Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: A case report and systematic review

Canadian Journal of Emergency Medicine

Volumn 10, Issue 1, 2008, Pages 69-74

  Wojtowicz, Jeremy M ^a,b,e   Yarema, Mark C ^a,c   Wax, Paul M ^d  

^a UNIVERSITY OF CALGARY   (Canada)

^b UNIVERSITY OF CALGARY   (Canada)

^c CALGARY HEALTH REGION   (Canada)

^d Section of Toxicology   (Canada)

^e NONE   (Canada)

Author keywords

1,4 butanediol; Gamma butyrolactone; Gamma hydroxybutyrate; Substance withdrawal syndrome

Indexed keywords

1,4 BUTANEDIOL; 4 HYDROXYBUTYRIC ACID; ALANINE AMINOTRANSFERASE; ALCOHOL; ALPRAZOLAM; ANTICONVULSIVE AGENT; ANTIEMETIC AGENT; ASPARTATE AMINOTRANSFERASE; BACLOFEN; BARBITURIC ACID DERIVATIVE; BENZODIAZEPINE; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; BICARBONATE; BILIRUBIN; BROMOCRIPTINE; CANNABIS; CHLORAL HYDRATE; CLONIDINE; COCAINE; CREATINE KINASE; FENTANYL; GAMMA BUTYROLACTONE; HALOPERIDOL; LORAZEPAM; NEUROLEPTIC AGENT; PAROXETINE; PHYSOSTIGMINE; PROPOFOL; TRAZODONE; 1,4-BUTANEDIOL; BUTANEDIOL; OXYBATE SODIUM; STREET DRUG;

ADULT; AGITATION; ARTICLE; CASE REPORT; CLINICAL FEATURE; DATA COLLECTION METHOD; DISEASE COURSE; DISEASE DURATION; DRUG DEPENDENCE; DRUG EFFICACY; EMERGENCY CARE; GAS CHROMATOGRAPHY; HALLUCINATION; HUMAN; INSOMNIA; INTENSIVE CARE UNIT; LABORATORY TEST; MALE; MASS SPECTROMETRY; MEDICAL LITERATURE; MENTAL DISEASE; MONOTHERAPY; OUTCOME ASSESSMENT; QUALITATIVE ANALYSIS; RHABDOMYOLYSIS; SUBSTANCE ABUSE; SYMPTOMATOLOGY; SYSTEMATIC REVIEW; TACHYCARDIA; TONIC CLONIC SEIZURE; TREMOR; URINALYSIS; VITAL SIGN; WITHDRAWAL SYNDROME; CHEMICALLY INDUCED DISORDER; REVIEW; SEIZURE;

4-BUTYROLACTONE; ADULT; BUTYLENE GLYCOLS; HUMANS; MALE; RHABDOMYOLYSIS; SEIZURES; SODIUM OXYBATE; STREET DRUGS; SUBSTANCE WITHDRAWAL SYNDROME;

EID: 47249117171     PISSN: 14818035     EISSN: 14818035     Source Type: Journal    
DOI: 10.1017/S1481803500010034     Document Type: Article

References (47)

