Medical Screening

For long-acting opioids such as methadone and buprenorphine we require patients to switch to short acting opioids prior to arrival.

• For methadone, we require a minimum of 15-20 days.
• For buprenorphine-based medications, we require a minimum of 35-50 days.

Stimulants can interact with ibogaine in a number of ways, from prolonging the QT interval (cocaine/crack, methamphetamine), affecting CYP2D6 metabolism (methamphetamine), or simply because of ibogaine’s potential interaction with their acute and residual effects.

• For cocaine and crack we require a minimum of 7 days abstinence.
• For other stimulants such as methamphetamine, MDMA, or prescription stimulants like Ritallin or Adderall, we require 5 days abstinence prior to treatment.
• For coffee we also recommend a period of 5 days abstience prior to treatment.

We recommend that all patients refrain from drinking alcohol for at least 3 days before ibogaine administration, and for at least a week afterwards.

We require that patients who are at risk for alcohol withdrawal syndrome, and specifically for seizures during withdrawal, be completely detoxed from alcohol dependency under medical supervision for 5 to 7 days prior to treatment.

Benzodiazepines affect the GABAnergic neurotransmitter system on which ibogaine has no effect. Ibogaine does not reduce withdrawal symptoms associated with benzodiazepines, and actually could pose some potential risks, such as ampliflying the risk of seizures during withdrawal. Seizures during the ibogaine experience an lead to dangerous cardiac arrhyhtmias that require medical intervention.

It is extremely important that patients report any benzodiazepine use within the past 3 months.

For patients who are physically dependent on benzodiazepines and who are pursuing treatment for other reasons, such as opioid dependence, we require that the dose be stabilized prior and continued throughout the ibogaine treatment process.

Detoxification from benzodiazepines can require a long-term slow taper. For more information, please refer to the Ashton Manual.

Ibogaine causes bradycardia, hypotension, and prolongation of the QT interval. Each of these symptoms may be in conjunction with or independent of the others. Other QT prolonging drugs exacerbate these effects, which can put a patient at greater risk for lethal cardiac arrhythmias.

We assess the potential interaction of any other QT prolonging medication on a case-by-base basis.

CYP2D6 is the enzyme by which ibogaine is metabolized in the liver. Other medications that affect CYP2D6 metabolism could have an impact on treatment.

We assess the potential interaction of any and all CYP2D6 affective drug on a case-by-case basis.

Ibogaine can increase serotonin levels in the body, and in conjunction with other medications that have the same action can lead to serotonin syndrome with symptoms of acute confusional state.

Examples of these medications include, but are not limited to 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, and some dietary supplements like St. John’s Wort.

We require that patients be off of these medications and stable for at least 7 days prior to treatment.

MAOIs affect the metabolism of many different drugs. They are infrequently used as anti-depressants, but may still form part of regimens for Parkinsons disease, and are a constituent part of ayahuasca.

We require that patients refrain from the use of MAOIs for at least 7 days prior to arrival.

These medications can lower blood pressure and heart rate dramatically, and alter electrical conduction through the heart. However, there may be concern about the underlying conditions that these medications are meant to treat and the cardiac effects of ibogaine.

We consider the potential interactions of these drugs on a case-by-base basis.

Because of many possible and sometimes poorly understood interactions with ibogaine and certain centrally acting medications, we may recommend that any non-essential medications be paused prior to treatment.

This can include certain non-essential blood pressure medications, non-benzodiazepine hypnotics (i.e. Z class drugs), barbiturates, muscle relaxants, antipsychotics, anticonvulsants and general anesthetics.

Diuretics can lead to a reduction of certain key electrolytes. We generally require the discontinuation of diuretic medication prior to conducting intake lab tests for accurate pre-treatment readings.