Iboga Plant Medicine and Pharmaceuticals

In this article we will discuss in depth the very important subject of pharmaceutical medications that are contraindicted with Iboga use. If you are currenlty taking medications and would like support to wean down and/or cease use in preperation for Iboga Plant Medicine, ask us about our Medication Support Program. We look forward to helping you on the path to true and lasting healing!

When considering the use of Iboga (Tabernanthe iboga) or its primary alkaloid, ibogaine, it is crucial to identify contraindicated pharmaceuticals due to the plant's potent effects on the central nervous system, cardiovascular system, and its interaction with enzymes like CYP2D6. Below is a list of pharmaceuticals that are generally contraindicated or should be used with extreme caution:

1. Antidepressants:

• Selective Serotonin Reuptake Inhibitors (SSRIs):

  • Fluoxetine (Prozac)

  • Sertraline (Zoloft)

  • Paroxetine (Paxil)

  • Citalopram (Celexa)

  • Escitalopram (Lexapro)

• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

  • Venlafaxine (Effexor)

  • Duloxetine (Cymbalta)

• Monoamine Oxidase Inhibitors (MAOIs):

  • Phenelzine (Nardil)

  • Tranylcypromine (Parnate)

  • Selegiline (Emsam)

  • Risk: Serotonin syndrome, hypertensive crisis, and other serious complications.

• Tricyclic Antidepressants (TCAs):

  • Amitriptyline

  • Nortriptyline

  • Imipramine

  • Risk: Cardiotoxicity and interactions leading to arrhythmias.

2. Antipsychotics:

• Risperidone (Risperdal)

• Olanzapine (Zyprexa)

• Quetiapine (Seroquel)

• Haloperidol (Haldol)

• Risk: QT prolongation and increased risk of arrhythmias.

3. Stimulants and Psychoactive Substances:

• Amphetamines (e.g., Adderall, Vyvanse)

• Methylphenidate (e.g., Ritalin, Concerta)

• Cocaine

• MDMA (Ecstasy)

• Methamphetamine

• Risk: Overstimulation of the central nervous system, cardiac complications, and seizures.

4. Opiates and Opioids:

• Morphine

• Codeine

• Fentanyl

• Hydrocodone (Vicodin)

• Oxycodone (OxyContin)

• Methadone

• Buprenorphine (Suboxone, Subutex)

• Risk: Potentially dangerous respiratory depression, exacerbation of withdrawal symptoms.

5. Benzodiazepines and Sedatives:

• Diazepam (Valium)

• Lorazepam (Ativan)

• Alprazolam (Xanax)

• Clonazepam (Klonopin)

• Barbiturates (e.g., Phenobarbital)

• Risk: Synergistic effects on the central nervous system, respiratory depression.

6. Cardiovascular Medications:

• Beta-blockers:

  • Metoprolol

  • Atenolol

  • Risk: Compounded bradycardia and hypotension.

• Calcium Channel Blockers:

  • Verapamil

  • Diltiazem

  • Risk: Cardiac conduction issues.

• Antiarrhythmics:

  • Amiodarone

  • Quinidine

  • Risk: Increased risk of QT prolongation and torsades de pointes.

7. Anticonvulsants:

• Phenytoin (Dilantin)

• Carbamazepine (Tegretol)

• Valproic Acid (Depakote)

• Risk: Altered seizure thresholds and potential neurotoxicity.

8. CYP2D6 Substrate Medications:

Ibogaine is metabolized by the CYP2D6 enzyme, so any drug metabolized by this pathway can lead to toxic buildup or inhibited metabolism:

• Codeine

• Tramadol

• Fluoxetine

• Paroxetine

9. Antihistamines (with sedative or QT-prolonging effects):

• Diphenhydramine (Benadryl)

• Hydroxyzine (Vistaril)

• Promethazine (Phenergan)

• Risk: QT prolongation and increased risk of arrhythmias.

10. Miscellaneous:

• Anti-nausea medications with QT-prolonging potential:

  • Ondansetron (Zofran)

  • Metoclopramide (Reglan)

• Alcohol:

  • Risk: Central nervous system and respiratory depression.

Key Considerations:

• QT Prolongation Risk: Iboga and ibogaine are known to prolong the QT interval on an electrocardiogram, increasing the risk of life-threatening arrhythmias. Avoid combining with any drug that also prolongs the QT interval.

