Introduction
A metabolite of GABA
Acts on GABA B and GHB receptor
Symptoms
Sedation
Euphoria
Aphrodisiac
Given improves sleep architecture has been FDA approved to treat narcolepsy
In Europe it has been used to treat AUD
Misuse
Used in sexual assaults
Increases hGH so used in bodybuilding
Consumed as powder or liquid
Onset within 15 min
Symptoms last for 2-4 hours
Narrow Therapeutic index
Low dose causes:
Ataxia
Hypotonia
Vomiting
High dose causes:
Myoclonus
Bradycardia
Seizures
Coma
Treatment
No effective antidote for overdose
For seizures Given benzodiazepines
For bradycardia give atropine
For respiratory depression intubate
Withdrawal
Chronic use leads to down regulation of GABA and GHB receptors
Discontinuation after chronic use can result in sedative hypnotic like withdrawal. Resembles DTs
Can last 1-2 weeks
Treatment:
1st line: benzodiazepines. Typically requires high doses
2nd line: barbiturates.
References
Wakeman SE, Lee JD, Alvanzo AAH. Pocket Addiction Medicine. Wolters Kluwer; 2022