Gamma Hydroxybutyrate (GHB) and Gamma Butyrolactone (GBL) Withdrawal: Five Case Studies

McDaniel, Charles H.; Miotto, Karen

doi:10.1080/02791072.2001.10400479

Cited by 76 publications

(64 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[25][26][27] In cases where the same patient presented with multiple episodes of withdrawal, each episode was considered separately. Twenty-seven articles, all case series or case reports, fulfilled study eligibility criteria, [5][6][7][8][9][10][11][12][13][14][15][16][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] describing 57 patients with withdrawal: GHB in 36 cases, 1,4-BD in 3 cases and GBL in 18 cases. Mean age was 31 years (range 18-57 yr) and 65% (37/57) were male.…”

Section: Resultsmentioning

confidence: 99%

“…4 GBL and 1,4-BD are present in some health food products and industrial solvents, making them relatively accessible to people who seek to use them as recreational drugs. 5 Withdrawal symptoms of GHB, 1,4-BD and GBL are related to central nervous system (CNS) and autonomic dysregulation, 2,[5][6][7][8][9][10][11][12][13][14][15][16] and are similar to withdrawal from other sedative-hypnotic drugs such as ethanol and benzodiazepines. 17 While the prevalence of seizures and death during withdrawal from ethanol and benzodiazepines are known, the frequency of these complications during withdrawal from GHB analogues is unknown.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Wojtowicz

Yarema

Wax

2008

CJEM

View full text Add to dashboard Cite

1,4-Butanediol (1,4-BD) is an industrial solvent that is metabolized to gamma-hydroxybutyrate (GHB), a gamma-aminobutyric acid agonist and central nervous system depressant. GHB and its analogues are popular drugs of abuse. Withdrawal from these agents is characterized by autonomic instability and altered mental status. We report a case of withdrawal from 1,4-BD lasting 6 days and complicated by new onset of seizures and rhabdomyolysis. In addition, we conducted a systematic review of the English literature pertaining to withdrawal from GHB, 1,4-BD and gamma-butyrolactone (GBL). Data collected from source articles included last use prior to symptom onset, clinical features on presentation, duration of symptoms and outcome. Twenty-seven studies with 57 episodes of withdrawal were included. Thirty-six cases (63%) involved GHB, 3 cases (5%) involved 1,4-BD and 18 (32%) involved GBL. The most common patient symptoms were tremor (67%), hallucinations (63%), tachycardia (63%) and insomnia (58%). Seizures and rhabdomyolysis each occurred in 7% of cases, but only 1 death occurred. Emergency physicians must consider withdrawal from these agents when patients present with clinical features suggestive of a sedative-hypnotic withdrawal syndrome. RÉSUMÉLe butane-1,4-diol (BD-1,4) est un solvant industriel qui se métabolise en 4-hydroxybutanoate (GHB), un agoniste de l'acide 4-aminobutanoïque et un dépresseur du système nerveux central. Le GHB et ses analogues sont des drogues populaires faisant l'objet d'abus. Le sevrage de ces agents se manifeste par une instabilité autonome et un état mental altéré. Nous présentons un cas de sevrage de BD-1,4 ayant duré 6 jours et ayant été compliqué par une nouvelle apparition de convulsions et de rhabdomyolyse. Nous avons en outre réalisé une revue systématique de la littéra-ture anglaise portant sur le sevrage du GHB, du BD-1,4 et du gamma-butyrolactone (GBL). Les données recueillies des articles sources incluaient des renseignements sur la dernière utilisation avant la survenue de symptômes, les manifestations cliniques à l'arrivée des patients à l'urgence, la durée des symptômes et les résultats. La revue portait sur 27 études décrivant 57 épisodes de sevrage. Trente-six cas (63 %) étaient liés au GHB, 3 cas (5 %) au BD-1,4 et 18 (32 %) au GBL. Les tremblements (67 %), les hallucinations (63 %), la tachycardie (63 %) et l'insomnie (58 %) étaient les symptômes les plus courants observés chez les patients. Les convulsions et la rhabdomyolyse se sont manifestées respectivement dans 7 % des cas, mais seulement 1 décès a eu lieu. Lorsqu'un patient présente des manifestations cliniques évoquant le syndrome de sevrage de sédatifs hypnotiques, les médecins d'urgence devraient considérer la possibilité de sevrage de ces agents.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Wojtowicz

