Who Is a Good Candidate for Ibogaine? with Fernando Rivas, MD
In this episode of the Psychedelic Medicine Podcast, Fernando Rivas, MD, joins to unpack the safety and screening considerations for ibogaine therapy. Dr. Rivas is an emergency physician with over 15 years of clinical experience. As Chief Medical Officer of Transcend Clinic, he has led the development of innovative treatment protocols in addiction medicine and the clinical application of ibogaine.
In this conversation, Dr. Rivas discusses who may be a good candidate for ibogaine therapy and the clinical considerations involved in determining its safety. He explains that ibogaine has the strongest current support for interrupting substance use disorders and addressing TBI and PTSD, while potential applications in other areas remain emerging and require further research. Throughout the conversation, Dr. Rivas emphasizes the importance of distinguishing absolute from relative contraindications and of carefully screening patients for psychiatric risks, cardiac conditions, and medication interactions. He also discusses medically supported detox protocols, the importance of evaluating treatment through an individualized risk-benefit framework, and how lower-dose or non-psychedelic approaches may eventually broaden access to ibogaine’s potential neuroplastic effects.
In this episode, you'll hear:
What conditions ibogaine has been most studied for and where its potential applications may be expanding
The psychiatric and physical conditions that may make someone an unsuitable candidate for ibogaine treatment
How patients with active opioid or alcohol use may be medically supported and stabilized before treatment
Why relative contraindications should be evaluated through an individualized risk-benefit analysis
How ibogaine’s typical psychedelic experience may be shorter than its reputation suggests
Why the immediate improvements some patients experience should be understood within the broader context of neuroplasticity and long-term integration
Quotes:
“Ibogaine is the most robust of the [psycho]plastogens in terms of the window of time that it is able to open [for increased neuroplasticity]—at least as per preclinical research. So the potential is tremendous.” [3:22]
“Cardiovascular health is the most important [safety consideration for ibogaine therapy]. If you have a big hypertrophic heart and a large dilated heart, the risks are greater. If you have rhythm disturbances, the risks are greater and sometimes unacceptable.” [11:08]
“The chances [of an adverse cardiac event] are mitigated by properly screening and vetting patients, as well as by the addition of magnesium to ibogaine treatment. Magnesium is an essential component, as it is cardioprotective. … It simply raises the threshold for an irregular heartbeat or to occur.” [17:38]
“A first degree relative with schizophrenia, for example, would be a relative contraindication. However, we must think of this in terms of risk and benefit. If this person is injecting fentanyl every day, they are at risk of overdose and death every single day. … so that relative contraindication should always be ascertained in terms of risk-benefit, particularly risk to life when it is present.” [29:31]
“The science currently supports that sufficient exposure over a short enough period of time can yield pretty much the same results in terms of [neuro]plasticity without incurring a psychedelic experience. And we have tailored some specific treatments for patients that did not wish to incur a psychedelic experience, yet wanted to obtain the benefits of the plastic component of ibogaine treatment.” [32:15]
Links:
Previous episode: Psychedelics and Psychosis with Alexander Lebedev, MD, PhD