Preparing for Safe Ibogaine Journeys with Felipe Malacara, MD
In this episode of the Psychedelic Medicine Podcast, Dr. Felipe Malacara joins to discuss the safety considerations surrounding ibogaine therapy. Dr. Malacara is the chief clinical operations director for Beond, a Mexico-based Ibogaine clinic. He is also a general practice physician with a medical degree from Universidad Autónoma Metropolitana in Mexico City and has over 17 years of experience treating over 1,200 patients with Ibogaine therapy.
In this conversation, Dr. Malacara shares important safety information about ibogaine, starting with major contraindications to using the powerful substance. These contraindications fall into three main groups: heart issues, electrolyte deficiencies, and liver problems. As Dr. Malacara explains, all of these have the potential to make Ibogaine dangerous due to the way it interacts with the heart, particularly if there is a metabolism issue. In terms of negative outcomes, cardiac issues are the most common as ibogaine can cause bradycardia—a dangerous slowing of the heart rate.
Due to these potential risks, Dr. Malacara encourages a thorough evaluation prior to ibogaine therapy, including full blood work, an EKG, and occasionally an ultrasound of the heart. Another crucial part of the evaluation is taking an inventory of the patient’s prescription medication and drug use. Dr. Malacara explains that patients may need to be weaned off a particular drug or be given a shorter-acting alternative so that they can come into the ibogaine therapy without any substances in their system which could lead to dangerous interactions or render the treatment less effective. In particular, Dr. Malacara notes that SSRIs could interact with ibogaine to produce serotonin syndrome, and while this can be straightforward to treat, diagnosis can be difficult, so avoiding this entirely by weaning off the medication under the direction of a physician is strongly suggested prior to treatment.
In closing, Dr. Malacara emphasizes that Ibogaine is not a magic bullet despite its unique efficacy for treating addiction. The will to change on the part of the patient is still crucial, especially as preparation for ibogaine therapy itself requires a lot of commitment and dedication. If that is present, however, Dr. Malacara maintains that the treatment can be extremely effective.
In this episode:
How Dr. Malacara got involved in Ibogaine therapy
The inherent risks of Ibogaine
What patients should be evaluated for prior to receiving Ibogaine therapy
Weaning patients off drugs or onto different, shorter acting substances in preparation for Ibogaine
The types of addictions may be successfully addressed by Ibogaine
Monitoring a patient’s heart following Ibogaine, and when they can be released
Quotes:
“In the event [that a patient] is not able to metabolize ibogaine in an appropriate way, the risk of heart toxicity of the Ibogaine increases.” [9:25]
“Something which is important is drug screening before the treatment. We need to know that the patient has no traces of the drugs that we are going to treat in the system, because otherwise the treatment will be more difficult, the recovery will be more difficult, or it will be even ineffective.” [26:48]
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