QT Prolongation With Methadone, Donepezil, and Ibogaine
September 2, 2026 DOI: 10.64239/pi-vl11508 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Commentary |
|---|---|
| Interventions | Buprenorphine Methadone Ibogaine Magnesium Donepezil |
| Topics | Ibogaine |
| Key points | The text advises considering buprenorphine over methadone when QT risk is a concern, citing QT prolongation in about 34% of methadone maintenance patients and torsades in roughly 2%. It states that ibogaine carries high QT and torsades risk, that Stanford developed a magnesium pre-dosing protocol to reduce this risk, and that donepezil evidence is mixed, with case reports linking it to QT prolongation and torsades while a 2024 meta-analysis found no increased risk of major adverse cardiac events. |
Abstract
When QT risk is a concern, consider buprenorphine over methadone. QT prolongation occurs in approximately 34% of methadone maintenance patients, and torsades in roughly 2%. Ibogaine carries a high risk of QT prolongation and torsades. Stanford developed a protocol to pre-dose patients with magnesium to reduce this risk. Evidence on donepezil's QT risk remains mixed. Case reports link it to QT prolongation and torsades, but a 2024 meta-analysis found no increased risk of major adverse cardiac events.