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.
Many medications can be safely managed with the right protocol, but this requires honest, complete disclosure. Withholding medication information is the single greatest risk factor we encounter.
Must be tapered and discontinued for a minimum of 2 weeks before treatment (4 to 6 weeks preferred for fluoxetine due to long half-life). Risk: serotonin syndrome. Taper must be physician-supervised.
criticalRequires 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.
criticalLow doses taken as prescribed may be managed with guidance. High-dose or long-term benzodiazepine use requires a physician-supervised taper prior to treatment. Ibogaine does not address benzo dependence. we are honest about this.
highClass 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.
highMany 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.
moderateCommon 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.
moderateRelative contraindications do not automatically exclude a patient from treatment. they require individualized evaluation, additional testing, and possibly protocol modifications.
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.
Evaluates kidney function (BUN, creatinine), liver enzymes (ALT, AST, ALP), electrolytes (critical for QT assessment), and glucose. Must be within 30 days of treatment.
Total bilirubin, direct bilirubin, albumin, PT/INR. Assesses hepatic capacity to metabolize ibogaine (primarily CYP2D6). Critical for safe dosing.
Evaluates baseline hematologic status. Anemia, thrombocytopenia, or leukopenia may require evaluation prior to treatment.
10-panel minimum. Required to confirm accuracy of reported substance use and identify any undisclosed substances that could create dangerous interactions.
Required for all patients who could be pregnant. Ibogaine is absolutely contraindicated in pregnancy.
Ibogaine is primarily metabolized by CYP2D6. Poor metabolizers (~7% of population) face significantly higher plasma levels and require dose adjustment. Strongly recommended.
Required for patients with any cardiac history, ECG abnormalities, or significant cardiovascular risk factors. Evaluates structural heart disease and ejection fraction.
Telemetry-grade ECG monitoring throughout the active treatment window and recovery period. QTc is tracked continuously. Any QTc prolongation >500ms triggers immediate clinical protocol.
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.
IV magnesium sulfate (for QT management), lidocaine, epinephrine, atropine, defibrillator, and full ACLS medication kit are immediately accessible throughout every treatment.
Our medical director and supervising physicians hold board certifications in emergency medicine, internal medicine, and/or anesthesiology. Not nurses. Physicians.
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.
We treat one patient at a time per physician. Medical oversight is never diluted by treating multiple patients simultaneously with complex protocols.
We turn away patients when it is the right thing to do. This is not a commercial consideration. it is a medical one.
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