- What other names is Gamma-hydroxybutyrate (ghb) known by?
- What is Gamma-hydroxybutyrate (ghb)?
- How does Gamma-hydroxybutyrate (ghb) work?
- Are there safety concerns?
- Are there any interactions with medications?
- Dosing considerations for Gamma-hydroxybutyrate (ghb).
4-Hydroxybutanoate, 4-Hydroxy Butyrate, 4-hydroxybutyric acid, Acide 4-hydroxybutanoïque, Acide Gamma-Hydroxybutyrique, Acide Gamma-Hydroxy-Butyrique, Ecstasy Liquide, Gamma Hydrate, Gamma-Hydroxybutyrate, Gamma-Hydroxy-Butyrate, Gamma Hydroxy-Butyrate de Sodium, Gamma Hydroxybutyrate Sodium, Gamma Hydroxybutyric Acid, Gamma-Hidroxibutirato, Gamma-OH, Oxybate de Sodium, Oxybutyrate de Sodium, Sodium 4-hydroxybutyrate, Sodium gamma-hydroxybutyrate, Sodium Oxybate, Sodium Oxybutyrate.
Gamma hydroxybutyrate (GHB) is a chemical found in the brain and other areas of the body. It can also be made in a laboratory.
GHB used to be available as a dietary supplement in the U.S., but it was taken off the market in 1990 because of safety concerns. GHB and two closely related chemicals, gamma butyrolactone (GBL) and butanediol (BD), were linked to 3 deaths and 122 serious side effects. Nevertheless, secret production and sales of GHB continued, often on the Internet. Continued interest in GHB might have been fueled by GHB's reputation as a “date rape” drug. Under the Date-Rape Drug Prohibition Act of 2000, regulation tightened. GHB was classified as a Schedule I controlled substance, like heroin. It is now illegal for Americans to produce, sell, or possess GHB except for medical use. A prescription form of GHB remains available, but the only legal access to this drug is through a physician or other healthcare provider who is licensed to prescribe medications.
GHB is used for weight loss, muscle building, and relief of some fibromyalgia symptoms including pain, fatigue, and sleep problems. It is also used as an alternative to the dietary supplement L-tryptophan for promoting relaxation and sleepiness. People who are addicted to alcohol or narcotic drugs sometimes use GHB to help them manage withdrawal symptoms. It is also used to cause sexual arousal.
The prescription form of GHB has been approved by the U.S. Food and Drug Administration (FDA) for treatment of narcolepsy, a sleep disorder caused by the brain's inability to regulate sleep-wake cycles. People with narcolepsy experience irresistible bouts of daytime sleep. They can also experience muscle control problems, paralysis, and hallucinations. GHB is available under the generic name sodium oxybate and trade name Xyrem (Orphan Medical) for the treatment of paralysis associated with narcolepsy. It is a Schedule III Controlled Substance, which means extra paperwork is necessary when this drug is prescribed, and prescriptions for this drug receive special scrutiny from regulators.
Possibly Effective for...
- Treatment of loss of muscle control and weakness associated with a condition called narcolepsy. Taking GHB seems to help people with narcolepsy sleep at night so they are less likely to feel sleepy during the day. GHB also seems to help reduce the temporary paralysis that sometimes goes along with narcolepsy.
- Pain, fatigue, and sleep problems associated with a condition called fibromyalgia.
- Alcohol dependence and withdrawal.
- Suppressing symptoms of withdrawal from heroin, opium, morphine, and other opiate drugs.
Insufficient Evidence to Rate Effectiveness for...
- Reducing weight.
- Enhancing muscle growth.
- Causing sexual arousal.
- Reducing pressure in the brain caused by head injury.
- Other conditions.
The natural function of GHB in the body might be to slow down brain activity during sleep. Gamma hydroxybutyrate affects several nerve pathways in the brain, including activating the body's pain-killing (opioid) system and raising levels of growth hormone.
The prescription medication gamma hydroxybutyrate (sodium oxybate) is POSSIBLY SAFE for adults who are taking it under close medical supervision for symptoms of a condition called narcolepsy.
Gamma hydroxybutyrate (GHB) is UNSAFE and illegal for use as a dietary supplement. Use of GHB, or the closely related gamma butyrolactone (GBL) and butanediol (BD), has been linked to at least three deaths and 122 cases of serious side effects. GHB can cause many serious side effects including headaches, hallucinations, dizziness, confusion, nausea, vomiting, drowsiness, agitation, diarrhea, sexual arousal, numbing of legs, vision problems, tightness of chest, mental changes, combativeness, memory loss, serious breathing and heart problems, seizures, coma, and death. GHB can be addictive. Long-term use may lead to withdrawal symptoms that are serious enough to require hospitalization.
GHB also has some major interactions with prescription medications.
