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As patient interest and off-label use grow, clinicians require an understanding of emerging dosing strategies, investigational protocols, and reported adverse effects to appropriately counsel patients and contextualize potential risks and benefits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Databases were searched for human studies of ibogaine, noribogaine, or 5-MeO-DMT with relevant clinical outcomes, prioritizing randomized controlled trials (RCTs), microdosing paradigms, and sequential protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Only three RCTs were identified. First, a double-blind pilot study in 20 cocaine-dependent adults found that a single 1800\u2009mg dose of ibogaine was associated with reduced craving versus placebo over follow-up of up to 24\u2009weeks. Second, an ascending-dose trial in 36 healthy volunteers showed that noribogaine doses of 3\u201360\u2009mg were safe and well-tolerated, without opioid-agonist effects. Third, a randomized crossover trial in 27 opioid-dependent patients receiving noribogaine 60\u2013180\u2009mg demonstrated dose-dependent heart rate-corrected QT interval (QTc) prolongation with non-significant reductions in withdrawal symptoms. Thus, two RCTs enrolled substance-dependent populations, while one focused on safety and pharmacokinetics in healthy volunteers. Microdosing and escalating sequential protocols remain experimental, lack standardized definitions, and are supported only by preliminary observational data. Adverse effects include neurologic, psychiatric, and cardiac events, including QTc prolongation; fatalities have occurred in the presence of medical and substance use comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The available evidence is confined to case reports, observational analyses, and small early-phase or proof-of-concept studies. Given ibogaine\u2019s cardiotoxicity and narrow therapeutic margin, clinical use cannot be recommended without confirmation from larger, well-controlled trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02698811261443674","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T08:29:38Z","timestamp":1778574578000},"page":"1103-1117","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["From monotherapy to sequential models: An updated scoping review on ibogaine\u2019s role in treatment for psychiatric disorders"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9503-5016","authenticated-orcid":false,"given":"Pravesh","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychology, Mayo Clinic Health System, Eau Claire, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Kendrick","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Wisconsin\u2014Eau Claire, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Schram","sequence":"additional","affiliation":[{"name":"Mayo Clinic Libraries\u2014Wisconsin, Eau Claire, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam M.","family":"Stumo","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Wisconsin\u2014Eau Claire, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Averi","family":"Garscia","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Wisconsin\u2014Eau Claire, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas B.","family":"Matthews","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Wisconsin\u2014Eau Claire, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2020.03.017"},{"key":"e_1_3_2_3_1","unstructured":"Adolf SJ (1957) Tabernanthine ibogaine containing analgesic compositions. 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