Small open-label pilot of ibogaine for alcohol use disorder: heart rhythm changes seen

The question

Is it practical and safe to give ibogaine, a plant-derived hallucinogen, to people with moderate or severe alcohol use disorder, and does their drinking change afterwards?

What they did

Nine adults with moderate to severe alcohol use disorder took ibogaine hydrochloride by mouth in a hospital setting. Doses were escalated in sequence: the first volunteer received 20/40/80 mg, the second 80/160/240 mg, the third 240/320 mg, and the remaining six received a single 400 mg dose. Everyone was admitted to hospital 24 to 48 hours before dosing and monitored continuously. Safety was the main outcome, including the QTc interval (a measure of the heart’s electrical recovery time), vital signs, blood tests, side effects and psychiatric assessments; alcohol and other substance use was a secondary outcome.

What they found

Five of the nine patients had QTc changes, including temporary lengthening and shortening of that heart interval. Mild to moderate blood pressure changes also occurred. Mild or moderate side effects were common, especially at the higher 240-400 mg doses, and included drowsiness, nausea and anxiety. No serious adverse effects were recorded, but two patients needed medication for agitation, insomnia and high blood pressure. Most participants reported drinking less, though only five completed the study.

The fine print

This was a very small pilot with nine people, no placebo group and no blinding, so any reported drop in drinking could reflect motivation, expectation or the hospital setting rather than the drug. Only five participants finished, and alcohol use was self-reported. Doses varied widely between participants, and the abstract does not give follow-up length or numerical outcome data. This summary is based on the abstract only.

What it means

Ibogaine could be given under close hospital monitoring in this small group, but heart-rhythm and blood pressure changes were frequent enough that the authors call for rigorous cardiovascular screening; no conclusion about effectiveness for alcohol use disorder can be drawn from a study this small and uncontrolled.

Evidence grade: Very low. A pilot open-label study in only nine people, with no control group, no blinding and only five completers.

This summary is based on the study’s published abstract.