GHB withdrawal

The onset of GHB withdrawal symptoms typically begins 1—5 hours after the last dose initial symptoms include anxiety, tremor, tachycardia, nausea, and insomnia (Table 7—1). Untreated, the symptoms may progress within 24 hours to a more severe pattern that is similar to delirium tremens, with dys-... 

Other sedative-hypnotic medications, such as barbiturates, may play a useful role in severe withdrawal from this group of drugs. For example, in a case series of GBL withdrawal, use of intravenous pentobarbital in the range of 1-2 mg/kg/hour lowered the total requirement for intravenous lorazepam (Sivilotti et al. 2001). Antipsychotic medications are often used to reduce psychotic agitation. However, because antipsychotic medications lower the seizure threshold and may contribute to loss of central control of temperature leading to hyperthermia or neuroleptic malignant syndrome (NMS), they are not indicated as first-line medications for GHB withdrawal delirium (Dyer and Roth 2001 McDaniel and Miotto 2001 Sharma et al. 2001). If anti-... 

Although the evidence base for this relatively rare disorder is not well developed, patients who are dependent on GHB appear to benefit from cognitive and motivational psychosocial therapies and from support of recovery in a manner similar to alcohol-dependent patients. However, because of the high likelihood of amnesia and cognitive dysfunction during the acute and subacute phases of GHB withdrawal, psychosocial interventions should, when possible, include significant others who can review and reinforce with the patient the negative consequences of GHB dependence. 

McGuire PK, Cope H, Fahy TA Diversity of Psychopathology associated with use of 3,4-methylenedioxymethamphetamine ( Ecstasy ). Br J Psychiatry 165 391—395, 1994 Miotto K, Roth B GHB Withdrawal. Austin, TX, Texas Commission on Alcohol and Drug Abuse, 2001. Available at http //www.tcada.state.tx.us/research/popula-tions/GHB Withdrawal.pdf. Accessed Fehruary 28, 2003. 

The diagnosis of GHB withdrawal may be difficult because it is similar to sedative or alcohol withdrawal syndromes, as well as to withdrawal from sympathomimetic agents such as cocaine, methamphetamine, and ecstasy. GHB withdrawal may also be confused with serotonin syndrome (a reaction caused by a combination of drugs, one of which increases serotonin levels in the body, such as Prozac) and neuroleptic malignant syndrome (a rare reaction to an antiseizure medication). 

Respiratory support with oxygen may be required for respiratory depression associated with Rohypnol ingestion. A benzodiazepine antagonist can reverse respiratory depression and coma caused by overdose but is not routinely recommended because it can precipitate withdrawal symptoms and seizures. There is no antidote to GHB overdose. Ventilator respiratory support, seizure control, and supportive care may be required. Symptoms often resolve within 3-4 h. Abuse of both rohypnol and GHB can cause withdrawal symptoms. Long-term use of Rohypnol can cause seizures, tremors, and anxiety. Long-term abuse of GHB withdrawal can last from days to weeks. GHB withdrawal includes anxiety, tremors, disorientation, hallucinations, and insomnia. 

B. Specific drugs and antidotes. There are no specific antidotes available. Flumazenil and naloxone are not clinically effective. GHB withdrawal syndrome is managed with benzodiazepine (see p 415) sedation similar to other depressant withdrawal syndromes. Large doses may be needed. Withdrawal refractory to benzodiazepines is not uncommon and may benefit from the addition of barbiturates (p 486) or propofol (p494). 

Dyer JE et al Gamma hydmxybutyrate withdrawal syndrome. Ann Emerg Med 2001 37 (2) 147-153. [PMID 111 74 231] (Descrption of severe GHB withdrawal syndrome.)... 

Another potential chnical use of GHB is in the treatment of alcohol withdrawal and alcohol dependence. In prechnical studies, GHB inhibited voluntary ethanol consumption in ethanol-preferring rats and suppressed the... 

