The considerations in this chapter, and in any section titled “Preparation” in the previous chapters, are considerations for the period between receiving the patient’s application and receiving them in person for intake. In some cases, there are further instructions for these conditions noted in the chapters that follow.
Cardiovascular Pre-care
Hypertension
Patients should continue to take blood pressure medication that is not centrally acting. If patients are not on any medication, they should seek medical recommendation about a prescription for blood pressure medication. Patients should not demonstrate hypertensive crisis for at least three days prior to treatment.
Hypotension
Ibogaine may lower blood pressure in patients with hypotension and this could lead to serious complications. Check fluid intake and recommend that patient hydrate with at least 1 fl. oz. per kg of body weight throughout the day, more for physically active people. A good indicator of sufficient hydration is light or clear urine.
This intake should be with fluids that contain electrolytes such as coconut water, or other electrolyte preparation, and not with plain water or other fluids. If blood pressure does not increase with hydration, patient should be considered a poor candidate, and should seek further medical attention.
Limited Vein Access
If patient has limited vein access, they should be informed about this risk factor and should attempt to follow the following vascular pre-care protocol for at least 10 days, or if possible, until veins become easily accessible.
- Stop all intravenous substance use.
- Take 1 aspirin per day to thin the blood.
- Take 2g oral Vitamin C per day to help with vein repair.
Cleansing/Fasting
Patients will be encouraged not to engage in any cleansing regimens, to severely restrict diet or proteins (example: juice fasting, master cleanse), or any other diet that may otherwise deplete physical energy level or electrolytes from the time of application until after discharge.
Except when appetite is suppressed by ibogaine during treatment, patients will not be encouraged to cleanse or fast. Patients should be advised to eat healthy, whole meals in order to develop strength.
Nutrition & Supplementation
If patients are below the normal or preferred range of potassium and magnesium (Ch. 2), they should be instructed to supplement until normal blood test results can be returned. If results are not lower than normal, then no supplementation should be recommended. Levels higher the preferred range present a similar risk as deficiency.
Psychological Preparation
Therapy providers should work with patients prior to arrival to maintain realistic intentions, to prepare mentally for the experience, and to begin to develop plans for continuing therapeutic care after treatment.
Informed Consent
A written copy of informed consent should be provided prior to arrival. This document should clearly explain the risks involved in taking ibogaine, as well as the treatment methods and expectations of the center.
Additionally, major potentially life-threatening risks should also be discussed prior to intake. This include information such as:
- Stopping benzodiazepines or alcohol suddenly or within 72 hours prior to treatment may cause seizures during treatment and can be life threatening.
- Using substances such as stimulants, opiates, or others that interact with ibogaine during treatment, or misrepresenting current or previous use of these substances, greatly increases risk of ibogaine potentiating an overdose.
- Malnutrition or dehydration prior to treatment increases risk of complications which can be life threatening.
- If choosing to use of opiates, stimulants, or other substances that interact with ibogaine after treatment, account for the fact that tolerance has been significantly reduced to that of an opiate naïve person. Otherwise, there is an acute risk of overdose.
- Having an active infection, abscess or inaccessible veins is an absolute exclusion criteria. If the patient has any either of these conditions upon arrival they will need to undergo further medical care. Patients should instead follow the vascular pre-care protocols mentioned above.
Travel Medical Insurance
If receiving patients who are traveling from another country, it is very important that patients obtain a travel medical insurance policy that covers emergency medical care through the entire duration of the patient’s stay. There are many suitable insurance brokers that offer affordable policies that can be purchased online.
