Toxicokinetics of ibogaine and noribogaine in a patient with prolonged multiple cardiac arrhythmias after ingestion of internet purchased ibogaine.
Clinical toxicology (Philadelphia, Pa.) July 1, 2017 Marieke Henstra, Liza Wong, Abdel Chahbouni et al. 13 citations
A single patient who took ibogaine, an unapproved anti-addictive agent, developed a severely prolonged QTc interval of 647 milliseconds and multiple cardiac arrhythmias, including atrial tachycardia, ventricular tachycardia, and Torsades de Pointes. The QTc prolongation persisted for 12 days after ingestion, even after ibogaine plasma levels had become low. A newly developed LC-MS/MS method measured ibogaine and noribogaine concentrations, revealing that noribogaine, the metabolite, remained at clinically relevant levels long after ibogaine cleared. A linear relationship was found between noribogaine concentration and the prolonged cardiac effects, implicating the metabolite rather than the parent drug in the extended duration of cardiac arrhythmia risk.