Background: Ibogaine is an alkaloid from the Tabernanthe Iboga shrub. It has traditionally been used in religious rituals, but recently proposed for use in treatment of addiction. Though the mechanism has not yet been fully elucidated, it is thought that ibogaine and the active metabolite noribogaine interacts with several different neurotransmitter receptors including mu and kappa opioid receptors. However, the use of ibogaine for treatment of addiction has been limited by reports of adverse cardiac effects, including prolonged qtc and ventricular arrhythmias due to inhibition of cardiac hERG/IKr potassium channels. Case report: A 55-year-old woman traveled to Mexico to undergo treatment with ibogaine for management of withdrawal from buprenorphine. She presented to an emergency department upon her return to the United States with hallucinations, hypovolemia, and electrolyte abnormalities including hypokalemia and hypomagnesemia. Her calcium level was normal. On ECG, her QTc was prolonged at 630 msec. Her electrolytes were replaced and over the course of the next several hours her QTc trended down to 500 msec. She did not experience any cardiac arrhythmia. Discussion: Currently, ibogaine is classified as a schedule I drug in the United States. Due to the relative unavailability and unaccepted medical use of ibogaine in the United States, patients may not be well-educated regarding the potential adverse effects of this drug, leaving them at increased risk for cardiac toxicity such as prolonged QTc and dysrhythmias. Conclusion: Ibogaine is increasingly being used in certain patient populations for treatment of addiction; it is important to consider this drug in patients presenting with cardiac related toxic effects such as prolonged qtc or ventricular arrhythmias, or in patients reporting to take an herbal compound for treatment
of addiction.