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GHB Withdrawal and Detoxification - 14 references with abstracts

[Last updated 11/2001]   -    See also: Gamma-Hydroxybutyrate Withdrawal Syndrome  Annals of Emergency Medicine, Vol. 37, No. 2, pp 148-53. Report on 8 cases in which a severe withdrawal syndrome followed ingestion every 3 hours around the clock. (Full Text - PDF)

1
UI - 8
AU - Bowles TM
AU - Sommi RW
AU - Amiri M
AD - Department of Pharmacy Practice, School of Pharmacy, University of Missouri-Kansas City, Western Missouri Mental Health Center, USA
TI - Successful management of prolonged gamma-hydroxybutyrate and alcohol withdrawal
AB - A 27-year-old man was admitted with tremulousness, diaphoresis, tachypnea (28 breaths/min), full-body rigidity, irritability, paranoia, and auditory and visual hallucinations 2 days after stopping long-term gamma-hydroxybutyrate (GHB) and 8 hours after stopping alcohol intake. He received intravenous fluids and tapering dosages of lorazepam to control agitation and rigidity, and recovered with no significant sequelae after 8 days. Abrupt cessation of GHB after high-dosage abuse can precipitate a clinically significant withdrawal syndrome. Lorazepam should be considered for treatment of GHB withdrawal. Concomitant alcohol abuse may mask early GHB withdrawal symptoms and exacerbate withdrawal
NT - UI - 21081564DA - 20010213IS - 0277-0008LA - engPT - Journal ArticleCY - United StatesJC - PARRN - 0 (Anesthetics, Intravenous)RN - 0 (Anticonvulsants)RN - 0 (Central Nervous System Depressants)RN - 502-85-2 (Sodium Oxybate)RN - 64-17-5 (Ethanol)RN - 846-49-1 (Lorazepam)SB - IM
UR - PM:11213862
SO - Pharmacotherapy 2001 Feb ;21(2):254-257

2
UI - 6
AU - Doyon S
AD - Medical Director, Maryland Poison Control Center, Baltimore, Maryland, USA. sdoyon@rx.umaryland.edu
TI - The many faces of ecstasy
AB - References to the word ecstasy in popular culture can mean different things to different individuals. The most common form of ecstasy (3,4-methylenedioxymethamphetamine [MDMA]), is an amphetamine with some hallucinogenic properties at high doses. It is directly neurotoxic to the human brain and has been linked to a number of deaths worldwide. Deaths result from hyperthermia, hyponatremia, or cerebral edema. A naturally occurring metabolite of gamma-aminobutyric acid, gammahydroxybutyrate (GHB) is a potent central nervous system depressant. Although GHB is a Schedule I drug, analogs remain widely available for consumption. Acute intoxication with GHB or its analogs leads to coma and respiratory depression. Chronic use of GHB or its analogs is associated with a withdrawal syndrome characterized by autonomic excitation. Herbal ecstasy refers to ephedrine-containing preparations. Acute and chronic overdoses of herbal ecstasy have been linked to hypertension, tachydysrythmias, myocardial infarctions, cerebrovascular accidents, and deaths. There is no regulation of the ephedrine content of available herbal ecstasy products
NT - UI - 21216458DA - 20010424IS - 1040-8703LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialCY - United StatesJC - BUTRN - 0 (Anesthetics)RN - 0 (Central Nervous System Stimulants)RN - 0 (Hallucinogens)RN - 299-42-3 (Ephedrine)RN - 42542-10-9 (N-Methyl-3,4-methylenedioxyamphetamine)RN - 502-85-2 (Sodium Oxybate)SB - IM
UR - PM:11317061
SO - Curr Opin Pediatr 2001 Apr ;13(2):170-176

3
UI - 5
AU - Dupont P
AU - Thornton J
AD - Department of Medicine, Ashford Hospital NHS Trust, Middlesex, UK
TI - Near-fatal gamma-butyrolactone intoxication--first report in the UK
AB - Gamma-hydroxybutyrate (GHB) is a compound used in the treatment of alcohol withdrawal, narcolepsy, and for induction of anaesthesia. It is also contained in many products illegally marketed as "dietary supplements" and is increasingly being recognised as a potential drug of abuse. We report the case of a 44-year-old man who suffered coma and life-threatening respiratory depression following an accidental overdose of the GHB prodrug, gamma-butyrolactone (GBL), contained in a "health drink". He made a full recovery following appropriate supportive treatment. GHB toxicity should be included in the differential diagnosis of patients with altered mental state, particularly where there is a history of recreational drug abuse
NT - UI - 21236210DA - 20010507IS - 0960-3271LA - engPT - Journal ArticleCY - EnglandJC - AQLRN - 0 (GABA Modulators)RN - 96-48-0 (4-Butyrolactone)SB - IM
UR - PM:11339620
SO - Hum Exp Toxicol 2001 Jan ;20(1):19-22