Yarema

Wax

2008

CJEM

View full text Add to dashboard Cite

show abstract

“…This progresses over a period of days to include confusion, delirium and hallucinations and wanes over a period of 1-2 weeks. 36 Initial management of GHB/GBL overdose involves supportive measures, including airway management where necessary. Renal function and creatine kinase should be checked, given reports of rhabdomyolysis.…”

Section: Gamma-hydroxybutyric Acid/gamma-butyrolactonementioning

confidence: 99%

‘Designer drugs’: update on the management of novel psychoactive substance misuse in the acute care setting

Smith

Robert

2014

Clinical Medicine

View full text Add to dashboard Cite

The use of novel psychoactive substances ('legal highs' or 'designer drugs') is increasing worldwide. Patients misusing such substances have been reported to experience severe or prolonged side effects requiring admission to acute or critical care wards. These complications can be life threatening if misdiagnosed or mismanaged. As physicians have traditionally had less involvement with the management of such patients compared with their colleagues in emergency departments an update in the management of such patients is indicated. Here we present a summary of the management of those novel substances with the potential for serious complications based on a review of current literature.

show abstract

“…Para el GHB y derivados se ha descrito un síndrome de abstinencia con sintomatología de insomnio, temblor, ansiedad, confusión, alucinaciones, delirium y taquicardia según la gravedad del mismo (3,5,14) .…”

Section: Ghb (Gammahidroxibutirato) Y Simi-laresunclassified

Aproximación terapéutica al uso y abuso de drogas recreativas

Vázquez

Fraile

2003

Adicciones

View full text Add to dashboard Cite

ResumenObjetivo: describir y analizar el estado actual del tratamiento del uso y abuso de las drogas recreativas y de sus efectos adversos de tipo psiquiátrico. Méto-do: la información recopilada en la búsqueda bibliográfica se ha organizado por sustancias -MDMA, GHB (gammahidroxibutirato) y ketamina-y por el tipo de efectos. Resultados: a pesar de la escasez de publicaciones parece existir un cierto grado de acuerdo en el abordaje de los problemas con MDMA y GHB; para las complicaciones psiquiátricas agudas, subagudas y residuales por éxtasis se recomienda la utilización de benzodiazepinas, antidepresivos y/o antipsicóticos atípicos; para la intoxicación y síndrome de abstinencia producido por el GHB y similares, se recomienda la utilización de benzodiacepinas, y la utilización conjunta de estabilizadores del humor y antipsicóticos atípicos. En el caso del síndrome de abstinencia y de la sintomatología positiva, negativa y cognitiva que puede producir el consumo de Ketamina, ya que no existe un tratamiento protocolizado, se comentan resultados de recientes estudios. Conclusiones: dada la insuficiente experiencia clínica y terapéutica, así como la falta de estudios clínicos controlados, en la actualidad no existe un consenso terapéutico establecido para las drogas de recreo. Palabras claves:Tratamiento farmacológico, MDMA, GHB, Ketamina. SummaryObjective: to describe and analyze the state of the art of the treatment of use-abuse of "club drugs" and their psychiatric adverse effects. Method: data from literature were organized according to the type of drug -MDMA, GHB (Gammahidroxibutirate) and Ketamine-and to the type of adverse effects. Results: does exist certain agreements in how to approach problems related with the use of MDMA and GHB; for acute, subacute and residual psychiatric disorders induced by Ecstasy, the use of benzodiazepines, antidepressants and/or atypical antipsychotics has been suggested; for intoxication and withdrawal syndromes induced by GHB and similar drugs, the use of benzodiazepines, and the use of mood stabilizers and atypical antipsychotics has been suggested. With respect to withdrawal and positive, negative and cognitive simtomatology induced by Ketamine, and due to the fact that there is no treatment currently in use, the results reported by recent studies are discussed. Conclusion: due to the insuficient clinical and therapeutical experience and to the lack of controlled clinical trials, there is no therapeutic consensus for "club drugs" .

show abstract

Gamma Hydroxybutyrate (GHB) and Gamma Butyrolactone (GBL) Withdrawal: Five Case Studies

Cited by 76 publications

References 29 publications

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

‘Designer drugs’: update on the management of novel psychoactive substance misuse in the acute care setting

Aproximación terapéutica al uso y abuso de drogas recreativas

Contact Info

Product

Resources

About