An electrocardiogram (ECG or EKG) tracing.
For those considering a full session for chemical dependence, an effective dose is advised. (See: Ibogaine Therapy: Forms & Dose Regimens by Howard Lotsof, USA). Extreme care should be taken to ensure that the % ibogaine that one is taking is established beforehand. For this reason ibogaine HCl is generally preferred as the dose is definitive.
A chemically dependent person whose health has been compromised is at higher risk of post-session fatality due to the intense physical & psychological nature of a high-dose session combined with other medical factors, such as vascular disease, which may not emerge in the pre-session screening or safety checks. Consequently many chemically dependent persons take ibogaine as an option of last resort knowing full well the risks they are taking (please see Fatalities).
Dangers of Dehydration:
Dehydration is a very serious issue in the taking of ibogaine.
In the days leading up to the session one should drink plenty of liquids. It is advised to fast from liquids some hours before the session and this does have the advantage of a quicker uptake of the ibogaine into the bloodstream on the back of the water taken at the time of ingestion as the body is dehydrated – 1 or 2 glasses of water can be drunk at this time.
However, dehydration does occur during the session and water should be drunk at regular intervals during the session (e.g. 1 glass drunk in stages from one urination to the next), and most certainly should be drunk post-session and in the days following the session.
Post session one can have a false sense that one does not require liquids or ones appetite may be low. This can cause problems as one continues to dehydrate post session. Therefore one should continue to drink plenty of water in the days following even if one does not feel the need. One should also try to eat sensibly.
If one has problems post session due to dehydration taking glucose and water can help recovery. High fibre foods, such as brown rice, are a good source of water as they allow the body to manage its own absorption rate.
Determination of Ibogaine to Nor-Ibogaine Metabolism:
A genetic test can be performed for the presence of the enzyme CYP2D6 in the liver, the principle enzyme via which ibogaine is metabolized to noribogaine, as this will have a significant impact on the session itself. This test can be purchased online at eviCore healthcare. CYP2D6 mediated metabolism of ibogaine results in high levels of noribogaine in the blood while in CYP2D6 deficient subjects the oncentrations are markedly lower. See: CYP2D6 metabolism of Ibogaine. See also p.4: Graphs of Ibogaine vs Nor-ibogaine Concentrations in Different Metabolizers.
This can be aided by exercise, hot baths, body work, healthy foods, fluids, Vitamins, B-Complex and of course plenty of clean water. Becoming grounded in this period is something to be aware of. For some sexual practise is a way to achieve this.
Melatonin can be taken for the first 2 weeks to help in sleep recovery.
Many recovering from addiction chose to smoke marijuana.
Make a Plan:
For those in recovery from drug dependence it is advised to have a plan beforehand for a change in lifestyle, i.e., make arrangements that allow you to start anew and leave behind the old haunts and friends who you associate with your drug dependence. A change of job may be in order etc. Without putting in place a new healthy lifestyle the odds are stacked towards relapse.
1. Session Pre-requisites:
Prior to undergoing an ibogaine session the following minimum tests should be undertaken:
(i) Blood Test with Liver Panel: Check for liver abnormalities, blood count and general health.
(ii) A Stress Tested EKG Test: Checks the functioning of the heart while under stress.
(ii) Test Dose: Preferably 24 hours before otherwise 1 hour before. Take 100mg to check for any adverse reactions.
n.b: These tests will not pick up adverse conditions such as vascular disease which when combined with a high-dose session can lead to post-session fatality. If in doubt consider a heart stress test and a 24-Hour Heart Holtor.
2. Basis of Exclusion from Session:
(i) Liver Problems: the liver is important in the processing of ibogaine. See: The Many Functions of the Liver. For those whose livers have been compromised, taking Milk Thistle (Silybum Marianum) over a period of months can help considerably to improve liver function. Also, Livotrit Plus, or Liver 52 is a classic Ayurvedic mix that reportedly will rebuild a liver even from very injured conditions.
(ii) Heart: The biggest concern related to ibogaine use is that ibogaine lowers the heart rate (bradycardia) and prolongs the QT Interval, a measure of the time between the start of the Q wave and the end of the T wave in the heart’s electrical cycle. Therefore, people with a history of heart attack, heart murmurs, arrhythmia, heart operation or severe obesity should not take ibogaine. Ibogaine can be very physically demanding at high doses. One can self test by going for a jog and running until one’s heart is beating hard. If it doesn’t hurt and you feel fine and there is no chest pain and no breathing problems then you may be in good shape. This however does not in any way excude the need for a proper EKG test. This test however is not conclusive. If in doubt consider a 24-hour heart holter which is much better than a straight EKG test. Alternatively, a stress tested EKG can be carried out.
