Notes from the Field: Phenibut Exposures Reported to Poison Centers — United States, 2009–2019

Graves, Janessa M.; Dilley, Julia A.; Kubsad, Sanjay; Liebelt, Erica L.

doi:10.15585/mmwr.mm6935a5

Cited by 19 publications

(27 citation statements)

References 4 publications

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“…The U.S. Centers for Disease Control and Prevention reported a rapid increase in the use of phenibut from 2009 to 2019, and most of this use was driven by unregulated online sales. 1 This case highlighted some of the dangers of co-ingestion of phenibut with other pharmacologically similar drugs that potentially can enhance its effects. Our patient had co-ingestion of gabapentin and phenibut, which have very similar mechanisms of action, potentially enhancing the toxicity of phenibut.…”

Section: Discussionmentioning

confidence: 95%

“…β-Phenyl-γ-aminobutyric acid (phenibut) is a glutamic acid analog that acts on the γ-aminobutyric acid receptors (GABA A and GABA B ) and B-phenethylamine receptors. 1 It has been used for anxiety, posttraumatic stress disorder, and insomnia, but it has not been approved by the U.S. Food Drug Administration (FDA) for use. Phenibut is advertised as a supplement and easily purchased from online retailers and has high abuse potential.…”

Section: Introductionmentioning

confidence: 99%

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Acute Psychosis Associated With Phenibut Ingestion

Acosta¹,

Munguti²

2021

kjm

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Acute Psychosis Associated With Phenibut Ingestion

Acosta¹,

Munguti²

2021

kjm

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“…The risks of phenibut have been well documented. More than 1,300 calls to US poison centers have involved phenibut ingestions with lethargy, agitation, tachycardia and confusion among the most commonly reported reactions with coma and death among the most serious adverse events [3]. In addition to adverse effects of acute consumption, consumers may seek medical care for symptoms due to phenibut withdrawal, and several pharmacological treatments, including phenobarbital and baclofen, have been used to manage phenibut withdrawal [2].…”

Section: Discussionmentioning

confidence: 99%

“…Phenibut has the potential to produce physical dependence, withdrawal and addiction [2]. In the United States, poison control centers have received more than 1,300 calls involving phenibut, the great majority since 2015 [3]. Lethargy, agitation, tachycardia and confusion are among the most commonly reported symptoms to poison control centers.…”

Section: Introductionmentioning

confidence: 99%

“…Lethargy, agitation, tachycardia and confusion are among the most commonly reported symptoms to poison control centers. Lifethreatening adverse events from overdose and withdrawal include delirium, psychosis and coma [2,3]. In a recent study from the Centers for Disease Control and Prevention, lifethreatening reactions or long-term disability occurred in 1 in 8 reported exposures to phenibut, including 80 cases of coma and three deaths [3].…”

Section: Introductionmentioning

confidence: 99%

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Quantity of phenibut in dietary supplements before and after FDA warnings

Cohen

Ellison

Travis

et al. 2021

Clinical Toxicology

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Introduction: Phenibut is used to treat anxiety, insomnia, alcohol withdrawal and other conditions in Russia. The drug, however, has abuse potential and may cause lethargy, delirium, psychosis and coma. In the United States (US), the US Food and Drug Administration (FDA) has never approved the use of phenibut as a prescription medication, but the drug is available over-the-counter in dietary supplements. More than 80 cases of coma and death have been associated with phenibut consumption and withdrawal, and the FDA recently warned that the drug is not permitted in over-the-counter supplements. We designed our study to determine the presence and quantity of phenibut in over-the-counter supplements before and after the FDA warnings. Methods: Phenibut products were included if they (a) listed phenibut or a synonym as an ingredient on the label, (b) were labeled as a dietary supplement, and (c) were available for sale both before and after the FDA warning. Supplements were analyzed by liquid chromatography time-of-flight mass spectrometry; quantification was performed by isotope dilution method. Results: Four brands of dietary supplements labeled as containing phenibut met the inclusion criteria. Prior to the FDA warnings, two of the four brands contained phenibut, at dosages of 484 mg and 487 mg per serving. After the FDA warning, all four products contained phenibut, ranging in dosages from 21 mg to 1,164 mg per serving. Phenibut was first detected only after the FDA warnings in two brands, and the quantity of phenibut increased in three of four products after the FDA warnings. Quantities detected per dose were as much as 450% greater than a typical 250 mg pharmaceutical tablet manufactured in Russia. Conclusion: Following FDA issuing an advisory that phenibut is not permitted in dietary supplements, the quantity of phenibut increased in 3 of 4 brands of over-the-counter phenibut supplements.

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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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Notes from the Field: Phenibut Exposures Reported to Poison Centers — United States, 2009–2019

Cited by 19 publications

References 4 publications

Acute Psychosis Associated With Phenibut Ingestion

Acute Psychosis Associated With Phenibut Ingestion

Quantity of phenibut in dietary supplements before and after FDA warnings

Phenibut: Review and Pharmacologic Approaches to Treating Withdrawal

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