Conditions That Preclude Treatment
The following conditions represent absolute contraindications. Patients with these conditions will not be accepted for treatment, regardless of how compelling their clinical case may otherwise be.
Cardiac Contraindications
- Long QT syndrome (congenital or acquired, QTc >450ms)
- Brugada syndrome (Pattern 1 ECG findings)
- Wolff-Parkinson-White (WPW) syndrome
- Recent myocardial infarction (within 6 months)
- Congestive heart failure (NYHA Class III to IV)
- Second- or third-degree heart block
- History of sudden cardiac arrest or ventricular fibrillation
- Uncontrolled atrial fibrillation
Other Absolute Contraindications
- Hepatic failure or severe hepatic impairment (Child-Pugh C)
- Pregnancy or breastfeeding
- Cerebellar ataxia or significant cerebellar disease
- Active psychosis (schizophrenia, schizoaffective disorder, acute manic episode)
- Severe respiratory failure
- Active suicidal ideation with intent and plan
Why we say no — and the path from here
Roughly one in three people who complete our pre-screen is not accepted for treatment. Each line above exists for a reason we can explain — and being declined should come with a direction, not a closed door. Here is the reasoning behind the exclusions we are asked about most, what to do instead, and when a no can become a yes.
Active suicidal ideation with intent and plan
A residential retreat provides continuous medical supervision — not 24/7 inpatient psychiatric hospitalization. An active crisis needs the latter, and pretending otherwise would put you in danger.
If you are in the US, call or text 988 (Suicide & Crisis Lifeline) or go to the nearest emergency room now. Stay connected to your psychiatrist or crisis team.
After sustained stabilization under psychiatric care — commonly six months or more — we will reevaluate together with input from your treating clinician.
Long QT syndrome (QTc >450ms)
Ibogaine prolongs the cardiac QT interval. Adding that effect to an interval that is already long is the specific mechanism behind reported ibogaine fatalities — this line exists because of real deaths, not caution theater.
See a cardiologist about the underlying finding. If a medication is causing acquired QT prolongation, treating that may change your screening result.
Acquired prolongation that resolves (for example, after a medication change confirmed by repeat ECG) can be reevaluated. Congenital long QT syndrome is a permanent exclusion.
Active psychosis (schizophrenia, schizoaffective disorder, acute mania)
Ibogaine produces an intense, hours-long visionary state. In primary psychotic disorders that state can trigger severe decompensation that a retreat setting cannot safely manage.
Continuity with your psychiatric team is the safest care we can point you toward — changing or stopping antipsychotic medication to qualify for treatment would be dangerous, and we will never ask for it.
This is a permanent exclusion for primary psychotic disorders. We would rather tell you that plainly than leave you waiting.
Pregnancy or breastfeeding
There is no human safety data for ibogaine in pregnancy, and no responsible way to obtain it. The fetal risk is unknowable and therefore unacceptable.
Your obstetric team remains the right home for care decisions during this period.
This exclusion is time-bound, not personal: after pregnancy and breastfeeding conclude, standard screening applies as it would for anyone.
Recent myocardial infarction (within 6 months)
Healing heart muscle plus a QT-prolonging medicine is a combination our cardiac protocols are built to refuse. The six-month line follows post-MI cardiology practice.
Complete your cardiac rehabilitation and follow-up with your cardiologist.
After six months, with documented cardiology clearance and a clean screening ECG, reevaluation is routine.
Severe hepatic impairment (Child-Pugh C)
Ibogaine is metabolized by the liver into noribogaine, which drives much of its effect and its duration. Severe impairment makes blood levels unpredictable — and unpredictable is exactly what a cardiac-monitored protocol cannot be.
Hepatology care comes first; your liver team should know you were considering this treatment and why it was declined.
At Child-Pugh C this exclusion is, in practice, permanent. Milder impairment is a case-by-case review with recent labs.
This section follows our published screening criteria but has not yet completed review by our clinical team. It is educational, not medical advice.