• Polypharmacy: Combining multiple contraindicated drugs can exponentially increase risks.

• Medical Supervision: Anyone considering iboga treatment should undergo thorough screening for drug interactions and medical conditions.

Recommendation:

Before using iboga, consult a healthcare professional knowledgeable in psychotropic medicines, detox protocols, and potential drug interactions. Cardiovascular screening (e.g., EKG) is also strongly recommended.

Taking Iboga (or its active alkaloid ibogaine) while using Selective Serotonin Reuptake Inhibitors (SSRIs) is dangerous because of several significant pharmacological and physiological interactions. These risks stem from how ibogaine affects neurotransmitter systems, cardiac function, and metabolism. Here's an explanation of the key dangers:

1. Risk of Serotonin Syndrome

• What is serotonin syndrome? Serotonin syndrome occurs when there is an excessive accumulation of serotonin in the brain, leading to overstimulation of serotonin receptors. Symptoms range from mild (agitation, sweating, diarrhea) to severe (seizures, hyperthermia, and even death).

• How does iboga contribute? Ibogaine has been shown to modulate serotonin pathways. When combined with SSRIs, which increase serotonin levels by preventing its reuptake, the two substances can synergistically amplify serotonin activity, increasing the risk of serotonin syndrome. This is especially dangerous during the long duration of ibogaine's effects.

2. Cardiotoxicity and QT Prolongation

• Both iboga and SSRIs are associated with prolongation of the QT interval on an electrocardiogram (ECG). A prolonged QT interval indicates delayed electrical repolarization of the heart, which can lead to torsades de pointes, a life-threatening type of arrhythmia.

• Iboga's cardiac effects:Ibogaine significantly prolongs the QT interval, even at therapeutic doses.

• SSRIs with QT effects:Some SSRIs, such as citalopram and escitalopram, can also prolong the QT interval. Combining these substances compounds the risk of severe arrhythmias.

3. CNS Overstimulation and Seizures

• Ibogaine affects multiple neurotransmitter systems, including serotonin, dopamine, and NMDA receptors. This can cause central nervous system (CNS) hyperactivity, which may manifest as agitation, hallucinations, or seizures.

• SSRIs can also lower the seizure threshold in some individuals. The combination of iboga and SSRIs heightens the risk of seizures, which are not only dangerous on their own but can lead to secondary complications like aspiration or trauma.

4. Metabolic Interactions via CYP Enzymes

• Ibogaine is metabolized by the CYP2D6 enzyme, a key liver enzyme also involved in the metabolism of many SSRIs (e.g., fluoxetine, paroxetine).

• CYP2D6 inhibition:Both ibogaine and SSRIs inhibit CYP2D6, leading to a slower breakdown of either substance. This can cause ibogaine and the SSRI to reach toxic levels in the bloodstream, significantly increasing the risks of side effects and toxicity.

5. Psychological Overload

• Ibogaine induces an intense psychoactive experience that can bring up repressed memories, emotions, and trauma. This experience may be amplified or destabilized by the presence of SSRIs, which also alter emotional processing.

• The combination can result in heightened anxiety, panic, or overwhelming psychological distress, especially in individuals already prone to anxiety or depression.

6. Potential for Increased Withdrawal Symptoms

• If someone stops SSRIs abruptly to take iboga, they may experience SSRI discontinuation syndrome (withdrawal symptoms such as dizziness, nausea, mood swings, or brain zaps). This can compound the physical and psychological challenges of the iboga experience.

Conclusion: A High-Risk Combination

The combination of iboga and SSRIs presents severe risks, including serotonin syndrome, cardiac arrhythmias, seizures, and toxicity due to metabolic interactions. It is essential to completely discontinue SSRIs under medical supervision well in advance (often several weeks, depending on the SSRI) before considering iboga treatment. Furthermore, individuals should consult with a healthcare provider experienced in iboga therapy to evaluate their readiness and ensure safe practices.

Guidelines for Safely Weaning Off Depression and Anxiety Medications

Deciding to stop taking medications for depression or anxiety is a significant step that requires careful planning, patience, and medical guidance. While it’s possible to safely taper off these medications, doing so improperly can lead to withdrawal symptoms, a return of symptoms, or other health complications. This guide outlines steps to help you navigate the process thoughtfully and effectively.

