Toxicokinetics of ibogaine and noribogaine in a patient with prolonged multiple cardiac arrhythmias after ingestion of internet purchased ibogaine.
Clinical toxicology (Philadelphia, Pa.) – July 01, 2017
Source: PubMed
Summary
A crucial insight reveals that ibogaine's cardiac effects can linger long after the drug itself clears. Researchers precisely investigated the toxicokinetics of ibogaine and its metabolite, noribogaine, in a patient with severe cardiac arrhythmia. Employing a novel lc-ms/ms method, they discovered that despite declining ibogaine levels, the patient's heart issues persisted. This finding strongly links noribogaine concentrations to the prolonged duration of cardiac arrhythmia, underscoring the metabolite's significant role in extended health risks.
Abstract
Ibogaine is an agent that has been evaluated as an unapproved anti-addictive agent for the management of drug dependence. Sudden cardiac death has been described to occur secondary to its use. We describe the clinical effects and toxicokinetics of ibogaine and noribogaine in a single patient. For this purpose, we developed a LC-MS/MS-method to measure ibogaine and noribogaine plasma-concentrations. We used two compartments with first order absorption. The maximum concentration of ibogaine was 1.45 mg/L. Our patient developed markedly prolonged QTc interval of 647ms maximum, several multiple cardiac arrhythmias (i.e., atrial tachycardia and ventricular tachycardia and Torsades des Pointes). QTc-prolongation remained present until 12 days after ingestion, several days after ibogaine plasma-levels were low, implicating clinically relevant noribogaine concentrations long after ibogaine had been cleared from the plasma. The ratio k12/k21 for noribogaine was 21.5 and 4.28 for ibogaine, implicating a lower distribution of noribogaine from the peripheral compartment into the central compartment compared to ibogaine. We demonstrated a linear relationship between the concentration of the metabolite and long duration of action, rather than with parent ibogaine. Therefore, after (prolonged) ibogaine ingestion, clinicians should beware of long-term effects due to its metabolite.