4.4. Ibogaine and Noribogaine
Ibogaine is an alkaloid substance obtained from the root bark of the
shrub Tabernanthe iboga, endemic to Western African
regions.88 It has been historically used by indigenous
communities in West Africa for religious ceremonies, and also to treat
fatigue.88 Its ceremonial use is due to itsoneirophrenic properties, which means it can invoke dream-like
states without loss of consciousness.88 While
preclinical studies of ibogaine and noribogaine have suggested that both
ibogaine and noribogaine dose-dependently increase the antinociceptive
properties of morphine, making it a potential opioid-sparing strategy in
pain management, no human laboratory clinical trials have investigated
the use of ibogaine for pain.
Convergent preclinical models have suggested that ibogaine could be used
as a modulator of morphine antinociception.89,90Co-administration of ibogaine in various doses (1-40mg/kg) and morphine
(4 mg/kg) increased morphine-induced antinociception in a dose-dependent
manner for rats in a heat-pain paradigm. Further, the administration of
40mg/kg of noribogaine, the primary metabolite of ibogaine, resulted in
similar effects. Ibogaine enhances the pain-relieving effects of
morphine in mice. After making all mice tolerant to morphine,
researchers compared two groups: one given morphine alone and the other
with morphine and varying doses of ibogaine or noribogaine. Both
ibogaine and noribogaine were found to increase morphine’s
antinociception effects. To our knowledge, no studies have investigated
whether patients receiving morphine could have analgesic effects
maximized by ibogaine, thus reducing the total opioid requirement to
alleviate pain.