The Anti-Addiction Drug Ibogaine and the Heart: A Delicate Relation

Introduction

Ibogaine is a naturally occurring indole alkaloid from the root bark of Tabernanthe iboga that produces profound psychoactive effects and has attracted interest for anti-addiction therapy. Animal experiments have shown that ibogaine reduces opioid withdrawal signs and decreases self-administration of opioids, cocaine, nicotine and alcohol; anecdotal and uncontrolled human use reports describe reduced craving and transient resolution of withdrawal after single high doses. Interest in clinical development was curtailed in the 1990s after reports of sudden death and safety concerns, and ibogaine today remains largely used in alternative-medicine clinics. The related synthetic congener 18-methoxycoronaridine (18-MC) has anti-addictive properties in animals and reportedly lower toxicity. Koenig and colleagues set out to synthesise and evaluate the evidence regarding ibogaine's cardiovascular actions and associated risks. The review brings together chemical and pharmacokinetic data, electrophysiological studies (including the authors' own laboratory work), clinical case reports of QT prolongation, arrhythmias and fatalities, and considerations about 18-MC, with the aim of assessing cardiac risk and deriving practical implications for potential therapeutic use.