Psychedelic Therapy: A Primer for Primary Care Clinicians—Ibogaine
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Clinician primer covering safety (33 deaths, cardiotoxicity, Mg protection), OUD efficacy (50-65% craving reduction), veteran PTSD outcomes (86% remission). Only 1 RCT exists.
Dosing: 6–30 mg/kg (cited as typical therapeutic range in neurotoxicity comparison — not a prescribing recommendation) (not-specified)
Contraindications: Pre-existing cardiac conditions (coronary artery sclerosis, hypertension, myocardial infarct, cardiac hypertrophy, dilated cardiomyopathy) [evidence: fatality review — 6/19 cases], Prolonged baseline QT interval, including drug-induced (antibiotics, antidepressants) [evidence: hERG channel mechanism + clinical pharmacology], hERG mutations associated with long-QT syndrome [evidence: genetic/mechanistic literature], Concurrent long-acting opioids — must switch to short-acting opioids up to two weeks in advance [evidence: fatality review + pharmacokinetic interaction — nearest operational exclusion], Poor CYP2D6 metabolism (risk factor for impaired ibogaine clearance; methadone also inhibits CYP2D6) [evidence: pharmacokinetic rationale], Motor impairment conditions (Parkinson's disease, multiple sclerosis) [evidence: precautionary principle only — 'has yet to be investigated in a study'], Concurrent QT-prolonging medications — antibiotics, antidepressants (no washout intervals specified in this paper), Multiple concurrent substance addictions (polysubstance use increases fatality risk) [evidence: fatality review — deaths with concurrent cocaine, alcohol, methamphetamine], History of mania or psychosis (3 reported cases, all in unregulated settings) [evidence: case reports — protocol adherence unknown]