Severe phenibut poisoning: An adolescent case cluster

Isoardi, Katherine Z; Kulawickrama, Sanjeewa

doi:10.1111/jpc.14605

Cited by 7 publications

(13 citation statements)

References 7 publications

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“…The subjective benefits of GHB and its analogs outweigh adverse events only over a narrow range of doses. Adverse events include a lower level of consciousness, hypothermia, respiratory depression, aspiration, bradycardia, gastrointestinal upset, and nonsedative adverse effects, such as agitation, seizures, and myoclonus (Busardò and Jones 2015;Isoardi et al 2020;Liakoni et al 2016;McCabe et al 2019;Schep et al 2012;Zvosec and Smith 2005). These adverse effects typically have a relatively short duration and are usually managed with supportive care (Busardò and Jones 2015;Schep et al 2012;Wood et al 2011).…”

Section: Adverse Effects Of Gaba Analogsmentioning

confidence: 99%

Designer drugs: mechanism of action and adverse effects

2020

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Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at l-opioid receptors and c-aminobutyric acid-A (GABA A) or GABA B receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N-methyl-D-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB 1) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT 2A) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.

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Section: Adverse Effects Of Gaba Analogsmentioning

confidence: 99%

Designer drugs: mechanism of action and adverse effects

2020

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“…In addition to adverse effects of acute consumption, consumers may seek medical care for symptoms due to phenibut withdrawal, and several pharmacological treatments, including phenobarbital and baclofen, have been used to manage phenibut withdrawal [2]. Case series have documented delirium, psychosis and respiratory arrest following phenibut consumption or withdrawal [1,2,5,6]. One recent case series, for example, included five adolescents all of whom were hospitalized and mechanically ventilated following acute phenibut intoxication [1].…”

Section: Discussionmentioning

confidence: 99%

“…Case series have documented delirium, psychosis and respiratory arrest following phenibut consumption or withdrawal [1,2,5,6]. One recent case series, for example, included five adolescents all of whom were hospitalized and mechanically ventilated following acute phenibut intoxication [1].…”

Section: Discussionmentioning

confidence: 99%

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Quantity of phenibut in dietary supplements before and after FDA warnings

Cohen

Ellison

Travis

et al. 2021

Clinical Toxicology

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Introduction: Phenibut is used to treat anxiety, insomnia, alcohol withdrawal and other conditions in Russia. The drug, however, has abuse potential and may cause lethargy, delirium, psychosis and coma. In the United States (US), the US Food and Drug Administration (FDA) has never approved the use of phenibut as a prescription medication, but the drug is available over-the-counter in dietary supplements. More than 80 cases of coma and death have been associated with phenibut consumption and withdrawal, and the FDA recently warned that the drug is not permitted in over-the-counter supplements. We designed our study to determine the presence and quantity of phenibut in over-the-counter supplements before and after the FDA warnings. Methods: Phenibut products were included if they (a) listed phenibut or a synonym as an ingredient on the label, (b) were labeled as a dietary supplement, and (c) were available for sale both before and after the FDA warning. Supplements were analyzed by liquid chromatography time-of-flight mass spectrometry; quantification was performed by isotope dilution method. Results: Four brands of dietary supplements labeled as containing phenibut met the inclusion criteria. Prior to the FDA warnings, two of the four brands contained phenibut, at dosages of 484 mg and 487 mg per serving. After the FDA warning, all four products contained phenibut, ranging in dosages from 21 mg to 1,164 mg per serving. Phenibut was first detected only after the FDA warnings in two brands, and the quantity of phenibut increased in three of four products after the FDA warnings. Quantities detected per dose were as much as 450% greater than a typical 250 mg pharmaceutical tablet manufactured in Russia. Conclusion: Following FDA issuing an advisory that phenibut is not permitted in dietary supplements, the quantity of phenibut increased in 3 of 4 brands of over-the-counter phenibut supplements.

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“…Usually phenibut is orally ingested and less commonly used via nasal insufflation and rectal administration 12 . Phenibut is renally excreted unchanged; its plasma half-life is approximately 5.3 hours 10,13 …”

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confidence: 99%

A Case of Phenibut Directed Detoxification Leading to Toxicity During the COVID-19 Pandemic

2022

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Background: Phenibut is a non-Food and Drug Administrationapproved gamma-aminobutyric acid analog marketed in the United States as an anxiolytic, cognitive enhancer, and alcohol withdrawal treatment through online supplement vendors. In this case report, we describe a woman's self-directed detoxification with phenibut used to manage withdrawal symptoms from fentanyl and benzodiazepines in March 2020 during the height of the COVID-19 pandemic. Case: A 38-year-old woman with severe opioid, benzodiazepine, gabapentin, stimulant use disorders developed altered mental status after oral phenibut ingestion intended to help self-manage opioid and benzodiazepine withdrawal. She chose self-directed detoxification as she feared COVID-19 exposure in detoxification facilities. Her altered mental status drove her to jump out a third-story window causing multiple spinal fractures. After a long hospitalization, she self-directed her discharge home due to concerns about COVID-19. Her premature discharge disrupted opioid and benzodiazepine use disorder treatment plans. Conclusion: This case highlights the risks of phenibut use for selfdirected detoxification. With COVID-19 related changes in the drug supply, people may be more likely to use online pharmaceuticals, therefore, substance use assessments should inquire about the online acquisition of new psychoactive drugs. Public health messaging regarding the risks of infectious disease transmission in addiction care settings is needed to guide addiction treatment choices among people who use substances.

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Severe phenibut poisoning: An adolescent case cluster

Cited by 7 publications

References 7 publications

Designer drugs: mechanism of action and adverse effects

Designer drugs: mechanism of action and adverse effects

Quantity of phenibut in dietary supplements before and after FDA warnings

A Case of Phenibut Directed Detoxification Leading to Toxicity During the COVID-19 Pandemic

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