4
UI - 9
AU - Dyer JE
AU - Roth B
AU - Hyma BA
AD - California Poison Control System, San Francisco Division, San Francisco General Hospital, CA 94110, USA. jodyer@itsa.ucsf.edu
TI - Gamma-hydroxybutyrate withdrawal syndrome
AB - STUDY OBJECTIVE: Gamma-hydroxybutyrate (GHB) withdrawal syndrome is increasingly encountered in emergency departments among patients presenting for health care after discontinuing frequent GHB use. This report describes the characteristics, course, and symptoms of this syndrome. METHODS: A retrospective review of poison center records identified 7 consecutive cases in which patients reporting excessive GHB use were admitted for symptoms consistent with a sedative withdrawal syndrome. One additional case identified by a medical examiner was brought to our attention. These medical records were reviewed extracting demographic information, reason for presentation and use, concurrent drug use, toxicology screenings, and the onset and duration of clinical signs and symptoms. RESULTS: Eight patients had a prolonged withdrawal course after discontinuing chronic use of GHB. All patients in this series were psychotic and severely agitated, requiring physical restraint and sedation. Cardiovascular effects included mild tachycardia and hypertension. Neurologic effects of prolonged delirium with auditory and visual hallucinations became episodic as the syndrome waned. Diaphoresis, nausea, and vomiting occurred less frequently. The onset of withdrawal symptoms in these patients was rapid (1 to 6 hours after the last dose) and symptoms were prolonged (5 to 15 days). One death occurred on hospital day 13 as withdrawal symptoms were resolving. CONCLUSION: In our patients, severe GHB dependence followed frequent ingestion every 1 to 3 hours around-the-clock. The withdrawal syndrome was accompanied initially by symptoms of anxiety, insomnia, and tremor that developed soon after GHB discontinuation. These initial symptoms may progress to severe delirium with autonomic instability
NT - UI - 21091525DA - 20010222IS - 0196-0644LA - engPT - Journal ArticleCY - United StatesJC - 4Z7RN - 502-85-2 (Sodium Oxybate)SB - AIMSB - IM
UR - PM:11174231
SO - Ann Emerg Med 2001 Feb ;37(2):147-153

5
UI - 3
AU - McDaniel CH
AU - Miotto KA
AD - ULCA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California 90024, USA
TI - Gamma hydroxybutyrate (GHB) and gamma butyrolactone (GBL) withdrawal: five case studies
AB - There is little medical information available about gamma-hydroxybutyrate (GHB) or gamma-butyrolactone (GBL) dependence or withdrawal. In this study the authors treated and reviewed multiple cases of GHB and GBL withdrawal in high-dose users. Five patients during nine hospitalizations were treated for GHB or GBL withdrawal. The authors describe a spectrum of GHB or GBL withdrawal from mild to severe and discuss medications used for treatment. They conclude that patients with GHB or GBL withdrawal may present with agitated psychosis, delirium, and autonomic instability. In this sample, relapse to GHB or GBL use occurred soon after treatment of withdrawal
NT - UI - 21368498DA - 20010730IS - 0279-1072LA - engID - Y01DA50038/DA/NIDAPT - Journal ArticleCY - United StatesJC - JLPSB - IM
UR - PM:11476261
SO - J Psychoactive Drugs 2001 Apr ;33(2):143-149

