Clinical features and management of gamma-hydroxybutyrate (GHB) withdrawal: a review

Psychosis in the Context of Sodium Oxybate Therapy

“…As GHB is related to GABA, withdrawal should be treated similar to alcohol withdrawal, with benzodiazepines. 1 The confusion, anxiety, and perceptual disturbances ("pins and needles") that this patient experienced on initial presentation to the ED is consistent with other case reports of psychiatric side effects while taking SO. 7 The more severe psychotic withdrawal symptoms, such as visual hallucinations and religious delusions, which emerged after abrupt discontinuation of SO are also consistent with previously described cases of GHB withdrawal.…”

Baclofen and Gamma-Hydroxybutyrate Withdrawal

“…In a recent review of GHB withdrawal, benzodiazepines were the most common agents employed, often in combination with other drugs [13]. For our patient, benzodiazepine dose was increased during GHB tapering but seizures were still observed.…”

“…Despite receiving benzodiazepines, which are currently recommended to treat GHB withdrawal [13], the patient had seizures, delirium, and worsening of an intention tremor with modest reductions in the GHB dose. Introduction of low-dose baclofen led to resolution of the tremor and anxiety, and prevented further seizures during completion of the GHB withdrawal.…”

“…Much like alcohol withdrawal, GHB withdrawal symptoms are serious and include tachycardia, hallucinations, and coma [13]. Seizures have been reported rarely [11,25] as part of the GHB withdrawal syndrome but are well recognized in animal-based studies of GHB withdrawal [26].…”

“…prolonged intensive monitoring and is fraught with complications [13]. Lack of activation of GABA A receptors by GHB may explain why benzodiazepines are unsatisfactory [14].…”