Tolerabilidade e eficácia da ibogaína no tratamento do transtorno por uso de álcool: um estudo aberto e de escalonamento de doses

A single dose of ibogaine, a hallucinogenic alkaloid from the iboga shrub, produced mild to moderate reductions in alcohol and cocaine consumption among nine adults with Alcohol Use Disorder, with two volunteers remaining abstinent for up to three months. Effects were more pronounced at higher doses (up to 400 mg). Ibogaine was well tolerated but caused mild to moderate side effects including nausea, anxiety, and dose-dependent cardiovascular changes such as tachycardia and QT interval prolongation, highlighting the need for medical supervision. Depressive symptoms decreased, but other psychiatric variables showed no significant change.

Study at a glance

Abstract

Introduction: Currently, 5% of the global adult population is affected by Alcohol Use Disorder (AUD), and alcohol consumption is linked to 3% of all deaths worldwide, being one of the main contributors to various diseases and mortality.Although the medications currently available demonstrate some efficacy, their adverse effects and the relatively long duration of treatment can hinder adherence.Ibogaine is a hallucinogenic alkaloid found in the Tabernanthe iboga (iboga) shrub, native to Central Africa.Animal studies and case series suggest that one or a few doses of ibogaine can significantly reduce withdrawal syndrome and drug use patterns, including alcohol.However, no clinical studies have explored these effects in AUD.Objective: To evaluate the efficacy, safety, and tolerability of different doses of ibogaine in patients diagnosed with AUD.Method: The first three patients received single, escalating doses of ibogaine (ranging from 20 to 320 mg).The following six volunteers received a single 400 mg dose.The primary outcome was the self-reported weekly use of alcohol and other drugs.Secondary variables included vital signs, electrocardiogram (QTc interval), laboratory tests, dissociative effects, psychiatric symptoms, adverse effects, psychoactive/hallucinogenic effects, impulsivity, self-esteem, alcohol craving, anxiety, depression, personality traits, and social cognition.Results: Preliminary findings suggest that doses ranging from 20 to 400 mg led to a mild to moderate reduction in alcohol and cocaine consumption, with two volunteers remaining abstinent throughout the study (up to three months post-intervention).The data indicates that these effects were more pronounced at higher ibogaine doses.The administered doses produced mild to moderate side effects and were well tolerated, with no severe adverse reactions.The most common effects included nausea, anxiety, and difficulty concentrating.Other reported effects included headaches, dizziness, altered sensory perception, gastrointestinal discomfort, vomiting, and tingling sensations.Transient mild to moderate changes were observed in vital signs and ECG readings (tachycardia, hypertension, and QT interval prolongation).Both side effects, including cardiovascular changes, and subjective effects followed a dose-dependent pattern.Ibogaine administration resulted in reduced depressive symptoms, but did not lead to significant changes in other variables.Conclusion: Ibogaine produced positive but modest effects in reducing the frequency and quantity of alcohol and cocaine consumption.These effects were dose-dependent, as were the side effects.Although ibogaine was well tolerated, the observed cardiovascular changes highlight the need for a controlled environment, supervision by a trained medical team, and continuous monitoring in any potential clinical application.Further studies with larger samples and varied dosing regimens are necessary to clarify the dose-response relationship of ibogaine in AUD.