Last Updated — April 2026
Medical Disclaimer
This information is for educational purposes only.
The content on this page does not constitute medical advice and is not a substitute for consultation with a licensed physician. Ibogaine and Ayahuasca are powerful substances with serious medical risks. Never attempt either outside of a properly screened, medically supervised setting.
About This Document
Nekawa is committed to providing honest, evidence-based information about the medicines we work with. Ibogaine and Ayahuasca are not casual wellness tools — they are biologically active substances with documented medical benefits and documented medical risks. This page exists so that you have a clear picture of both.
Nothing on this website, including this page, should be interpreted as a recommendation to self-administer any substance, seek treatment at any facility other than one with proper medical infrastructure, or discontinue any prescribed medication without physician guidance.
Ibogaine: Known Risks
Ibogaine is a pharmacologically complex alkaloid with a long half-life and active metabolites. When administered without proper screening and monitoring, it can be fatal. The following risks are well-documented in scientific literature:
- Cardiac Arrhythmia: Ibogaine prolongs the QT interval of the cardiac cycle. This can lead to torsades de pointes — a potentially fatal ventricular arrhythmia — particularly in individuals with pre-existing cardiac conditions, electrolyte imbalances, or concurrent use of QT-prolonging medications.
- Drug Interactions: Ibogaine interacts dangerously with a wide range of substances (see Contraindications below). Interactions with serotonergic drugs, opioids, and certain antibiotics have been implicated in reported fatalities.
- Physical Intensity: The experience involves significant physical discomfort including ataxia (loss of muscle coordination), nausea, extreme sensitivity to light and sound, and prolonged immobility. Medical supervision is essential to manage these safely.
- Psychological Distress: Ibogaine can surface difficult memories, traumas, and emotional content with great intensity. Without a skilled support environment, this can result in acute psychological distress or lasting adverse reactions.
- CYP2D6 Metabolizer Variations: Individuals with impaired CYP2D6 liver enzyme function metabolize Ibogaine more slowly, leading to dangerous plasma accumulation. Genetic testing is required to screen for this risk.
- Fatalities in Unregulated Settings: Multiple deaths associated with Ibogaine have been reported globally, most occurring in non-clinical settings without adequate cardiac monitoring, proper screening, or emergency response capabilities.
Ibogaine: Absolute Contraindications
Ibogaine should not be administered to individuals with any of the following conditions. These are not risk factors to be weighed — they are absolute exclusions:
- Clinically significant cardiac disease (coronary artery disease, heart failure, cardiomyopathy)
- Prolonged QTc interval (> 450ms on baseline EKG)
- History of ventricular arrhythmia or sudden cardiac arrest
- Severe hepatic (liver) or renal (kidney) impairment
- Active psychosis, schizophrenia, or schizoaffective disorder
- Bipolar disorder type I with active manic episodes
- Current use of SSRIs, SNRIs, or MAOIs without an adequate washout period
- Current use of lithium, tramadol, or other serotonergic compounds
- Active opioid use without proper tapering protocol under medical supervision
- Long QT syndrome (congenital or medication-induced)
- Uncontrolled hypertension
- Pregnancy or breastfeeding
- Severe electrolyte imbalances (hypokalemia, hypomagnesemia)
Required substance-free period: Depending on the substance, participants must be fully off contraindicated medications and drugs for 7 to 42 days before Ibogaine treatment. Short-acting substances (e.g. most SSRIs, stimulants) typically require a minimum of 7–14 days. Longer-acting compounds — particularly fluoxetine, MAOIs, and methadone — require 4–6 weeks (28–42 days) due to extended half-lives and active metabolite accumulation. Exact washout windows are determined on a case-by-case basis by the supervising physician after a full medication review.
Ibogaine: Drug Interactions
Ibogaine has potentially life-threatening interactions with the following drug classes. This list is not exhaustive. A complete medication review with a physician is mandatory before any Ibogaine treatment:
- SSRIs and SNRIs (fluoxetine, sertraline, venlafaxine, duloxetine, escitalopram, etc.)
- Tricyclic antidepressants (amitriptyline, nortriptyline)
- MAO inhibitors (phenelzine, tranylcypromine, selegiline)
- Opioids and opioid agonist therapies (methadone, buprenorphine, heroin, fentanyl)
- Stimulants (amphetamine, methylphenidate, cocaine)
- Antiarrhythmics (amiodarone, sotalol, quinidine)
- Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin)
- Antipsychotics (haloperidol, quetiapine, ziprasidone)
- Lithium
- Tramadol
- Cannabis (caution advised)
- Alcohol (must be discontinued prior to treatment)
Ayahuasca: Known Risks
Ayahuasca contains beta-carboline MAO inhibitors and DMT. When used in a properly screened ceremonial context, its safety profile is generally considered favorable for healthy adults. However, the MAOI content creates critical drug-drug and drug-food interactions that can be severe or fatal:
- Serotonin Syndrome: Combining Ayahuasca with serotonergic drugs (SSRIs, SNRIs, MAOIs, tramadol, St. John's Wort) can trigger serotonin syndrome — a life-threatening condition characterized by agitation, rapid heart rate, high fever, and seizures.
