Three deaths associated with use of Xyrem®

Zvosec, Deborah L.; Smith, Stephen W.; Hall, Brad

doi:10.1016/j.sleep.2009.01.005

Cited by 63 publications

(33 citation statements)

References 7 publications

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“…Although post-mortem blood GHB levels in two other deaths are consistent with therapeutic levels (110 and 141mg/L), cause and effect cannot be established although other drugs were again present, including CNS depressants. It is likely that Xyrem ® contributed to the deaths in this way (Zvosec et al, 2009). Another case involved a 53-yearold woman undergoing treatment with Xyrem ® for narcolepsy; the decedent was also prescribed tramadol, gabapentin, cetirizine, modafinil, and carisoprodol.…”

Section: Fatalitiesmentioning

confidence: 99%

Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use

Corkery

Loi

Claridge

et al. 2015

Neuroscience & Biobehavioral Reviews

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Misuse of gamma hydroxybutrate (GHB) and gamma butyrolactone (GBL) has increased greatly since the early 1990s, being implicated in a rising number of deaths. This paper reviews knowledge on GHB and derivatives, and explores the largest series of deaths associated with their non-medical use. Descriptive analyses of cases associated with GHB/GBL and 1,4-butanediol (1,4-BD) use extracted from the UK's National Programme on Substance Abuse Deaths database. From 1995 to September 2013, 159 GHB/GBL-associated fatalities were reported. Typical victims: White (92%); young (mean age 32 years); male (82%); with a drug misuse history (70%). Most deaths (79%) were accidental or related to drug use, the remainder (potential) suicides. GHB/GBL alone was implicated in 37%; alcohol 14%; other drugs 28%; other drugs and alcohol 15%. Its endogenous nature and rapid elimination limit toxicological detection. Post-mortem blood levels: mean 482 (range 0-6500; SD 758)mg/L. Results suggest significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, opiates, stimulants, and ketamine. More awareness is needed about risks associated with consumption.

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Section: Fatalitiesmentioning

confidence: 99%

Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use

Corkery

Loi

Claridge

et al. 2015

Neuroscience & Biobehavioral Reviews

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“…[17,18] Also, variation in clinical effects has been reported; [17,19] however, it is not known whether this relates to differently obtained GHB concentrations. Although not within the scope of this exploratory study, our results demonstrate that in future studies, it may be possible to explore the relationship between GHB blood levels and sleep quality in a real-life setting using DBS sampling.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Following up Gamma-Hydroxybutyric Acid Concentrations in Sodium Oxybate (Xyrem®)-Treated Narcoleptic Patients Using Dried Blood Spot Sampling at Home

et al. 2013

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Background: Gamma-hydroxybutyric acid (GHB), well known as a party drug, especially in Europe, is also legally used (sodium oxybate, Xyrem ® ) to treat a rare sleep disorder, narcolepsy with cataplexy. This exploratory study was set up to measure GHB concentrations in dried blood spots (DBS) collected by narcoleptic patients treated with sodium oxybate. Intra-and inter-individual variation in clinical effects following sodium oxybate administration has been reported. The use of DBS as a sampling technique, which is stated to be easy and convenient, may provide a better insight into GHB concentrations following sodium oxybate intake in a real-life setting. Objective:The aim was two-fold: evaluation of the applicability of a recently developed DBS-based gas chromatography-mass spectrometry (GC-MS) method, and of the feasibility of the sampling technique in an ambulant setting. Methods: Seven narcoleptic patients being treated with sodium oxybate at the Department for RespiratoryDiseases of Ghent University Hospital were asked to collect DBS approximately 20 min after the first sodium oxybate (Xyrem ® ; UCB Pharma Ltd, Brussels, Belgium) intake on a maximum of 7 consecutive days. Using an automatic lancet, patients pricked their fingertip and, after wiping off the first drop of blood, subsequent drops were collected on a DBS card. The DBS cards were sent to the laboratory by regular mail and, before analysis, were visually inspected to record DBS quality (large enough, symmetrically spread on the filter paper with even colouration on both sides of the filter paper). Results:Of the seven patients, three patients succeeded to collect five series of DBS, one patient decided to cease participation because of nausea, one was lost during follow-up and two patients stated falling asleep almost immediately after the intake of sodium oxybate. Analysing the DBS in duplicate resulted in acceptable within-DBS card precision. DBS with acceptable quality were obtained by patients without supervision. Conclusion:Our results demonstrate the acceptable precision of the complete procedure, from sampling at home to quantitative analysis in the laboratory. Given the intra-and inter-individual variability in clinical effects seen with sodium oxybate, the easy adaptation of DBS sampling opens the possibility of following up GHB concentrations in patients in real-life settings in future studies.3

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“…1 Of note, concurrent use of sedative medications such as benzodiazepines and opiates is contraindicated with SO, and their concurrent use may have contributed to three deaths reported in the literature. 8 The patient's use of these…”

Section: Discussionmentioning

confidence: 99%

Psychosis in the Context of Sodium Oxybate Therapy

Langford

Gross

2011

Journal of Clinical Sleep Medicine

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Sodium oxybate (brand name Xyrem) is a sodium salt of gamma-hydroxybutyric acid (GHB), an endogenous CNS depressant, which is an effective treatment of narcolepsy. As a drug of abuse, GHB produces severe psychiatric side effects and withdrawal. However, there are no reports of these effects when using clinically recommended doses. This paper presents a case of a patient who developed altered mental status while taking the recommended dose of sodium oxybate and subsequently became psychotic upon abrupt discontinuation of the medication. It is important for prescribers of sodium oxybate to be aware of the possibility of signifi cant psychiatric side effects of this medication, as well as withdrawal symptoms, even at clinical doses.

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Three deaths associated with use of Xyrem®

Cited by 63 publications

References 7 publications

Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use

Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use

Feasibility of Following up Gamma-Hydroxybutyric Acid Concentrations in Sodium Oxybate (Xyrem®)-Treated Narcoleptic Patients Using Dried Blood Spot Sampling at Home

Psychosis in the Context of Sodium Oxybate Therapy

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