(iii) Lungs: Another risk factor is pulmonary embolism which can result from blood clots in the veins resulting from long airplane journeys, a car accident, or blood-related diseases. During an ibogaine session these blood clots can end up in the lungs leading to an embolism with the resulting risk of suffocation. This risk can be reduced by doing sports or movement exercises prior to treatment.
(iv) Psychiatric Problems: Personality disorders can manifest in a session and present problems for the provider which they may not be able to manage. Depression and mood-disorders are not a reason for exclusion. However certain personality types are not suited to ibogaine/eboga and in such cases the risk of death is greater (in the unhealthy individual) as the heart enters a struggle of repression to keep eboga out and the repression in.
(v) Pregnancy and other conditions.
(vi) Interactions of drugs already in the body.
Regarding suitability, at low doses (typically around 300-400 mg) the energy of eboga will undermine whatever defenses are in place and thus the need to find relief from the rising pain, if not entered into, can lead to an unreasonable projection of anger (subsequent to a session) onto those in the environment. In such an individual (e.g. a psychopath – someone who typically has high verbal intelligence, but lacks what is commonly referred to as “emotional intelligence”) the eboga empowered self has becomed trapped in shadow influenced ego fueled activity rather than in entering the soul via the heart to progress with the healing of what lies there, i.e., avoidance. In this authors opinion such behaviour can indicate the unpreparedness or inappropriate disposition of the one seeking eboga healing or perhaps the need for proper psychiatric care while under the influence of eboga, before, during and after. Of course this behaviour may be understandable to a degree given the circumstances of a session. However, it can also be a warning sign regarding a persons true intentions & awareness especially if the person undergoing treatment cannot perceive or consider the nature of their projections of rage. Further eboga work would have to be considered very carefully, particularly at the low dose level where one retains a lot of ego/shadow & body control. Simply put: projecting rage (rather than connecting rage) can be damaging to others while it has little or no healing benefit for the person under treatment other than perhaps as part of a greater plan.
Certain similarities can be drawn between LSD psychotherapy and low dose ibogaine therapy as the following suggests:
“Observation from LSD psychotherapy suggest very strongly that the intensity of transference is directly proportional to the resistance to facing the original traumatic material.” LSD Psychotherapy by Stan Grof.
“Most of the technical problems in the sessions occur when the client, instead of treating the experience as an internal process, projects the emerging unconscious material onto the sitters and the treatment situation.” LSD Psychotherapy by Stan Grof.
Likewise in the same individual a high dose session may have added risk as the energy of eboga seeks to open the heart which can concieveably lead to a heart attack in the individual who has underlying cardiovascular problems and resists this movement. Hence, in part, why an EKG is required.
4. Heart EKG & QT Interval:
Based on: A Clinician’s View of Ibogaine Detoxification – Jeffrey Kamlet, MD- Certified American Society of Addiction Medicine.
Fruit juices are not advised at the time of session. Particularly do not drink grapefruit juice as it requires the same enzyme pathway known as Cytochrome, P450- 2D6, that is used by the liver to metabolize ibogaine into nor-ibogaine.
“Ibogaine, like many other drugs that are metabolized by c450-2D6, may produce a lengthening of the QT interval.” “The QT interval is the section on an electrocardiogram (EKG) that indicates the time it takes for the heart’s electrical system to fire an impulse through the ventricles and then recharge itself. A prolonged QT interval may lead to a potentially fatal disorder known as Torsades de Pointes.
An ibogaine pretreatment EKG, may indicate whether there is a preexisting prolonged QT interval in the patient and allow the physician to determine whether the patient should be treated with ibogaine or not.” “Many prescription and over the counter medications as well as foods and other substances are known to prolong the QT interval by this same metabolic pathway. Thus, all QT prolonging substances should be discontinued for at least four half lives of that substance, prior to treatment with ibogaine. Substances such as grapefruit and quinine are known potent QT prolongers.
It is therefore important that Ibogaine screening include an EKG to evaluate the Q-T length.”
n.b. While the QT interval is an area of concern, as such, there is no definitive evidence that is is a factor in heart related fatalities as no one knows what would occur if medical intervention were not undertaken.
5. 24-Hour Heart Holtor:
Based on: A Clinician’s View of Ibogaine Detoxification – Jeffrey Kamlet, MD- Certified American Society of Addiction Medicine.