6
UI - 2
AU - Miotto K
AU - Darakjian J
AU - Basch J
AU - Murray S
AU - Zogg J
AU - Rawson R
AD - UCLA Dept. of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, Los Angeles, CA 90024, USA. kmiotto@mednet.ucla.edu
TI - Gamma-hydroxybutyric acid: patterns of use, effects and withdrawal
AB - Gamma-hydroxybutyric acid (GHB) is gaining popularity as a drug of abuse. Reports of toxicity and lethality associated with GHB use have increased. This survey study was designed to identify patterns of GHB use, its effects, and withdrawal syndrome. A survey inquiring about the effects of GHB was administered to 42 users. The results showed that GHB was used to increased feelings of euphoria, relaxation, and sexuality. Adverse effects occurred more frequently in daily users and polydrug users than in occasional GHB users. Loss of consciousness was reported by 66%, overdose by 28%, and amnesia by 13% of participants during GHB use and by 45% after GHB use. Three daily users developed a withdrawal syndrome that presented with anxiety, agitation, tremor, and delirium. Participants described GHB intoxication as having similarities to sedative-hypnotic or alcohol intoxication. Regular use has been shown to produce tolerance and dependence. Participants dependent on GHB reported using multiple daily doses around the clock. High frequency users appeared at the greatest risk for developing withdrawal delirium and psychosis after abrupt discontinuation of GHB use
RP - NOT IN FILE
NT - UI - 21464076DA - 20011002IS - 1055-0496LA - engID - DA9419/DA/NIDAPT - Journal ArticleCY - United StatesJC - CM2SB - IM
UR - PM:11579621
SO - Am J Addict 2001 ;10(3):232-241

7
UI - 4
AU - Schneir AB
AU - Ly BT
AU - Clark RF
AD - Division of Medical Toxicology, Department of Emergency Medicine, UCSD Medical Center, California Poison Control System-San Diego Division, 200 West Arbor Drive, San Diego, CA 92103-8925, USA
TI - A case of withdrawal from the GHB precursors gamma-butyrolactone and 1,4-butanediol
AB - We describe a case of withdrawal from the gamma hydroxybutyric acid (GHB) precursors gamma butyrolactone and 1,4-butanediol. Symptoms included visual hallucinations, tachycardia, tremor, nystagmus, and diaphoresis. Administration of benzodiazepines and phenobarbital successfully treated the withdrawal symptoms. As predicted from the metabolism of gamma butyrolactone and 1,4-butanediol to GHB, the symptoms were nearly identical to those reported from GHB withdrawal. Because GHB is now illegal in the United States, individuals have begun abusing the legal and easier to acquire GHB precursors. More frequent cases of both abuse and withdrawal from these GHB precursors can be expected
NT - UI - 21293172DA - 20010611IS - 0736-4679LA - engPT - Journal ArticleCY - United StatesJC - IBORN - 0 (Anticonvulsants)RN - 439-14-5 (Diazepam)RN - 50-06-6 (Phenobarbital)RN - 846-49-1 (Lorazepam)RN - 96-48-0 (4-Butyrolactone)SB - IM
UR - PM:11399385
SO - J Emerg Med 2001 Jul ;21(1):31-33

8
UI - 1
AU - Sivilotti ML
AU - Burns MJ
AU - Aaron CK
AU - Greenberg MJ
AD - Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, and the Division of Emergency Medicine, Harvard Medical School, Boston, MA
TI - Pentobarbital for severe gamma-butyrolactone withdrawal
AB - Study Objective: Gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) have become popular drugs of abuse. Acute overdose with either agent results in a well-recognized syndrome of central nervous system and respiratory depression. Recently, a withdrawal syndrome has been described for GHB. We report a severe form of GBL withdrawal, characterized by delirium, psychosis, autonomic instability, and resistance to benzodiazepine therapy. METHODS: We performed a chart review of consecutive admissions for GBL withdrawal in a regional toxicology treatment center. RESULTS: During a 6-month period, 5 patients presented with severe withdrawal attributed to abrupt GBL discontinuation. Patients manifested tachycardia, hypertension, paranoid delusions, hallucinations, and rapid fluctuations in sensorium. Test results for ethanol and routine drugs of abuse were negative. Initial treatment with high doses of lorazepam proved ineffective. Pentobarbital was then administered, resulting in excellent control of behavioral, autonomic, and psychiatric symptoms and in rapid reduction or avoidance of benzodiazepines. Median hospital stay was 5 days. No patient had respiratory depression or required mechanical ventilation. Patients were discharged on tapering doses of benzodiazepines or pentobarbital and were free of psychotic symptoms at follow-up. CONCLUSION: GBL discontinuation can result in severe withdrawal, necessitating ICU admission. Pentobarbital may be more effective than benzodiazepines at controlling delirium in patients with abnormal vital signs, paranoid delusions, and hallucinations as a result of GBL withdrawal
NT - UI - 21575520DA - 20011123IS - 0196-0644LA - engPT - Journal ArticleCY - United StatesJC - 4Z7SB - AIMSB - IM
UR - PM:11719746
SO - Ann Emerg Med 2001 Dec ;38(6):660-665

