Ibogaine: complex pharmacokinetics, concerns for safety, and preliminary efficacy measures

ABSTRACT: Ibogaine is an indole alkaloid found in the roots of Tabernanthe Iboga (Apocynaceae family), a rain forest shrub that is native to western Afri-ca. Ibogaine is used by indigenous peoples in low doses to combat fatigue, hun-ger and thirst, and in higher doses as a sacrament in religious rituals. Members of American and European addict self-help groups have claimed that ibogaine promotes long-term drug abstinence from addictive substances, including psychostimulants and opiates. Anecdotal reports attest that a single dose of ibogaine eliminates opiate withdrawal symptoms and reduces drug craving for extended periods of time. The purported efficacy of ibogaine for the treatment of drug dependence may be due in part to an active metabolite. The majority of ibogaine biotransformation proceeds via CYP2D6, including the O-demeth-ylation of ibogaine to 12-hydroxyibogamine (noribogaine). Blood concentra-tion-time effect profiles of ibogaine and noribogaine obtained for individual subjects after single oral dose administrations demonstrate complex pharma-cokinetic profiles. Ibogaine has shown preliminary efficacy for opiate detoxifi