Management of Phenibut Use Disorder and Withdrawal in a Geriatric Patient

Wainblat, Ethan; Weleff, Jeremy; Anand, Akhil

doi:10.1016/j.jagp.2022.09.008

Cited by 6 publications

(14 citation statements)

References 23 publications

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“…26 Multiple studies highlighted how their subjects took phenibut multiple times throughout the day to achieve mind-altering effects, address their cravings, and manage their withdrawals. 10,27,28 Caution about the addictive potential of phenibut and specifically against the daily dosing of phenibut to avoid withdrawal symptoms and dependence is found in many online communities made of those that use this substance. These online communities highlight warnings about phenibut and direct those who are using it and have concerns about withdrawal or dependence to support communities and contain many stories of those struggling with problematic phenibut use.…”

Section: Discussionmentioning

confidence: 99%

“…Phenibut's addictive liability became evident from this review. The effects ranged from a potential neonatal abstinence syndrome to addiction in a geriatric patient 10,25 . Because of its short half-life and its impact on GABA and dopamine systems, phenibut appears to likely be a very potent addictive substance.…”

Section: Discussionmentioning

confidence: 99%

“…One study reported that a patient developed withdrawals after only 10 days of use 26 . Multiple studies highlighted how their subjects took phenibut multiple times throughout the day to achieve mind-altering effects, address their cravings, and manage their withdrawals 10,27,28 . Caution about the addictive potential of phenibut and specifically against the daily dosing of phenibut to avoid withdrawal symptoms and dependence is found in many online communities made of those that use this substance.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, at higher dosages, users report it causing sedation, anxiolysis, muscle relaxation, and cognitive slowing effects. Along with these reported effects, users have also reported adverse effects, including tolerance, withdrawals, dependence, rebound anxiety, and psychosis 5,10 . Furthermore, previous anecdotal literature reports very serious, even lethal consequences from phenibut use 1,4,12 …”

Section: Phenibutmentioning

confidence: 99%

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Clinical Presentations and Treatment of Phenibut Toxicity and Withdrawal: A Systematic Literature Review

et al. 2023

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Objectives: This systematic review aimed to identify published articles that evaluated all phenibut toxicity and withdrawal cases to understand better their clinical presentations and treatments. Methods: A comprehensive literature search was conducted using Medline (Ovid), Embase (Ovid), and Cochrane Library databases to capture all published cases on the presentations and management of phenibut toxicity or withdrawal. Results: Sixty-two cases from 36 studies on presentation and management of phenibut toxicity or phenibut withdrawal were identified. Of all subjects, 80.7% were male. The average age was 30.9 years (SD, 13.2 years; range, 0-71 years). A total of 86.8% reported obtaining phenibut online, and 63.2% reported concomitant substance use with other addictive agents; benzodiazepines and alcohol were the most combined drugs. The average length of hospital stay was 5.0 days (n = 25; SD, 5.4 days; range, 1-25 days) for phenibut toxicity and 7.7 days (n = 20; SD, 7.8 days; range, 0-30 days) for phenibut withdrawals. The most common symptoms reported during phenibut toxicity were altered mental status, somnolence, psychosis, and movement disorders. Of the phenibut toxicity cases, 48.7% required intubation. Benzodiazepines and antipsychotics were most used to treat phenibut toxicity. For phenibut withdrawal cases, 95.7% reported daily use. The most common symptoms reported during phenibut withdrawals were anxiety, irritability or agitation, insomnia, and psychosis. Sixteen (69.6%) of phenibut withdrawal cases required multiple medications for treatment. Benzodiazepines, baclofen, atypical antipsychotics, gabapentanoids, and barbiturates were commonly used to treat phenibut withdrawals. Conclusions: The seriousness of presentations, combined with the assortments of medications used for both syndromes, reflects the potential dangers of phenibut use and the need for systematized treatment protocols.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Phenibutmentioning

confidence: 99%

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Clinical Presentations and Treatment of Phenibut Toxicity and Withdrawal: A Systematic Literature Review

et al. 2023

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“…Many baclofen dosing regimens have been reported (Table 1). 1,[3][4][5][6][7][8][9][10][11] Initial starting doses range from 5 to 25 mg three to four times daily with maximum doses in some cases exceeding the Food and Drug Administration (FDA)-approved regimens of 60 to 80 mg. Most regimens involve a taper strategy with or without a cross-taper with phenibut; the extent and duration of the taper can vary greatly from a period of days to months.…”

