Ibogaine Hydrochloride (HCl) interactions

Ibogaine Hydrochloride (HCl) and Haloperidol (Haldol) Absolute Contraindication

Torsades de Pointes and fatal arrhythmia from additive QT prolongation.

Evidence: Clinical Guideline

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Ibogaine Hydrochloride (HCl) and Propranolol Strong Caution

Ibogaine is associated with severe QTc prolongation (>500 ms documented in safety study). Bradycardia is a recognized risk factor for torsades de pointes in drug-induced long QT states. Propranolol lowers heart rate and can cause bradycardia, functioning as a meaningful QT risk multiplier.

Evidence: Knuijver 2021 ibogaine QT safety study + AHA arrhythmia statement + FDA label (Inderal)

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Ibogaine Hydrochloride (HCl) and Zepbound (tirzepatide) Strong Caution

Ibogaine is associated with marked QTc prolongation (>500 ms in safety studies). Zepbound causes vomiting, diarrhea, and dehydration-linked AKI — all of which can cause electrolyte derangements that amplify QT risk. Dehydration from any source is a recognized torsades risk multiplier.

Evidence: Knuijver 2021 QTc safety study + FDA label (Zepbound 2025) + mechanistic

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Ibogaine Hydrochloride (HCl) and Methadone Absolute Contraindication

Torsades de Pointes, fatal arrhythmia risk from additive hERG channel blockade and CYP2D6 competition.

Evidence: Case report, Mechanistic

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Ibogaine Hydrochloride (HCl) and Pristiq (desvenlafaxine) Clinician Review

Ibogaine QT prolongation risk dominates this pairing. Pristiq does NOT prolong QT in a thorough QTc study — it should not be over-weighted as a QT driver. Pristiq contributes BP elevation and seizure screening requirements.

Evidence: Knuijver 2021 ibogaine QT + FDA label (Pristiq 2017)

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