9
UI - 15
AU - Craig K
AU - Gomez HF
AU - McManus JL
AU - Bania TC
AD - Department of Emergency Medicine of St. Luke's-Roosevelt Hospital, New York, New York, USA
TI - Severe gamma-hydroxybutyrate withdrawal: a case report and literature review
AB - We report a case of gamma-hydroxybutyrate (GHB) withdrawal resulting in severe agitation, mental status changes, elevated blood pressure, and tachycardia hours after stopping chronic use of GHB. The patient admitted to substantial GHB abuse on a daily basis for 2.5 years. Previous attempts at cessation reportedly resulted in diaphoresis, tremors, and agitation. The patient's symptoms, negative polypharmacy history, and negative urine and blood toxicological analysis for alcohol, benzodiazepines, sedative-hypnotics, or other substances suggested the diagnosis of GHB withdrawal. Later analysis of a patient drug sample confirmed the presence of GHB. The patient required 507 mg of lorazepam and 120 mg of diazepam over 90 h to control agitation. This is one of the few reported cases of GHB withdrawal and one of the most severe. Given the increasing use of GHB, more cases of severe GHB withdrawal should be anticipated
NT - UI - 20108439DA - 20000207IS - 0736-4679LA - engPT - Journal ArticleCY - UNITED STATESJC - IBORN - 0 (Anti-Anxiety Agents, Benzodiazepine)RN - 0 (GABA Modulators)RN - 502-85-2 (Sodium Oxybate)RN - 846-49-1 (Lorazepam)SB - IM
UR - PM:10645841
SO - J Emerg Med 2000 Jan ;18(1):65-70

10
AU - Schneir AB
AU - Ly BT
AU - Clark RF
AD - Division of Medical Toxicology, Department of Emergency
Medicine, University of California San Diego Medical Center,
California Poison Control System-San Diego Division, San Diego,
California, USA
TI - A case of withdrawal from the GHB precursors gamma-butyrolactone
and 1,4-butanediol
AB - We describe a case of withdrawal from the gamma hydroxybutyric
acid (GHB) precursors gamma butyrolactone and 1,4-butanediol. Symptoms
included visual hallucinations, tachycardia, tremor, nystagmus, and
diaphoresis. Administration of benzodiazepines and phenobarbital
successfully treated the withdrawal symptoms. As predicted from the
metabolism of gamma butyrolactone and 1,4-butanediol to GHB, the
symptoms were nearly identical to those reported from GHB withdrawal.
Because GHB is now illegal in the United States, individuals have
begun abusing the legal and easier to acquire GHB precursors. More
frequent cases of both abuse and withdrawal from these GHB precursors
can be expected
RP - NOT IN FILE
NT - UI - 21293172LA - engPT - Journal ArticleDA - 20010611IS - 0736-
4679SB - IMCY - United StatesJC - IBO
UR - PM:11399385
SO - J Emerg Med 2001 Jul ;21(1):31-33


11
UI - 21
AU - Addolorato G
AU - Caputo F
AU - Capristo E
AU - Bernardi M
AU - Stefanini GF
AU - Gasbarrini G
AD - Institute of Internal Medicine, Universita Cattolica, Rome, Italy
TI - A case of gamma-hydroxybutyric acid withdrawal syndrome during alcohol addiction treatment: utility of diazepam administration
AB - Gamma-hydroxybutyric acid (GHB) is an emerging drug for alcoholism therapy. We present a case of GHB withdrawal syndrome secondary to GHB addiction during alcoholism treatment. A complete disappearance of drug withdrawal syndrome was achieved with oral diazepam and the symptoms resolved without sequelae. GHB has been used for alcoholism therapy for only a few years now, but the trend is increasing, and other cases similar to this one are foreseeable. This risk could be higher in some countries in which GHB use is increasing not for alcoholism therapy, but for its euphoric and anabolic effects. The present experience indicates that administration of benzodiazepines would seem to be sufficient to achieve total regression of the withdrawal syndrome in a short time, at least if recognized early
NT - UI - 99157466DA - 19990528IS - 0362-5664LA - engPT - Journal ArticleCY - UNITED STATESJC - CNKRN - 0 (Anti-Anxiety Agents, Benzodiazepine)RN - 0 (Hydroxybutyrates)RN - 439-14-5 (Diazepam)RN - 591-81-1 (4-hydroxybutyric acid)SB - IM
UR - PM:10047936
SO - Clin Neuropharmacol 1999 Jan ;22(1):60-62

