Sedative‐Hypnotic Agents That Impact Gamma‐Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma‐Hydroxybutyric Acid, Phenibut, and Selank

Abstract

There are many nonopioid central nervous system depressant substances that share a gamma‐aminobutyric acid (GABA) receptor–related mechanism of action. These sedatives‐hypnotics can be indicated to treat anxiety, seizures, depression, and insomnia but are also used as substances of abuse and used to facilitate sexual assault. Barbiturates, methaqualone, and glutethimide were among the first type A GABA receptor–mediated sedative‐hypnotics. Their clinical use was limited for most indications by serious adverse events and strong abuse potential but continue to be used illicitly around the world. The benzodiazepines supplanted barbiturates for most indications because they were less likely to cause severe adverse events in monotherapy. Flunitrazepam is a newer benzodiazepine that is preferentially used recreationally and to facilitate sexual assault. Flunitrazepam has greater potency and higher affinity for the type A GABA receptor than most benzodiazepines. Gamma‐hydroxybutyric acid is sought illicitly for its hypnotic, euphoric and anabolic effects as well as to facilitate sexual assault. When any of these GABAergic drugs are used in high doses or with other sedative hypnotic agents, respiratory depression, coma, and death have occurred. Chronic use of these GABAergic drugs can lead to significant withdrawal syndromes. Phenibut and selank are poorly studied Russian drugs with GABAergic mechanisms that are inexplicably sold to US consumers as dietary supplements. Poison control center calls regarding phenibut have increased substantially over the past 5 years. Desired euphoriant effects account for the recreational and illicit use of many GABA‐modulating agents. However, illicit use can lead to significant toxicities related to abuse, dependence, and subsequent withdrawal syndromes. Significant evaluation of developing agents with GABA properties should be conducted to determine abuse potential before public access ensues.

The brain in chronic insomnia and anxiety disorder: a combined structural and functional fMRI study

“…This comorbidity is frequently observed in epidemiological research and may stem from a shared pathogenesis (4). For instance, individuals with both disorders may exhibit abnormal levels of neurotransmitters such as 5-hydroxytryptamine (5,6), gaminobutyric acid (7) and dopamine (8), which maintain a state of hyperarousal and stress (9). Moreover, elevated cortisol levels and dysfunction in the hypothalamic-pituitary-adrenal axis (10) may predispose these patients to a heightened stress response and disrupted sleep (11).…”

Socio-Economic and Demographic Factors Associated with Raw Alcohol Consumption

“…Raising knowledge of the negative health consequences of alcohol use in homes, particularly among parents and siblings, is critical since they are influential variables in substance use. Setting up a peer education programme in which teenagers learn how peer pressure promotes alcohol intake via simulated experiences might potentially be an effective strategy to raise awareness of the negative consequences of alcohol use and urge adolescents to avoid and minimise their use of alcohol 8 .…”