“Dr. Kamlet also recommended ibogaine patients obtain a 24 hour Holter monitor prior to treatment with ibogaine. This 24 hour record of your heart provides more information regarding the QT interval and also screens for ventricular extra heartbeats (PVC’S) which can occur during ibogaine therapy. Dr. Kamlet indicated that an extremely low number of patients experienced significant ventricular ectopy (irregular heart beats) while under ibogaine and that the heart’s response to the anti arrthymic drug lidocaine, was very affective, requiring only a small amount of lidocaine to stabilize the heart. Ibogaine patients, who are smokers or have abused stimulants or sedatives, may be more prone to ventricular ectopy while on ibogaine due to cardiac hyperexcitability. Careful attention should be paid to cardiac monitoring while on ibogaine. It is important that a medical professional who is able to differentiate Ventricular ectopy from Torsades be present during treatment. These two possible arrthymia’s have very different treatments and misinterpretation of the EKG and subsequent inaccurate treatment may have serious consequences.”
6. Treatment for Chemical Dependence:
Ibogaine has been shown to be effective in the treatment of addiction to opiates, cocaine, amphetamine, alcohol and nicotine as well as methadone. It has been shown to be “non-toxic” (less toxic than aspirin) and does not create dependency.
Danger: Alcohol & Benzos
Do not use ibogaine without proper supervision for withdrawal from dependence to alcohol or benzos as seizures can occur. For more information on treatment of different drugs please see Treatment Types.
7. Fasting & Abstinence:
(i) All drug use, food & liquids should cease at least 10 hours before the session. In the case of chemical dependence treatment, the client can go to sleep after their last drug use and begin treatment in the morning. Within an hour of administration the onset of withdrawal symptoms should disappear.
(ii) It is good to eat properly (& to drink plenty of water) in the days prior to the session in such a way that ones digestive tract is as empty as possible prior to the session. Ibogaine pushes down on this area and sometimes brings on a strong desire to empty one’s bowels.
(iii) The stomach needs to be empty.
8. Session Dangers:
(i) Nausea: Ataxia (loss of muscular coordination similar to drunkenness) while trying to move is very common. Should the client be unattended there is a possibility of choking. Apart from this, vomiting in the first 2 to 3 hours leads to a loss of undissolved ibogaine, thus undermining the session. The client should be properly fasted with minimal need to use the toilet, and encouraged to move as little as possible. Initially rythmic breathing can be used to ensure the initial uptake is less nausous. Sea sickness pills (Medramine) can be taken prior to taking ibogaine to help against the onset of vomiting as can ginger tea. However it is best to take a liquid preparation rather than pills.
(ii) Ibogaine potentiates opiates that are still in the system. Opiates taken during a session can lead to overdose as ibogaine resets the users tolerance to the pre-dependence state. It should be remembered that during a session a client is likely to feel exhausted. However, this passes after a period of sleep usually in the last part of the session and is not a symptom of withdrawal.
(iii) Be careful when you are relaxing or the position you take in the bed as iboga relaxes the muscles and it is quite possible that, if one is predisposed, one can find ones back out post-session.
9. Post-Session Safety Issues:
(i) Do not drive for a period of time as your reflexes are considerably less: accidents have happened.
(ii) If you feel the need to use drugs remember that your tolerance has been reset to the pre-addictive state. If you use the same quantity as before treatment there is a strong possibility that you will kill yourself from an overdose.
(iii) Out of the ordinary mood changes etc, will in time balance themselves out.
(iv) Remember to rehydrate by drinking lots of water in the days following treatment.
(v) Physical discomfort symptoms in this period are attributed to the effects of ibogaine cleaning the body as opposed to being withdrawal symptoms.
10. Safety Precautions:
(i) Calcium/Magnesium: According to one author the use of an acute dose of calcium(1000mg)/magnesium one or two hours prior to administration of the ibogaine can be taken as a limited form of protection against acute adverse cardiac events. Absorption is better if taken as an oral solution. Failing that crushing a tablet or opening a capsule into some lemon water or vinegar water helps these minerals to be absorbed easier. Coral calcium is reportedly the best form of calcium to use.
(ii) Dehydration: Take care not to be dehydrated!
n.b. Omega-3 & Omega 6 oils are reported to be of benefit. An editorial in Circulation: Journal of the American Heart Association suggests that increasing dietary omega-3 fatty acids, which come from fatty fish or flaxseed oil, and decreasing omega-6 fatty acids, found in plant seed oils such as corn, safflower, and sunflower, is a way to reduce the risk of sudden death from irregular heart rhythms or heart attacks.