12
UI - 23
AU - Hernandez M
AU - McDaniel CH
AU - Costanza CD
AU - Hernandez OJ
AD - University of Southern California School of Medicine, Los Angeles, California, USA
TI - GHB-induced delirium: a case report and review of the literature of gamma hydroxybutyric acid
AB - We describe what we believe is the first psychiatric hospitalization due to GHB-induced delirium reported in the medical literature. We examine the use of the substance gamma hydroxybutyric acid (GHB) and describe the clinical findings in a patient who presented to an acute inpatient psychiatric unit with a chief complaint of feeling suicidal and a 1-year history of GHB use. A review of the literature and GHB's availability through the Internet are discussed
NT - UI - 98174823DA - 19980511IS - 0095-2990LA - engPT - Journal ArticleCY - UNITED STATESJC - 3GWRN - 0 (Adjuvants, Anesthesia)RN - 502-85-2 (Sodium Oxybate)SB - IM
UR - PM:9513637
SO - Am J Drug Alcohol Abuse 1998 Feb ;24(1):179-183

13
UI - 22
AU - Hovda KE
AU - Liberg JP
AU - Nordby G
AU - Jacobsen D
AD - Klinikk for akuttmedisin, Ulleval sykehus, Oslo
TI - [Gamma-hydroxybutyrate--an endogenous substance and an intoxicant]
AB - Gamma-hydroxybutyrate (GHB), a compound found in the mammalian brain, meets many criteria of a neurotransmitter. Experimentally, GHB has been used as a model for petit mal epilepsy; clinically it has been used as a general anaesthetic, to treat certain sleep disorders and alcoholism. Lately GHB has been abused for its euphoric, sedative and anabolic effects. Coma and seizures following abuse of GHB have been reported, but dependency has received little attention. Adverse effects of GHB include seizure activity and a withdrawal syndrome characterised by insomnia, anxiety and tremor. The present paper reviews the neuropharmacology, potential therapeutic uses and acute adverse effects of GHB, together with a presentation of three cases
NT - UI - 99106287DA - 19990128IS - 0029-2001LA - norPT - Journal ArticleCY - NORWAYJC - VRVRN - 0 (Neurotransmitters)RN - 502-85-2 (Sodium Oxybate)SB - IM
UR - PM:9889613
SO - Tidsskr Nor Laegeforen 1998 Nov 20 ;118(28):4390-4393

14
UI - 27
AU - Galloway GP
AU - Frederick SL
AU - Staggers FE
AU - Gonzales M
AU - Stalcup SA
AU - Smith DE
AD - Haight-Ashbury Free Clinics, San Francisco, California, USA
TI - Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence
AB - Gamma-hydroxybutyrate (GHB) is a compound found in mammalian brain which meets many criteria of a neurotransmitter. GHB has been investigated as a tool for inducing absence (petit mal) seizures, for use as an anesthetic, and for treatment of narcolepsy, alcohol dependence and opiate dependence. Since 1990 GHB has been abused in the United States for euphoric, sedative and anabolic effects. Coma and seizures have been reported following abuse of GHB, but dependence liability has received little attention. The neuropharmacology, potential therapeutic uses and acute adverse effects of GHB are reviewed, followed by a case series of eight people using GHB. Adverse effects of GHB may include prolonged abuse, seizure activity and a withdrawal syndrome. This withdrawal syndrome includes insomnia, anxiety and tremor; withdrawal symptoms resolve in 3-12 days. GHB has the potential to cause a significant incidence of abuse and adverse effects. Prolonged use of high doses may lead to a withdrawal syndrome, which resolves without sequelae. Educational efforts should address the narrow therapeutic index, possible physical dependence and dangers of combining GHB with other drugs of abuse
NT - UI - 97213471DA - 19970326IS - 0965-2140LA - engPT - Journal ArticleCY - ENGLANDJC - BM3RN - 0 (Anesthetics, Intravenous)RN - 502-85-2 (Sodium Oxybate)SB - IM
UR - PM:9060200
SO - Addiction 1997 Jan ;92(1):89-96

Alexander DeLuca, M.D., FASAM.
Copyright   2001. All rights reserved.                            [Top Of Page]
Revised: November 28th, 2001.