This document provides a comprehensive pharmacovigilance and clinical safety synthesis of ibogaine integrating controlled human trials, systematic reviews, mechanistic studies, case reports, forensic analyses, and pharmacogenetic data.

It demonstrates that while low-dose, medically supervised ibogaine protocols have been used with relative safety in selected populations, there exists a narrow and unpredictable therapeutic window driven by:This document is divided into following sections: 

• Dose-dependent cardiotoxicity (QTc prolongation and malignant arrhythmias)
• Long-lived active metabolites with delayed toxicity
• High interindividual variability in metabolism
• Substantial product purity and dosing uncertainty
• Compounding risks from electrolyte abnormalities, comorbidities, and polypharmacy