Ibogaine and Mirtazapine

Major risk. Frequently prescribed in detox for sleep and appetite, so it is often not reported as an antidepressant. Noradrenergic and specific serotonergic action carries serotonin syndrome risk with noribogaine, plus reported QTc prolongation. Physician-supervised taper before treatment. Do not restart for 14 days post-treatment.

Pre-arrival washout (under your prescribing physician). Discontinuation is completed before arrival, under the patient's own prescribing physician, with the medication-specific washout interval observed before the flood dose. 7 days minimum before treatment. Wait at least 14 days post-treatment before restarting.

Serotonergic activity (serotonin syndrome). Noribogaine is a potent serotonin reuptake inhibitor. Combining it with another drug that raises synaptic serotonin (SSRIs, SNRIs, MAOIs, triptans, tramadol, MDMA, St John's Wort) can trigger serotonin syndrome — autonomic instability, hyperthermia, neuromuscular hyperactivity, and altered mental state. This is a leading cause of preventable harm in psychedelic medicine and the reason serotonergic medications carry the longest washout windows.

In many cases yes. Our medical team works with your prescribing physician to taper or substitute medications safely before treatment. The right substitution depends on the underlying condition you are treating with Mirtazapine — contact us for an individual review.