Medication Contraindications & Requirements
MindScape accepts patients currently taking antidepressants and anti-anxiety medications. Medications marked managed are tapered onsite under continuous physician supervision using twice-daily ibogaine TA boosters — patients do not need to discontinue these before arrival. Medications marked critical remain absolute contraindications because their pharmacology cannot be safely bridged by TA boosters. Honest, complete medication disclosure is the foundation of safe treatment.
Not a contraindication when managed onsite. Patients arrive on their current SSRI or SNRI dose and are tapered at MindScape under continuous physician supervision using twice-daily ibogaine TA booster doses, which provide graduated serotonergic bridging that prevents serotonin syndrome and discontinuation symptoms. The flood dose is administered only after the supervised onsite taper has reached the protocol-defined safe threshold. Self-directed pre-arrival tapering is not required and is actively discouraged.
managedRequires a specific bridging protocol, transition to a short-acting opioid (typically morphine or oxycodone) for 7 to 14 days before treatment. Standard ibogaine protocols are not safe with active methadone on board. We manage this process with you.
criticalNot a contraindication when managed onsite. Patients arrive on their current benzodiazepine or Z-drug dose and are tapered at MindScape under 24/7 physician supervision with continuous cardiac and neurological monitoring. Twice-daily ibogaine TA boosters support the taper alongside short-acting benzodiazepine cover when clinically indicated to eliminate seizure risk during dose reduction. Short-acting agents (alprazolam, lorazepam) may be crossed over to diazepam onsite to smooth the pharmacokinetic curve. Pre-arrival self-tapering is not required.
managedClass I and III antiarrhythmics (amiodarone, sotalol, flecainide, quinidine) are absolute contraindications due to additive QT prolongation risk. Require thorough cardiac evaluation and cardiologist consultation.
criticalFluoroquinolones (ciprofloxacin, levofloxacin), azithromycin, and clarithromycin prolong QTc and must be completed and cleared before treatment. Minimum 5 half-lives clearance required.
highMust be discontinued with physician guidance prior to treatment due to neurotoxicity risk and QT effects. Requires careful tapering and monitoring.
criticalStrict contraindication. MAOIs must be completely cleared (minimum 14 days for irreversible MAOIs) before any ibogaine administration. Risk of hypertensive crisis and serotonin syndrome.
criticalLowers seizure threshold significantly. Must be discontinued and cleared prior to treatment. Tramadol withdrawal also requires careful management, discuss with our team.
highSupplement & Herbal Interactions
Many patients do not consider supplements “medications,” but several common herbal products interact with ibogaine at the metabolic or neurotransmitter level. Disclose everything you take — including health store supplements.
Potent CYP3A4 inducer that significantly alters ibogaine metabolism. Also raises serotonin levels, creating serotonin syndrome risk. Must be discontinued minimum 2 weeks prior to treatment.
criticalDirect serotonin precursor. Combined with ibogaine's serotonin reuptake effects, this creates serotonin syndrome risk. Discontinue minimum 1 week before treatment.
highPartial mu-opioid agonist with complex pharmacology. Requires tapering similar to opioid protocol. Some kratom products contain adulterants that compound the risk. See our kratom-specific treatment page for detailed guidance.
highHepatotoxic potential compounds ibogaine's hepatic metabolic burden. CYP2D6 inhibition may alter ibogaine clearance. Discontinue minimum 1 week before treatment.
highStrong CYP3A4 inhibitor that significantly alters ibogaine metabolism and may increase plasma levels. Avoid for at least 72 hours before treatment.
highGABAergic activity may interact with ibogaine's neurological effects. Discontinue at least 1 week before treatment. Generally lower risk than other items on this list.
moderateOTC Medications That Require Disclosure
Common over-the-counter medications can have clinically significant interactions with ibogaine. These are frequently overlooked because patients assume “it's just Benadryl” or “it's just cough medicine.” They are not benign in this context.
