Ibogaine Contraindications — Who Should Not Take Ibogaine

Cardiac Contraindications

Prolonged QTc interval (>450ms in men, >470ms in women), history of cardiac arrhythmia, structural heart disease, and recent myocardial infarction are absolute contraindications. An EKG is mandatory before every ibogaine treatment.

Psychiatric Contraindications

Active psychosis, schizophrenia spectrum disorders, and active bipolar disorder (especially manic phase) are absolute contraindications. A thorough psychiatric assessment is required before treatment.

Medication Contraindications

Many medications interact dangerously with ibogaine. SSRIs, SNRIs, MAOIs, lithium, antipsychotics, and QT-prolonging medications require careful management or discontinuation before treatment.

Medical Contraindications

Severe liver disease (ibogaine is hepatically metabolized), severe kidney disease, uncontrolled hypertension, and pregnancy are contraindications. Liver function tests are mandatory before treatment.

Absolute vs. Relative Contraindications

Absolute contraindications are conditions where ibogaine should never be administered under any circumstances. These include: prolonged QTc interval (>450ms men, >470ms women), history of ventricular arrhythmia, active psychosis or schizophrenia spectrum disorder, severe liver failure, and current use of MAOIs.

Relative contraindications are conditions that require careful consideration, additional precautions, or dose modification. These include: mild to moderate liver disease, controlled bipolar disorder (euthymic phase), history of seizures, current use of QT-prolonging medications (which may need to be discontinued), and significant cardiovascular disease without arrhythmia.

The Mandatory Pre-Treatment Screening Protocol

Every ibogaine candidate must undergo the following before treatment: 12-lead EKG with QTc interval measurement, comprehensive metabolic panel including liver function tests (AST, ALT, bilirubin), complete medication review with drug interaction assessment, psychiatric evaluation, and a detailed medical history including family history of cardiac disease.

This screening must be performed by or reviewed by a qualified medical professional. Integration coaches (Tier 1) must understand contraindications to advise clients appropriately and ensure they are screened before treatment. Clinical facilitators (Tier 2) must be able to perform and interpret the screening themselves.

Can someone with a history of heart disease take ibogaine?

It depends on the specific cardiac condition. A history of arrhythmia or prolonged QTc is an absolute contraindication. Controlled hypertension or a history of myocardial infarction (with normal current EKG) may be a relative contraindication requiring additional precautions. A cardiologist consultation is essential for any patient with cardiac history.

Can someone on antidepressants take ibogaine?

SSRIs and SNRIs must be discontinued before ibogaine treatment — typically 2–4 weeks before (longer for fluoxetine due to its long half-life). MAOIs are an absolute contraindication and must be discontinued at least 2 weeks before treatment. Discontinuation must be managed medically to avoid withdrawal effects.

Is ibogaine safe for people with liver disease?

Ibogaine is metabolized by the liver (CYP2D6 and CYP3A4 enzymes). Severe liver disease significantly impairs ibogaine metabolism, increasing the risk of toxic accumulation. Mild to moderate liver disease may be manageable with dose reduction and enhanced monitoring, but severe liver failure is an absolute contraindication.

Can pregnant women take ibogaine?

No. Pregnancy is a contraindication for ibogaine. There is insufficient safety data for ibogaine in pregnancy, and the potential risks to the fetus are unknown. Women of childbearing age should take a pregnancy test before ibogaine treatment.