1. Assess Your Readiness

Before starting the tapering process, reflect on why you want to stop your medication:

• Have your symptoms improved significantly?Discuss whether your progress has been stable enough to consider tapering. Many experts recommend at least six months of symptom stability before making changes.

• Do you have strong support systems?Family, friends, or a therapist can help provide emotional support during this transition.

If you’re unsure about your readiness, speak openly with your healthcare provider to weigh the benefits and risks of discontinuing your medication.

2. Consult Your Healthcare Provider

Always consult your prescribing doctor before changing or discontinuing your medication. Abruptly stopping many antidepressants or anti-anxiety drugs can lead to withdrawal symptoms (also known as discontinuation syndrome) or cause a relapse. Your doctor can:

• Develop a tapering schedule tailored to your specific medication and dosage.

• Monitor your progress for any side effects or returning symptoms.

• Adjust the plan if needed.

3. Understand Your Medication

Different classes of medications require different tapering approaches. Understanding how your medication works can help you navigate the process.

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Examples: Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa).

• Tapering tip: These generally require a gradual reduction over weeks or months.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• Examples: Venlafaxine (Effexor), Duloxetine (Cymbalta).

• Tapering tip: SNRIs often cause more pronounced withdrawal symptoms and may need a slower taper.

Benzodiazepines

• Examples: Lorazepam (Ativan), Alprazolam (Xanax).

• Tapering tip: These should be tapered extremely slowly to prevent withdrawal or seizures.

Tricyclic Antidepressants (TCAs)

• Examples: Amitriptyline, Nortriptyline.

• Tapering tip: These require slow tapering to avoid side effects like dizziness or nausea.

4. Follow a Slow Tapering Schedule

Tapering is the process of gradually reducing your medication dosage. The speed of tapering depends on factors like the medication type, dosage, and duration of use. A common approach is to reduce the dose by 10-25% every 2-4 weeks, but this can vary.

• Start small: Even minor reductions can trigger withdrawal symptoms for some people. It’s better to reduce slowly and adjust as needed.

• Monitor progress: Keep a journal to track how you feel physically and emotionally after each reduction.

5. Manage Withdrawal Symptoms

Withdrawal symptoms can occur as your body adjusts to lower levels of medication. Common symptoms include:

• Mood changes (irritability, sadness, anxiety)

• Insomnia

• Dizziness or lightheadedness

• Flu-like symptoms

• Brain zaps (electrical shock sensations)

Strategies to cope with withdrawal:

• Stay hydrated: Dehydration can worsen symptoms.

• Practice self-care: Prioritize sleep, exercise, and a balanced diet.

• Consider supplements: Omega-3 fatty acids, magnesium, and other supplements may help support brain health (consult your doctor first).

If symptoms become overwhelming, talk to your doctor about temporarily slowing down or pausing the taper.

6. Seek Non-Medication Support

As you taper, incorporating non-medication strategies can help you manage anxiety or depression:

• Therapy: Cognitive Behavioral Therapy (CBT) and other modalities can provide tools to navigate emotions and build resilience.

• Mindfulness and meditation: Practices like deep breathing or progressive muscle relaxation can help reduce stress.

• Exercise: Regular physical activity releases endorphins and supports mood stability.

7. Be Prepared for Setbacks

It’s common to experience challenges during this process, including the return of symptoms. This doesn’t mean tapering isn’t possible; you may simply need to slow down or adjust your approach. Staying flexible and communicating with your doctor is key.

8. Know When to Stop

Stopping medication completely is a decision that should only be made in consultation with your healthcare provider. Even after fully discontinuing, it’s essential to:

• Monitor your mental health closely for the first 6-12 months.

• Maintain regular therapy or other support systems.

9. Maintain a Healthy Lifestyle

Building a solid foundation for your mental health can help ensure long-term success after tapering off medication:

• Diet: Focus on nutrient-rich foods that support brain health, like leafy greens, fatty fish, and whole grains.

• Sleep hygiene: Stick to a regular sleep schedule to support emotional stability.

• Social connections: Stay connected with loved ones and engage in community activities.

Final Thoughts

Weaning off depression or anxiety medication is a gradual and individualized process. With medical guidance, a slow tapering schedule, and strong support systems, many people can successfully transition away from medication. Remember, there’s no shame in needing to pause or restart your medication if symptoms return—it’s all part of taking care of your mental health.