Gamma hydroxybutyrate withdrawal

Background

  • Abbreviation: GHB
  • Central nervous system depressant
  • Abused for:
    • Body building or sleep enhancement
    • euphoric, sexual, stimulant, and relaxant effects
    • Surreptitious drugging to facilitate sexual assault

Pharmacokinetics

  • effect starts 15*20min, peaks in 30*60 min,
  • lipid soluble, no protein binding so crosses BBB readily
  • elimination is dose dependant with half life of 20*50 min
  • The duration of GHB's clinical effects depends upon the dose, and ranges from 2.5 to 4 hours

Pharmacology

  • Is a metabolite and precursor of GABA
  • Interacts with GHB-specific receptors and also acts as a direct agonist of GABA-B receptors
  • Affects multiple neurotransmitter systems, including those of opioids, dopamine, serotonin, glutamate, and acetylcholine
  • Gamma butyrolactone (GBL) and 1,4 butanediol (BD) are GHB analogs that are rapidly metabolized to GHB after ingestion, with the same toxic and recreational effects

Clinical Features

  • Similar to alcohol withdrawal
  • tremor, agitation, hallucinations, tachycardia, hypertension
  • Withdrawal only if have long term use, not episodic binging
    • Occur a few hours after use

Differential Diagnosis

Sedative/hypnotic withdrawal

Evaluation

  • Typically a clinical diagnosis

Management

Disposition

See Also

External Links

References

Authors:

Ross Donaldson