QTc-prolonging antihistamine. Multiple case reports of QTc prolongation at standard doses. Must be discontinued before treatment. Use cetirizine (Zyrtec) as alternative if antihistamine is needed pre-travel.
highNMDA antagonist and serotonin reuptake inhibitor. Combined with ibogaine, creates both serotonin syndrome and excessive NMDA modulation risk. Avoid all DXM-containing cough/cold products for at least 1 week before treatment.
criticalAt standard doses (2-4mg), minimal concern. At high doses sometimes used by opioid-dependent patients for withdrawal management, loperamide causes QTc prolongation and cardiac risk. Disclose all usage to our medical team.
highSympathomimetic decongestants may elevate heart rate and blood pressure during treatment. Discontinue at least 48 hours before treatment. Saline nasal spray is a safe alternative.
moderateConditions Requiring Case-by-Case Review
Relative contraindications do not automatically exclude a patient from treatment. they require individualized evaluation, additional testing, and possibly protocol modifications.
Required Pre-Treatment Evaluations
12-Lead ECG
The single most critical pre-screening test. Must be interpreted by a physician reviewing QT interval, QRS morphology, and Brugada pattern. Required within 30 days of treatment.
Comprehensive Metabolic Panel (CMP)
Evaluates kidney function (BUN, creatinine), liver enzymes (ALT, AST, ALP), electrolytes (critical for QT assessment), and glucose. Must be within 30 days of treatment.
Liver Function Panel
Total bilirubin, direct bilirubin, albumin, PT/INR. Assesses hepatic capacity to metabolize ibogaine (primarily CYP2D6). Critical for safe dosing.
Complete Blood Count (CBC)
Evaluates baseline hematologic status. Anemia, thrombocytopenia, or leukopenia may require evaluation prior to treatment.
Urine Drug Screen (UDS)
10-panel minimum. Required to confirm accuracy of reported substance use and identify any undisclosed substances that could create dangerous interactions.
Pregnancy Test
Required for all patients who could be pregnant. Ibogaine is absolutely contraindicated in pregnancy.
CYP2D6 Genotyping
Ibogaine is primarily metabolized by CYP2D6. Poor metabolizers (~7% of population) face significantly higher plasma levels and require dose adjustment. Strongly recommended.
Echocardiogram
Required for patients with any cardiac history, ECG abnormalities, or significant cardiovascular risk factors. Evaluates structural heart disease and ejection fraction.
How We Keep You Safe During Treatment
Continuous Cardiac Monitoring
Telemetry-grade ECG monitoring throughout the active treatment window and recovery period. QTc is tracked continuously. Any QTc prolongation >500ms triggers immediate clinical protocol.
Vital Signs q30min
Blood pressure, pulse, oxygen saturation, and temperature are recorded every 30 minutes throughout the acute experience. More frequent if any parameter is outside normal range.
Emergency Medications On-Site
IV magnesium sulfate (for QT management), lidocaine, epinephrine, atropine, defibrillator, and full ACLS medication kit are immediately accessible throughout every treatment.
Board-Certified Physicians
Our medical director and supervising physicians hold board certifications in emergency medicine, internal medicine, and/or anesthesiology. Not nurses. Physicians.
Hospital Transfer Protocol
A signed hospital transfer agreement with a cardiac-capable hospital within 20 minutes of our facility. If transfer is needed, it happens immediately, not after deliberation.
No Overbooking Policy
We treat one patient at a time per physician. Medical oversight is never diluted by treating multiple patients simultaneously with complex protocols.
Who Should Not Do Ibogaine
We turn away patients when it is the right thing to do. This is not a commercial consideration. it is a medical one.
- Anyone with a confirmed cardiac conduction abnormality who has not completed full cardiac workup
- Anyone currently taking methadone who has not completed our bridging protocol
- Anyone with active, untreated psychosis
- Anyone who is pregnant or may be pregnant
- Anyone in hepatic failure
- Anyone who is unwilling to disclose their complete medication list
- Anyone seeking ibogaine as a single magic solution without commitment to integration
- Anyone whose medical team has clearly contraindicated the treatment after full review
Find Out If You Are a Candidate
Our prescreen takes 15 minutes and gives you and our medical team the information needed to make an honest assessment. If you are not a candidate, we will tell you, and help you understand what your options are.
Get Screened