Physostigmine in the Treatment of γ-Hydroxybutyric Acid Overdose

Abstract

The widespread abuse of the recreational drug gamma-hydroxybutyric acid has resulted in several reports of overdose leading to coma. The use of a short-acting anticholinesterase agent such as physostigmine as a potential reversal agent has been proposed previously. We report 2 cases of gamma-hydroxybutyric acid-induced coma that rapidly reversed with intravenous administration of physostigmine.

Traumatic brain injury after a motor vehicle accident: Fact or "fantasy"?

“…We have had promising results, 17 with similar findings reported in the USA. 18 It is possible that in trauma cases that have no apparent injury despite detailed physical examination and appropriate imaging physostigmine might have a role in reversing isolated GHB overdose.…”

Sedation and analgesia for brief diagnostic and therapeutic procedures in children

“…Gamma-hydroxybutyric acid [24,28,30,39,63] Gamma-hydroxybutyric acid (GHB) is an endogenous neurotransmitter that has many similarities with GABA. It was first introduced into clinical anaesthesia in 1960, but was almost completely replaced because of its great variability in recovery time.…”

A Comprehensive Review of MDMA and GHB: Two Common Club Drugs

“…155,222 As a result of the increased rate of GHB abuse since the first CDC report in 1990, the number of acute intoxications due to GHB has increased. 158,160,200,202,[222][223][224][225][226][227][228][229][230][231][232][233][234][235] Some of the more common and better documented conditions that appear in various reports include coma, respiratory depression, seizure-like activity (uncontrollable or unusual movements), bradycardia, drowsiness or dizziness, confusion, amnesia, headache, nausea, vomiting, mild hypothermia, acidosis, and psychiatric complications (e.g., agitation, delirium).…”

“…Numerous reports of intoxication with GHB describe patients who present with Glasgow Coma Scale (GCS) scores as low as 3-5. [224][225][226][227][228][229][230][231] Recovery appears to be inversely related to GCS score, with a lower GCS score resulting in a longer time to recover. 228 Coma induced by GHB usually appears rapidly after ingestion, followed by a rapid and apparent full recovery.…”

“…Bradycardia has occurred when GHB was given for anesthesia 150,166,204 as well as in overdose situations. 200,222,224,228,231 In a retrospective review of GHB intoxication, 36% of patients had pulse rates defined as bradycardia (heart rate < 55 beats/minute) and one patient required a single dose of atropine for a heart rate of 24 beats/minute. 228 In the same case series, 10 patients had hypotension (systolic blood pressure ≤ 90 mm Hg) at presentation.…”