Clinical Guidelines for Ibogaine-Assisted Detoxification
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GOLD STANDARD: Comprehensive ibogaine clinical guidelines. ISO31001 risk framework, absolute contraindications, electrolyte targets (K 4.5-5.5, Mg 1.5-2.5), medication clearance timelines.
Dosing: ≤12mg/kg (max 24mg/kg/24h); test dose 2–3mg/kg; boosters 1–5mg/kg (oral)
Safety data present: QTC, HERG, ELECTROLYTE
Contraindications: QTc >450ms (M) or >470ms (F); borderline 430-470ms requires cardiologist review; >500ms requires immediate hospital transfer, Schizophrenia, Bipolar disorder (hospitalised/medicated), Depersonalisation and/or derealisation disorder, Cerebellar dysfunction, Psychosis or acute confusional state, Organic brain disease or dementia, Epilepsy (rule out benzodiazepine/alcohol withdrawal seizures misdiagnosed as epilepsy), Heart failure, enlarged/hypertrophic heart, Active blood clots (PE, DVT), Major respiratory conditions (emphysema, COPD, cystic fibrosis), Severe/chronic GI issues (bleeding ulcer, leaky gut syndrome), Abnormal electrolytes — must correct to preferred ranges: K 4.5-5.5 mEq/L, Mg 1.5-2.5 mEq/L, Liver enzymes >2.5x normal; impaired kidney function; abnormal BUN/creatinine, Active infection or abscess, Within 6 months of major surgery (require physician clearance), Pregnancy, QT-prolonging medications, foods and supplements (must be cleared), CYP2D6-metabolised drugs (competition for ibogaine metabolic pathway), Serotonin-increasing medications — SSRIs, SNRIs, MAOIs, buspirone, trazodone, tramadol, St John's Wort (serotonin syndrome risk), Centrally acting drugs — blood pressure medications, barbiturates, muscle relaxants, antipsychotics, anticonvulsants, general anaesthetics (interactions not well understood), Benzodiazepine or alcohol withdrawal (seizure risk — must be stabilised, never ceased acutely; factor in multiple fatalities), Stimulant use: cocaine ≥7 days clearance; methamphetamine ≥5 days; prescription stimulants ≥5 days; caffeine ≥5 days, Antipsychotic medications — haloperidol/chlorpromazine cause prolonged negative reactions with ibogaine; must not be used as intervention, Corticosteroids (prolong QT interval; caution if required as intervention), Calcium channel blockers or beta blockers (lower BP/HR dramatically, alter cardiac conduction — beta blockers must be tapered over 7-14 days, not stopped acutely)