hormone – fast metabolism) leads to increased risk of tachycardia.

       3. Make sure that thyroid medication has stabilized thyroid function.

   28. Major respiratory conditions

       1. Sleep Apnea makes it difficult for people to breath when they are in a sleep state like ibogaine can put people in. Could put the patient at risk for life-threatening hypoxia.

       2. Patient should use their prescribed respiratory device during ibogaine administration, and oxygen levels should be monitored closely.

       3. Oximeter readings should be between 95-100% – 90% is considered low (hypoxemia)

       4. Asthma, COPD (Chronic Obstructive Pulmonary Disease), emphysema, history of smoking more than 30 packs of cigarettes per day for 30 years. Depending on the severity of the condition. If the patient has been hospitalized or has had multiple severe attacks in the last 2 years, they should be considered a poor candidate.

       5. Check steroid inhalers are not contraindicated

       6. Pulmonary Fibrosis (scarring on lungs)

       7. Oxygen dependent patients are considered poor candidates.

       8. Sarcoidosis (inflammatory disease normally in lungs and lymph glands)

   29. Metabolism, Diet, and Gastrointestinal Issues

       1. CMC or Metabolic Panel results outside of normal ranges (Electrolyte levels)
          o Preferred ranges for potassium (4.5-5.5 mEq/L) and magnesium (1.5-2.5 mEq/L) are ideal.

       2. Constipation or Impaction
          o Movement of the diaphragm o Can impede metabolism of medications

   30. Obesity
       o In addition to significant concerns about energy metabolism, ibogaine is stored in fat tissue. Obesity will greatly affect metabolism of ibogaine.
       o At a BMI of 35+, risk of blood clot and stroke are dangerously high. These patients can be put on mini-dose heparin or enoxaparin sodium – blood thinners that don’t change coagulation factors – during treatment.
       • Eating disorders

   31. It can be extremely dangerous to treat with anorexia or bulimia. These patients must be stabilized with electrolytes prior to treatment, and must remain under constant observation to make sure they are not purging or binging prior to administration.

   32. Malnutrition
       o Noribogaine is stored in fat tissue and released back into the blood plasma, and by some accounts this may have an effect on lasting benefits.

   33. Crohn’s disease, Irritable bowel syndrome, diverticulosis, diverticulitis (a condition where pouches form in the wall of the colon)
       o Patient should be cleared by a gastroenterologist if the condition is stable.

   34. Pancreatitis – inflammation of the pancreas

   35. Other considerations

       1. Chronic infectious diseases (i.e. Tuberculosis, Hepatitis B or C, HIV)

       2. Overdose history

       3. History of head trauma with loss of consciousness for a significant amount of time

       4. Age 60+

          1. Recommended to obtain a stress ECG test.

       5. Family history of certain psychiatric conditions primarily in patients under 30 years of age

       6. Bipolar disorder

       7. Schizophrenia

       8. Depersonalization and/or Derealization disorder

       9. Cerebellar dysfunction

       10. Epilepsy

       11. Psychosis

       12. Organic brain disease

       13. Dementia

8. Absolute Exclusion Criteria – These conditions exclude people from being treated with ibogaine due to the gravity of the risks
   1. Certain psychiatric conditions
      • Schizophrenia
      • Bipolar disorder for which patient has been hospitalised or medicated
      • Depersonalisation and/or Derealisation Disorder
      • Cerebellar dysfunction
      • Epilepsy
      • Psychosis or acute confusional state
      • Organic brain disease
      • Dementia
   2. Certain pre-existing heart conditions
   3. Patients with blood pressure above 170 mm Hg systolic/105 mm Hg diastolic or below 80 mm Hg systolic/60 mm Hg diastolic
   4. A pulse greater than 120 beats per minute or less than 50 beats per minute.
   5. Prolonged QTc Interval ( > 450 milliseconds for males and > 470 milliseconds for females)
   6. History of heart failure, enlarged or hypertrophic heart
   7. Active blood clots / Pulmonary embolism / Deep vein thrombosis
   8. Certain major respiratory conditions
   9. Low oxygen levels and required steroid treatments lead to excessive risks.
   10. Emphysema
   11. Chronic Obstructive Pulmonary Disorder
   12. Cystic Fibrosis
   13. Severe or chronic gastrointestinal issues
       • Bleeding ulcer
       • Leaky gut syndrome
9. Other criteria
   1. Abnormal blood test results, especially if potassium or magnesium are outside normal ranges they should be corrected.
   2. Impaired Kidney or Liver function
   3. Any patient with liver enzymes greater than 2.5 times normal levels, on dialysis for kidney failure
   4. Abnormal Blood Urea Nitrogen (BUN) or creatinine (break down of creatine phosphate in muscles) levels
   5. Active infection or abscess
   6. Within 6 months of major surgeries.
   7. Pregnancy

Due to the potential dangers involved in taking ibogaine it is important that you take your preparation seriously and tell your provider the truth about your past medical history and current drug consumption