Cardiac arrest after ibogaine intoxication

Summary & key facts

This case report describes a 61-year-old man who took an estimated single dose of about 5.6 g of ibogaine (≈65–70 mg/kg) obtained outside medical care. Within 6–12 hours he had severe vomiting, became almost unresponsive, and arrived at the ER with a very fast ventricular rhythm (≈270 beats per minute) that required defibrillation. His ECG showed extreme QT prolongation (QTc up to 714 ms) that took 7 days to return to normal. The authors note the dose estimate is uncertain because capsule contents vary and no blood ibogaine level was measured.

Key facts:

• The patient reportedly ingested about 5.6 g of ibogaine, which the authors estimate as 65–70 mg/kg and state would be the highest survived ibogaine dose reported so far.
• Six to twelve hours after ingestion he developed heavy vomiting and diarrhea, became altered in consciousness, and arrived at the emergency department with a wide‑complex tachycardia at about 270 beats per minute that required emergent defi
• On arrival the corrected QT interval (QTc) was 655 ms and rose to 714 ms at 24 hours; the QTc needed 7 days to normalize despite correction of electrolytes.
• Initial serum potassium was 2.4 mmol/L (hypokalemia). The low potassium was treated and corrected within 12 hours and was considered a co‑trigger for the arrhythmia.
• Extensive cardiac imaging (coronary CT angiogram, cardiac MRI, echocardiogram) showed no significant structural heart disease in this patient.
• The authors did not measure serum ibogaine levels, and they note dose estimates are uncertain because nonstandardized capsule preparations can contain varying ibogaine alkaloid amounts (reported 15%–50%).
• Ibogaine’s active metabolite, noribogaine, has a long plasma half‑life (reported 28–40 hours), which the authors link to the delayed QT recovery and to the potential for late arrhythmia recurrence; they recommend prolonged cardiac monitorin

Abstract

Ibogaine is a psychoactive herbal medication with alleged antiaddiction properties. We report a case of ibogaine intoxication mimicking Long-QT syndrome resulting in ventricular flutter and nearby cardiac arrest. A 61-year-old man experienced massive QT prolongation and ventricular flutter at a rate of 270 beats per minute requiring defibrillation after ingestion of a large dose of Ibogaine. The ingested dose of 65-70 mg/kg represents the highest survived ibogaine dose reported to date. As a result of the long plasma half-life of ibogaine, it took 7 days for the patient's QT interval to normalize.

Topics

Cardiac electrophysiology and arrhythmias Ion channel regulation and function Neurotransmitter Receptor Influence on Behavior

Categories

Cardiology and Cardiovascular Medicine Health Sciences Medicine

Tags

Anesthesia Cardiology Defibrillation Ingestion Internal medicine Medicine Pharmacology QT interval

Substances

Ibogaine

Conditions & symptoms

Addiction Chronic Pain Depression Substance abuse disorder Addiction or harmful habbits