Section: Discussionmentioning

confidence: 99%

Seizure Occurring During Baclofen Monotherapy for Phenibut Withdrawal

et al. 2023

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ObjectivePhenibut is a widely available gamma-aminobutyric acid B receptor agonist. When taken chronically, phenibut causes dependence and subsequent withdrawal if stopped. Baclofen, a gamma-aminobutyric acid B receptor agonist structurally related to phenibut, has been used to manage phenibut withdrawal (PW), although baclofen doses for PW are not well defined and may exceed Food and Drug Administration–approved doses. Little data described outcomes from baclofen use.MethodsThis case details a patient who experienced a seizure while on baclofen 10 mg thrice daily as monotherapy for PW and highlights a potential risk of underdosing baclofen as monotherapy in the management of PW.ResultsA man in his early 30s with anxiety, depression, and substance use disorder presented to the emergency department by family for lethargy and confusion starting earlier that day. He had been using 25–30 g of phenibut daily for the past 6 months. On arrival, he was hypertensive, tachycardic, tachypneic, and lethargic. The patient received 1 mg of intravenous lorazepam and was admitted to the hospital for presumed PW. His symptoms improved overnight, and he was discharged on 10 mg of baclofen thrice daily. He returned 28 hours later after having a seizure and required intensive care admission in addition to multimodal drug therapy.ConclusionsPhenibut use is rising, and treatment options for PW, such as baclofen, warrant additional study. Potential risks of underdosing baclofen if used as monotherapy in PW may include seizures as withdrawal progresses. Baclofen's role in therapy may be more appropriate as an adjunct than a cornerstone of therapy. Treatment done in consultation with providers experienced in managing withdrawal such as a toxicologist may help reduce this risk.

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Phenibut: Review and Pharmacologic Approaches to Treating Withdrawal

Penzak,

Bulloch

2024

The Journal of Clinical Pharma

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Abstractβ‐Phenyl‐γ‐aminobutyric acid (phenibut) is an analog of the inhibitory neurotransmitter γ‐aminobutyric acid (GABA) that was first synthesized in Russia in the early 1960s. It is marketed as a nootropic (smart drug) to improve cognitive performance, and to treat generalized and social anxiety, insomnia, and alcohol withdrawal. The use of phenibut is legal in the USA and it is widely available online without a prescription. Increased public awareness of phenibut has led to a growing number of reports of acute intoxication and withdrawal. In this review, we describe the pharmacology of phenibut, the presentation and management of acute intoxication, and regulatory issues, placing particular emphasis on the treatment of acute withdrawal, for which there are no comparative studies. Among 29 cases of phenibut withdrawal, patients were successfully treated with baclofen, benzodiazepines, and phenobarbital, as individual agents or in various combinations. Ancillary medications included antipsychotics, dexmedetomidine, gabapentin, and pregabalin. After stabilization, a number of patients did well on baclofen tapers, whereas others were weaned off benzodiazepines or phenobarbital. Phenobarbital may be preferred over baclofen, or used as an added agent, in patients at risk for seizures. As long as phenibut remains legal, cases of phenibut intoxication and withdrawal are likely to increase. As urine or plasma drug screening for phenibut is not widely available, it is vital that clinicians obtain a detailed medication history in patients presenting to the emergency department with nonspecific symptoms that may represent phenibut intoxication or withdrawal. Further, clinicians may wish to consult an addiction specialist or toxicologist in these situations.

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Management of Phenibut Use Disorder and Withdrawal in a Geriatric Patient

Cited by 6 publications

References 23 publications

Clinical Presentations and Treatment of Phenibut Toxicity and Withdrawal: A Systematic Literature Review

Clinical Presentations and Treatment of Phenibut Toxicity and Withdrawal: A Systematic Literature Review

Seizure Occurring During Baclofen Monotherapy for Phenibut Withdrawal

Phenibut: Review and Pharmacologic Approaches to Treating Withdrawal

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