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The γ-Hydroxybutyrate Withdrawal Syndrome

  • GHB Symposium
  • Published:
Toxicological Reviews

Abstract

γ-Hydroxybutyrate (GHB) is endogenous inhibitory transmitter that, when administered in pharmacological doses, has sedative-hypnotic properties. It is used in anaesthesia for the treatment of narcolepsy/catalepsy and in alcohol/opioid detoxification treatment regimens. Based on its purported anabolic effects, GHB use became established among bodybuilders. As the euphorigenic effects of GHB became publicised, attendees at dance clubs and rave parties began to use it alone or in combination with other psychoactive drugs. Following the ban of GHB in 1990, several precursor products (e.g. γ-butyrolactone, butanediol) became widely used as replacement drugs until their ultimate proscription from lawful use in 2000. GHB and its precursors, like most sedative-hypnotic agents, can induce tolerance and produce dependence. Although many GHB users will experience a mild withdrawal syndrome upon drug discontinuation, those with chronic heavy GHB use can experience severe withdrawal. This syndrome clinically resembles the withdrawal syndrome noted from alcohol and other sedative-hypnotic drugs (e.g. benzodiazepines). Distinct clinical features of GHB withdrawal are its relatively mild and brief autonomic instability with prolonged psychotic symptoms. Patients with fulminant GHB withdrawal require aggressive treatment with cross-tolerant sedative hypnotics, such as benzodiazepines.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript and there are no conflicts of interest directly relevant to the content of this review.

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Authors and Affiliations

  1. New York City Poison Control Center, New York, New York, USA

    Asim F. Tarabar & Lewis S. Nelson

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  1. Asim F. Tarabar
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  2. Lewis S. Nelson
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Correspondence to Asim F. Tarabar.

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Tarabar, A.F., Nelson, L.S. The γ-Hydroxybutyrate Withdrawal Syndrome. Toxicol Rev 23, 45–49 (2004). https://doi.org/10.2165/00139709-200423010-00005

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