- Hypertensive Crisis: The MAOI content of Ayahuasca prevents the breakdown of tyramine. Consuming high-tyramine foods (aged cheeses, cured meats, fermented foods, alcohol) within the contraindicated window can cause a sudden, severe spike in blood pressure.
- Psychological Distress: Ayahuasca reliably surfaces unresolved trauma and unconscious material. Without an experienced facilitator and a safe ceremonial container, this can result in acute psychological crises, panic, or lasting adverse reactions, particularly in individuals with psychiatric history.
- Cardiovascular Stress: Ayahuasca typically elevates heart rate and blood pressure during the experience. Individuals with cardiovascular conditions or hypertension face heightened risk.
- Psychotic Episodes: In individuals with a personal or family history of schizophrenia, bipolar I disorder, or psychosis, Ayahuasca can trigger or accelerate psychotic episodes that may require acute psychiatric care.
Ayahuasca: Absolute Contraindications
- Current use of SSRIs, SNRIs, MAOIs, or serotonergic antidepressants — requires a supervised taper and a minimum washout period of 7 to 42 days depending on the specific medication and its half-life
- Tramadol, linezolid, or other drugs with MAOI-like activity (minimum 7-day washout)
- Personal or family history of schizophrenia, bipolar I disorder, or psychosis
- Lithium (risk of seizures)
- Active suicidality or severe borderline personality disorder without therapeutic support
- Uncontrolled hypertension or cardiovascular disease
- Severe liver disease (liver metabolizes the brew)
- Pregnancy or breastfeeding
- St. John's Wort, 5-HTP, or other serotonin-affecting supplements (minimum 7-day washout)
- Stimulants taken within 24–48 hours
Ayahuasca: Dietary Restrictions (The Dieta)
Due to the MAOI content, high-tyramine foods must be strictly avoided for at least 24–48 hours before an Ayahuasca ceremony (72 hours is recommended for safety):
- Aged cheeses (cheddar, parmesan, brie, blue cheese, gouda)
- Cured, smoked, or fermented meats (salami, pepperoni, bacon, ham)
- Fermented products (soy sauce, miso, tempeh, kimchi, sauerkraut)
- Alcohol of any kind (beer, wine, spirits)
- Overripe or dried fruits (especially bananas, figs, raisins)
- Certain beans (fava beans, broad beans)
- Leftover cooked meat (tyramine develops as protein ages)
- Concentrated yeast extracts (Marmite, Vegemite)
The Traditional Ayahuasca Dieta
Beyond the immediate tyramine restriction, traditional Amazonian practice requires participants to follow a broader preparatory diet for a minimum of 7 days before ceremony — and ideally up to 6 weeks for those undertaking deeper healing work. This is not a preference; it is a safety and efficacy requirement. Participants must refrain from:
- Red meat and pork (including all processed and cured meats)
- Excess salt (including heavily salted, cured, or packaged foods)
- Pungent spices and hot peppers (chili, cayenne, large amounts of black pepper)
- Heavy oils and fried foods (especially refined vegetable and seed oils)
- Refined sugar and highly processed foods
- Dairy products (especially aged or fermented varieties)
- Alcohol of any kind
- Cannabis and all recreational substances
- Sexual activity (observed in many traditional lineages as part of energetic preparation)
The traditional dieta is understood to reduce physiological load, heighten sensitivity to the medicine, and deepen the healing process. Nekawa provides detailed dieta guidance as part of all participant preparation materials.
This Is Not Medical Advice
The information on this page is provided for educational purposes and to help prospective participants understand the seriousness of these medicines. It is not a substitute for consultation with a qualified physician. Individual medical histories vary, and only a licensed doctor who has reviewed your full health record can determine whether either medicine is appropriate for you.
At Nekawa, every participant undergoes comprehensive medical and psychiatric screening before any treatment decision is made. We will always prioritize your safety over your desire — or ours — to proceed.
If you are experiencing a medical emergency:
Call your local emergency services immediately (911 in the US, 190 in Brazil, 999 in the UK, 112 in the EU). Do not delay seeking emergency care to consult any website.
Nekawa's Role: Referral Only
Nekawa does not offer ibogaine treatment and does not sell, prescribe, or dispense ibogaine or any controlled substance. All ibogaine prescriptions and administrations are carried out exclusively by independent licensed Brazilian physicians who operate under their own medical practices, hold their own ANVISA authorizations, and bear full clinical and legal responsibility for their patients' care.
Nekawa's relationship with these physicians is strictly one of referral. Nekawa connects prospective clients with qualified, independent medical professionals who independently evaluate each individual's suitability, issue prescriptions under their own authority, and administer treatment within their own clinical practice. Nekawa has no role in clinical decision-making, prescribing, dosing, or the administration of any substance.
Nothing on this website constitutes an offer to provide medical treatment. Any decision to proceed with ibogaine therapy is made solely between the client and the independent physician, not Nekawa.