GHB treatment in mice, tolerance develops to both the hypolocomotion and cataleptic effects of the drug (Itzhak and Ali 2002). There is also preclinical evidence of cross-tolerance and cross-dependence of GHB with alcohol (Colombo et al. 1995 Fadda et al. 1989). As described in the earlier section on clinical pharmacology, GHB and its analogues have been used in humans in the treatment of alcohol withdrawal. Nicholson and Balster (2001) reviewed the evidence for cross-tolerance and cross-dependence of GHB with alcohol. 

McDaniel CH, Miotto KA Gamma hydroxybutyrate (GHB) and gamma butyrolac-tone (GBL) withdrawal five case studies. J Psychoactive Drugs 33 143—149,2001... 

GHB is currently extremely popular in the dance club and rave scene. It is also popular among the gay community as well as with exotic dancers and strippers. It is primarily used for its ability to produce euphoria, intoxication, and enhanced sexual feelings. Others use it as a sleep aid or to enhance bodybuilding. Still others use it intentionally as a date rape drug. Abusers of other drugs, such as cocaine or methamphetamine, often take GHB to reduce the withdrawal... 

GHB has also been reported to have other medical benefits, such as a sleep aid for people suffering from temporary insomnia and for treating alcohol withdrawal and alcoholism. However, the risks and dangers of taking GHB, especially in combination with alcohol, have prohibited the FDA from approving its use for conditions other than narcolepsy. 

Although GHB is primarily used for recreational purposes, cases of addiction to GHB have been reported. Some GHB users go on binges during which they take GHB around the clock (every 2-4 hours) for a few days. As the user takes additional doses, he or she develops tolerance to the effects of the drug (GHB becomes less effective with subsequent doses, so the user takes even more). Eventually, the binge GHB user exhibits signs of withdrawal, such as anxiety, insomnia, delirium and hallucinations, muscle cramping and tremors, and tachycardia (abnormally fast heart rate). 

GHB is eliminated rapidly from the body, so in the binge GHB user, symptoms of withdrawal may begin within a few hours of the last dose. Despite being eliminated from the body quickly, the withdrawal symptoms may persist for weeks or months. 

Chloral hydrate, glutethimide, and methaqualone also produce a depressant effect. Chloral hydrate is dangerous to use as an anesthetic, but it has been used to treat persons undergoing withdrawal from heroin, GHB, and alcohol. A mixture of chloral hydrate and alcohol is termed a Mickey Finn and has been used as a date rape drug. 

GHB is also addictive. Regular, daily use of GHB can cause physical dependency with harsh withdrawal symptoms. At four to six average doses per week, people report finding that they need to increase their dose to get the same level of intoxication. Many subsequently report that they need a little GHB just to feel normal. With very heavy use (one or more doses per day), many people report very serious physical addiction. Stopping cold turkey results in anxiety, inability to sleep, and feeling like the heart is arrhythmic (irregular). 

From January 1999 to August 2000, the FDA received 48 reports of acute BD intoxication, including loss of consciousness, dangerously low respiratory rates, vomiting, and slowed heartbeat. In a series of nine toxic reactions to BD reported in the New England Journal of Medicine in early 2001, the effects of BD were similar to those of GBL and GHB, and included addiction, withdrawal, and death. 

Preliminary studies suggest that GHB-based drugs may also be useful in treating Alzheimer s disease or Parkinson s disease, but it is still too early to tell. Two European studies found GHB effective in relieving alcohol craving and alcohol withdrawal symptoms. In one study, alcoholics took a moderated daily dose for three months. Participants reduced their drinking by half, and their days of abstinence tripled. Another study found that GHB relieved opiate withdrawal symptoms. 

Repeated GHB use is associated with mood swings, liver tumors, violent behavior, and dependence. If the drug is discontinued, the user can experience withdrawal. Severe withdrawal symptoms include extreme agitation, delirium, insomnia, tremor, rapid heart rate, and anxiety. 

Use of GHB can impair judgment and cause shortterm (retrograde) amnesia, increasing the possibility for risky behavior and sexual assault. It also impairs ability to drive, increasing the risk for a car accident. If use is long term, the abuser risks unknown health consequences and, if use is discontinued, the abuser is subject to potential withdrawal illness. 

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