Main targets of ibogaine and noribogaine associated with its putative anti-addictive effects: A mechanistic overview.

Ibogaine and its main metabolite, noribogaine, modulate several brain targets associated with substance use disorders. Rather than having a single key mechanism, their anti-addictive action appears to arise from a complex modulation of multiple receptor systems, creating potential beneficial synergies. This understanding comes from a review of theoretical and experimental studies published up to July 2022. The authors suggest that future research should apply polypharmacology approaches to better describe the multifaceted patterns of this multi-target drug, which could guide both mechanistic and therapeutic studies.

Study at a glance

Abstract

There is a growing interest in studying ibogaine (IBO) as a potential treatment for substance use disorders (SUDs). However, its clinical use has been hindered for mainly two reasons: First, the lack of randomized, controlled studies informing about its safety and efficacy. And second, IBO's mechanisms of action remain obscure. It has been challenging to elucidate a predominant mechanism of action responsible for its anti-addictive effects. To describe the main targets of IBO and its main metabolite, noribogaine (NOR), in relation to their putative anti-addictive effects, reviewing the updated literature available. A comprehensive search involving MEDLINE and Google Scholar was undertaken, selecting papers published until July 2022. The inclusion criteria were both theoretical and experimental studies about the pharmacology of IBO. Additional publications were identified in the references of the initial papers. IBO and its main metabolite, NOR, can modulate several targets associated with SUDs. Instead of identifying key targets, the action of IBO should be understood as a complex modulation of multiple receptor systems, leading to potential synergies. The elucidation of IBO's pharmacology could be enhanced through the application of methodologies rooted in the polypharmacology paradigm. Such approaches possess the capability to describe multifaceted patterns within multi-target drugs. IBO displays complex effects through multiple targets. The information detailed here should guide future research on both mechanistic and therapeutic studies.