Toxicokinetics of ibogaine and noribogaine in a patient with prolonged multiple cardiac arrhythmias after ingestion of internet purchased ibogaine.
Marieke Henstra, Liza Wong, Abdel Chahbouni, Noortje Swart, Cor Allaart, Ferdi Sombogaard
Clinical Toxicology July 1, 2017 DOI: 10.1080/15563650.2017.1287372 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Single patient who ingested ibogaine |
| Intervention | Ibogaine |
| Duration | 12 days follow-up |
| Topics | Ibogaine |
| Keywords | Lc-ms/ms method Cardiac arrhythmia Ibogaine toxicokinetics ibogaine Cardiac effects Drug clears Declining levels Prolonged duration Extended health risks Severe arrhythmia Heart issues Noribogaine role noribogaine Metabolite Concentrations Significant role Novel method Precisely investigated |
| Citations | 13 |
| Key findings | Noribogaine concentrations, rather than ibogaine, are linearly related to the prolonged duration of cardiac arrhythmia and QTc prolongation after ibogaine ingestion. |
Abstract
Ibogaine is an agent that has been evaluated as an unapproved anti-addictive agent for the management of drug dependence. Sudden cardiac death has been described to occur secondary to its use. We describe the clinical effects and toxicokinetics of ibogaine and noribogaine in a single patient. For this purpose, we developed a LC-MS/MS-method to measure ibogaine and noribogaine plasma-concentrations. We used two compartments with first order absorption. The maximum concentration of ibogaine was 1.45 mg/L. Our patient developed markedly prolonged QTc interval of 647ms maximum, several multiple cardiac arrhythmias (i.e., atrial tachycardia and ventricular tachycardia and Torsades des Pointes). QTc-prolongation remained present until 12 days after ingestion, several days after ibogaine plasma-levels were low, implicating clinically relevant noribogaine concentrations long after ibogaine had been cleared from the plasma. The ratio k12/k21 for noribogaine was 21.5 and 4.28 for ibogaine, implicating a lower distribution of noribogaine from the peripheral compartment into the central compartment compared to ibogaine. We demonstrated a linear relationship between the concentration of the metabolite and long duration of action, rather than with parent ibogaine. Therefore, after (prolonged) ibogaine ingestion, clinicians should beware of long-term effects due to its metabolite.
Comparable studies
Other case reports and case series on ibogaine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Treatment of acute opioid withdrawal with ibogaine. Patients undergoing opioid detoxification with ibogaine in non-medical settings | 1999 | Case series | n = 33 |
| A preliminary investigation of ibogaine: case reports and recommendations for further study. Individuals addicted to opiates | 1994 | Case series | n = 7 |
| Long-QT Syndrome Induced by the Antiaddiction Drug Ibogaine A 31-year-old woman | 2009 | Case study | n = 1 |
| Distribution of ibogaine and noribogaine in a man following a poisoning involving root bark of the Tabernanthe iboga shrub. 48-year-old Caucasian male with a history of drug abuse who died after ingesting... | 2006 | Case study | n = 1 |
| A case report SPECT study and theoretical rationale for the sequential administration of ibogaine and 5-MeO-DMT in the treatment of alcohol use disorder. 31-year-old male military veteran with moderate alcohol use disorder | 2018 | Case study | n = 1 |
Citations in the library
Cited by 11
- DARK Classics in Chemical Neuroscience: Ibogaine ACS Chemical Neuroscience September 14, 2018
- Ibogaine as a treatment for substance misuse: Potential benefits and practical dangers. Progress in Brain Research 2018
- The adverse events of ibogaine in humans: an updated systematic review of the literature (2015-2020). Psychopharmacology June 1, 2022
- Evaluating the toxicity and therapeutic potential of ibogaine in the treatment of chronic opioid abuse Expert Opinion on Drug Metabolism & Toxicology June 18, 2021
- Ibogaine Consumption With Seizure-Like Episodes, QTc-Prolongation, and Captured Cardiac Dysrhythmias. Journal of Emergency Medicine October 1, 2019
and 6 more in the library
Cites 7
- The Anti-Addiction Drug Ibogaine and the Heart: A Delicate Relation Molecules January 29, 2015
- Fatalities temporally associated with the ingestion of ibogaine. Journal of Forensic Sciences March 1, 2012
- How toxic is ibogaine? Clinical Toxicology 2016
- Ascending-dose study of noribogaine in healthy volunteers: pharmacokinetics, pharmacodynamics, safety, and tolerability. The Journal of Clinical Pharmacology February 1, 2015
- Distribution of ibogaine and noribogaine in a man following a poisoning involving root bark of the Tabernanthe iboga shrub. Journal of Analytical Toxicology September 1, 2006
and 2 more in the library