Ibogaine
anti-addictive
What it isIboga alkaloid with NMDA antagonism, kappa agonism and SERT inhibition; unapproved treatment for opioid dependence.
Why this oneA single dose is reported to interrupt withdrawal and craving, which no approved agent does.
What limits it⚑ Fatal arrhythmias from QT prolongation have occurred in unmonitored clinic settings. Not approved anywhere in the US.
FDA-approved for
- opioid use disorder (investigational, non-US)
Off-label
- opioid use disorder (offered in clinics outside the US; cardiac deaths reported)
NO BOXED WARNINGS
Principal risk⚑ Fatal arrhythmias from QT prolongation have occurred in unmonitored clinic settings
Classes and tags
Clinical profile
Defining liabilityMarked QT prolongation, proarrhythmia and severe ataxia
Serotonin and MAOI
Provisional washout figures
Elevating mechanismSRI (noncompetitive)
Evidence confidenceModerate
InterpretationA confirmed but atypical SERT inhibitor: cryo-EM shows binding at the central site with the extracellular gate closed, competitive with SSRIs for binding yet NONcompetitive for transport, trapping the transporter inward-open. Weak -- less potent than S-citalopram or cocaine -- but real, with in vivo 5-HT increases and a stated serotonin-toxicity concern alongside other serotonergic agents.