1. Dyer J. Gamma-hydroxybutyrate: a health food product producing coma and seizure like activity. Am J Emerg Med 1991;9: 321-4.
2. Zvosec DL, Smith SW, McCutcheon JD, et al. Adverse events, including death, associated with the use of 1,4-Butanediol. N Engl J Med 2001;344:87-94.
3. Takahara J, Yunoki S, Yakushiji W, et al. Stimulatory effects of gamma-hydroxybutyric acid on growth hormone and prolactin release in humans. J Clin Endocrinol Metab 1977;44:1014-7.
4. Controlled Drugs and Substances Act. 1996, c. 19 Available: http://laws.justice.gc.ca/en/ShowFullDoc/cs/C-38.8///en (accessed 2007 Nov 21).
5. Dyer JE, Roth B, Hyma BA. Gamma-hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37:147-53.
6. Craig K, Gomez HF, McManus JL, et al. Severe gamma-hydroxybutyrate withdrawal: a case report and literature review. J Emerg Med 2000;18:65-70.
7. Catalano MC, Glass JM, Catalano G, et al. Gamma butyrolactone (GBL) withdrawal syndromes. Psychosomatics 2001;42: 83-8.
8. Greene T, Dougherty T, Rodi A. Gamma-butyrolactone (GBL) withdrawal presenting as acute psychosis. J Toxicol Clin Toxicol 1999;37:651.
9. Herold AH, Sneed KB. Treatment of a young adult taking gamma-butyrolactone (GBL) in a primary care clinic. J Am Board Fam Pract 2002;15:161-3.
10. McDaniel CH, Miotto KA. Gamma hydroxybutyrate (GHB) and gamma butyrolactone (GBL) withdrawal: five case studies. J Psychoactive Drugs 2001;33:143-9.
11. Mycyk MB, Wilemon C, Aks SE. Two cases of withdrawal from 1,4-butanediol use. Ann Emerg Med 2001;38:345-6.
12. Reeves J, Duda R. GHB/GBL intoxication and withdrawal: a review and case presentation. Addictive Disorders & Their Treatment 2003;2:25-8.
13. Schneir AB, Ly BT, Clark RF. A case of withdrawal from the GHB precursors gamma-butyrolactone and 1,4-Butanediol. J Emerg Med 2001;21:31-3.
14. Sharma AN, Nelson L, Hoffman RS. Severe gamma butyrolactone withdrawal. J Toxicol Clin Toxicol 2000;38:535.
15. Sivilotti MLA, Burns MJ, Aaron CK, et al. Pentobarbital for severe gamma-butyrolactone withdrawal. Ann Emerg Med 2001;38:660-5.
16. Wojtowicz JM, Yarema MC, Wax PM. A case of prolonged withdrawal from use of 1,4-butanediol complicated by seizure and rhabdomyolysis [abstract]. CJEM 2006;8:195.
17. Tarabar AF, Nelson LS. The gamma-hydroxybutyrate withdrawal syndrome. Toxicol Rev 2004;23:45-9.
18. Goldfrank LR, Flomenbaum NE, Lewin NA, et al. Goldfrank's toxicologic emergencies. 7th ed. New York (NY): McGraw-Hill; 2002.
19. Ford MD, Ling LJ, Delaney KA, et al. Clinical toxicology. 1st ed. Philadelphia (PA): W.B. Saunders; 2001.
20. Haddad LM, Shannon MW, Winchester JF. Clinical management of poisoning and drug overdose. 3rd edition. Philadelphia (PA): W.B. Saunders; 1997.
21. Gonzalez A, Nutt DJ. Gamma hydroxyl butyrate abuse and dependency. J Psychopharmacol 2005;19:195-204.
22. Miotto K, Darakjian J, Basch J, et al. Gamma-hydroxybutyric acid: patterns of use, effects and withdrawal. Am J Addict 2001;10:232-41.
23. Mullins ME, Fitzmaurice SC. Lack of efficacy of benzodiazepines in treating gamma-hydroxybutyrate withdrawal. J Emerg Med 2001;20:418-9.
24. Garvey R, Fitzmaurice B. Withdrawal delirium with dance drug 'liquid ecstasy' (GHB). Ir J Psych Med 2004;21:73-5.
25. Dyer JB. Andrews KM. Gamma hydroxybutyrate withdrawal. J Toxicol Clin Toxicol 1997;35:553-4.
26. Dyer JE, Roth B, Hyma BA. GHB withdrawal syndrome: 8 cases. J Toxicol Clin Toxicol 1999;37:650.
27. Galloway GP, Frederick SL, Staggers F Jr. Physical dependence on sodium oxybate. Lancet 1994;343:57.
28. Chew G, Fernando A. III. Epileptic seizure in GHB withdrawal. Australas Psychiatry 2004;12:410-1.
29. Chin RL. A case of severe withdrawal from gamma-hydroxybutyrate. Ann Emerg Med 2001;37:551-2.
30. Addolorato G, Caputo F, Capristo E, et al. A case of gamma-hydroxybutyric acid withdrawal syndrome during alcohol addiction treatment: utility of diazepam administration. Clin Neuropharmacol 1999;22:60-2.
31. Bowles TM, Sommi RW, Amiri M. Successful management of prolonged gamma-hydroxybutyrate and alcohol withdrawal. Pharmacotherapy 2001;21:254-7.
32. Friedman J, Westlake R, Furman M. "Grievous bodily harm:" gamma hydroxybutyrate abuse leading to a Wernicke-Korsakoff syndrome. Neurology 1996;46:469-71.
33. Galloway GP, Frederick SL, Staggers FE Jr, et al. Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence. Addiction 1997;92:89-96.
34. Glasper A, McDonough M, Bearn J. Within-patient variability in clinical presentation of gamma-hydroxybutyrate withdrawal a case report. Eur Addict Res 2005;11:152-4.
35. Hernandez M, McDaniel CH, Costanza CD, et al. GHB-induced delirium: a case report and review of the literature on gamma hydroxybutyric acid. Am J Drug Alcohol Abuse 1998;24:179-83.
36. Hutto B, Fairchild A, Bright R. gamma-Hydroxybutyrate withdrawal and chloral hydrate. Am J Psychiatry 2000;157:1706.
37. Mahr G, Bishop CL, Orringer DJ. Prolonged withdrawal from extreme gamma-hydroxybutyrate (GHB) abuse. Psychosomatics 2001;42:439-40.
38. Miglani JS, Kim KY, Chahil R. Gamma-hydroxybutyrate withdrawal delirium: a case report. Gen Hosp Psychiatry 2000; 22:213-6.
39. Price G. In-patient detoxification after GHB dependence. Br J Psychiatry 2000;177:181.
40. Rosenberg MH, Deerfield LJ, Baruch EM. Two cases of severe gamma-hydroxybutyrate withdrawal delirium on a psychiatric unit: recommendations for management. Am J Drug Alcohol Abuse 2003;29:487-96.
41. Slagel B, Kingstone E, Bhalerao S. Gamma hydroxybutyrate withdrawal in an orthopedic trauma patient. Can J Psychiatry 2003;48:131-2.
42. Trendelenburg G, Heinz A, Strohle A. Gamma-hydroxybutyrate dependence with social phobia. Am J Psychiatry 2004;161:375-6.
43. Hoes MJ, Vree TB, Guelen PJ. Gamma-hydroxybutyric acid as hypnotic: clinical and pharmacokinetic evaluation of gamma-hydroxybutyric acid as hypnotic in man. Encephale 1980;6:93-9.
44. Wong CGT, Chan KFY, Gibson KM, et al. Gamma-hydroxybutyric acid: neurobiology and toxicology of a recreational drug. Toxicol Rev 2004;23:3-20.
45. Snead OC III, Gibson KM. Gamma-hydroxybutyric acid. N Engl J Med 2005;352:2721-32.
46. Rang HP, Dale MM, Ritter JM. Anxiolytic and hypnotic drugs. In: Pharmacology. 4th ed. Edinburgh (UK): Churchill Livingstone; 1999. p 531-2.
47. McDonough M, Kennedy N, Glasper A, et al. Clinical features and management of gamma-hydroxybutyrate (GHB) withdrawal: a review. Drug Alcohol Depend 2004;75:3-9.