How is a withdrawal reaction to gamma-hydroxybutyrate (GHB) presented and how long could it last?/n

Fråga: How is a withdrawal reaction to gamma-hydroxybutyrate (GHB) presented and how long could it last?

A female patient has been abusing GHB for more than six months. Three days after discontinuation she has nausea and tachycardia. Could this be a withdrawal reaction?

Sammanfattning: Gamma-hydroxybutyrate withdrawal syndrome is characterized by tremulous, nausea, vomiting, paranoia, disorientation, diaphoresis, agitation, incoherency, audio/visual hallucinations, delirium, and confusion. The symptoms may last for one or two weeks. Benzodiazepines, antipsychotics, and phenobarbital have been used to relieve the symptoms.

Svar: Gamma-hydroxybutyrate (GHB) was introduced as an anesthetic agent, has been used to treat alcohol-and opiate abstinence, and abused as a nutritional supplement. It is now an illegal substance that is used as a drug of abuse for euphoria, sexual enhancement, and as an incapacitor for assault (1). GHB has an effect similar to GABA, the major inhibitory amino acid in the central nervous system, and affect the function of other neurotransmittors in the gabaergic and dopaminergic systems (2). Several reports of withdrawal syndrome have recently been published (1,3-5).

Withdrawal from GHB, or its prodrugs butyrolactone and 1,4-butanediol, have been described after continuous use for at least 1-2 months (1,3-5). The symptoms described include tremulous, nausea, vomiting, paranoia, diaphoresis (excessive sweating), agitation, incoherency, and disorientation (1,3-6). After the first 24 h audio/visual hallucinations, delirium, and confusion might develop (1). The symptoms in the described cases developed a couple of hours after the last intake of the drug and lasted between one and two weeks (1,3-6). The similarity between GHB withdrawal and delirium tremens are obvious. Several patients have required intensive care (1, 3) and the condition might become critical (1).

The present patient developed symptoms a couple of days after the last intake and that is a longer duration than in the published cases. The symptoms are coherent with withdrawal symptoms though.

Treatments to relieve the symptoms include general supportive treatment, bensodiazepines (1,4-6), antipsychotics (1,6-7), and phenobarbital (5). 1 Dyer JE, Roth B, Hyma BA. Gamma-hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37:147-53. 2 Okun MS, Booathby LA, Bartfield RB, Doering PL. GHB: an important pharmacologic and clinical update. J Pharm Pharmaceut Sci 2001;4:167-75. 3 Mahr G, Bishop CL, Orringer DJ. Prolonged withdrawal from extreme gamma-hydroxybutyrate (GHB) abuse. Psychosomatics 2001;42:439-40. 4 Mycyk MB, Wilemon C, Aks SE. Two cases of withdrawal from 1,4-butanediol use. Ann Emerg Med 2001;38:345-9. 5 Schneir AB, Ly BT, Clark RF. A case of withdrawal from the GHB precursor gamma-butyrolactone and 1,4-butanediol. J Emerg Med 2001;21:31-3. 6 Miglani AS, Kim KY, Cgagil R. Gamma-hydroxy butyrate withdrawal delirium: a case report. Gen Hosp Psychiatry 2000;22:213-6. 7 Mullins ME, Fitzmaurice SC. Lack of efficacy of bensodiazepines in treating gamma-hydroxybutyrate withdrawal. J Emerg Med 2001;20:418-20.