Ibogaine: complex pharmacokinetics, concerns for safety, and preliminary efficacy measures.

Ibogaine, an indole alkaloid from the Tabernanthe Iboga shrub, has been used in low doses by indigenous peoples to combat fatigue, hunger, and thirst, and in higher doses as a religious sacrament. Anecdotal reports from addict self-help groups claim a single dose eliminates opiate withdrawal symptoms and reduces drug craving for extended periods. The compound is rapidly metabolized via CYP2D6 into noribogaine, which may underlie its prolonged effects. In an inpatient detoxification setting, ibogaine significantly decreased craving for cocaine and heroin and reduced self-reported depressive symptoms, with benefits persisting 30 days after discharge. The findings suggest noribogaine's central nervous system activity may explain the lasting aftereffects on craving and mood.

Study at a glance

Abstract

Ibogaine is an indole alkaloid found in the roots of Tabernanthe Iboga (Apocynaceae family), a rain forest shrub that is native to western Africa. Ibogaine is used by indigenous peoples in low doses to combat fatigue, hunger and thirst, and in higher doses as a sacrament in religious rituals. Members of American and European addict self-help groups have claimed that ibogaine promotes long-term drug abstinence from addictive substances, including psychostimulants and opiates. Anecdotal reports attest that a single dose of ibogaine eliminates opiate withdrawal symptoms and reduces drug craving for extended periods of time. The purported efficacy of ibogaine for the treatment of drug dependence may be due in part to an active metabolite. The majority of ibogaine biotransformation proceeds via CYP2D6, including the O-demethylation of ibogaine to 12-hydroxyibogamine (noribogaine). Blood concentration-time effect profiles of ibogaine and noribogaine obtained for individual subjects after single oral dose administrations demonstrate complex pharmacokinetic profiles. Ibogaine has shown preliminary efficacy for opiate detoxification and for short-term stabilization of drug-dependent persons as they prepare to enter substance abuse treatment. We report here that ibogaine significantly decreased craving for cocaine and heroin during inpatient detoxification. Self-reports of depressive symptoms were also significantly lower after ibogaine treatment and at 30 days after program discharge. Because ibogaine is cleared rapidly from the blood, the beneficial aftereffects of the drug on craving and depressed mood may be related to the effects of noribogaine on the central nervous system.