Special Precautions & Warnings:Pregnancy and breast-feeding: GHB is UNSAFE. Don't use GHB if you are pregnant or breast-feeding. It's been linked with life-threatening side effects.
Slow heart rate (bradycardia): GHB should be avoided since it can cause bradycardia.
Surgery: GHB can affect the central nervous system. There is a concern that it might cause too much sleepiness if it is used along with anesthesia and other nerve-numbing medications used during and after surgery. Stop using GHB at least 2 weeks before a scheduled surgery.
AlcoholInteraction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Alcohol can cause sleepiness and drowsiness. Taking GHB along with alcohol might greatly increase sleepiness and drowsiness caused by alcohol. Taking GHB along with alcohol can lead to serious side effects. Do not take GHB if you have been drinking.
AmphetaminesInteraction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Amphetamines are drugs that can speed up your nervous system. GHB can slow down your nervous system. Taking GHB along with amphetamines can lead to serious side effects.
Haloperidol (Haldol)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
GHB can affect the brain. Haloperidol (Haldol) can also affect the brain. Taking haloperidol (Haldol) along with GHB might cause serious side effects.
Medications for mental conditions (Antipsychotic drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
GHB can affect the brain. Medications for mental conditions also affect the brain. Taking GHB along with medications for mental conditions might increase the effects and serious side effects of GHB. Do not take GHB if you are taking medications for a mental condition.
Some of these medications include fluphenazine (Permitil, Prolixin), haloperidol (Haldol), chlorpromazine (Thorazine), prochlorperazine (Compazine), thioridazine (Mellaril), trifluoperazine (Stelazine), and others.
Medications for pain (Narcotic drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Some medications for pain can cause sleepiness and drowsiness. GHB might also cause sleepiness and drowsiness. Taking GHB along with some medications for pain might cause severe side effects. Do not take GHB if you are taking medications for pain.
Medications used to prevent seizures (Anticonvulsants)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Medications used to prevent seizures affect chemicals in the brain. GHB is changed in the body to one of these brain chemicals called GABA. Taking GHB along with medications used to prevent seizures might decrease the effects of GHB.
Muscle relaxantsInteraction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Muscle relaxants can cause drowsiness. GHB can also cause drowsiness. Taking GHB along with muscle relaxants might cause too much drowsiness and serious side effects. Do not take GHB if you are taking muscle relaxants.
Some of these muscle relaxants include carisoprodol (Soma), pipecuronium (Arduan), orphenadrine (Banflex, Disipal), cyclobenzaprine, gallamine (Flaxedil), atracurium (Tracrium), pancuronium (Pavulon), succinylcholine (Anectine), and others.
Naloxone (Narcan)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
GHB can affect the brain. Taking naloxone (Narcan) along with GHB might decrease the effects of GHB on the brain.
Ritonavir (Norvir)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Ritonavir (Norvir) and saquinavir (Fortovase, Invirase) are commonly used together for HIV/AIDS. Taking both of these medications plus GHB might decrease how quickly the body gets rid of GHB. This could cause serious side effects.
Saquinavir (Fortovase, Invirase)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Saquinavir (Fortovase, Invirase) and ritonavir (Norvir) are commonly used together for HIV/AIDS. Taking both these medications plus GHB might decrease how fast the body gets rid of GHB. This could cause serious side effects.
Sedative medications (Benzodiazepines)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
GHB might cause sleepiness and drowsiness. Medications that cause sleepiness and drowsiness are called sedatives. Taking GHB along with sedative medications might cause serious side effects. Do not take GHB if you are taking sedative medications.
Sedative medications (CNS depressants)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
GHB might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking GHB along with sedative medications might cause serious side effects. Do not take GHB if you are taking sedative medications.
The following doses have been studied in scientific research:
- For narcolepsy and its symptoms: A dose of 25 mg/kg at bedtime, repeated 3 hours later. GHB should be used only under close medical supervision.
- For treating alcohol dependence: 50 to 150 mg/kg divided into 3 to 6 doses per day. GHB should be used only under close medical supervision.
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Health Solutions From Our Sponsors
Addolorato G, Cibin M, Caprista E, et al. Maintaining abstinence from alcohol with gamma hydroxybutyric acid. [Letter] Lancet 1998;351:38.
Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999. Available at: http://www.fda.gov/cder/graphics/ghb.gif
Anon. Important message for health professionals: Report serious adverse events associated with dietary supplements containing GBL, GHB or BD. Food and Drug Administration, Rockville, MD. August 25, 1999. Available at: http://vm.cfsan.fda.gov/~dms/mwgblghb.html
Anon. Multistate outbreak of poisonings associated with illicit use of gamma hydroxy butyrate. JAMA 1991;265:447-8.
Broughton R, Mamelak M. The treatment of narcolepsy-cataplexy with nocturnal gamma-hydroxybutyrate. Can J Neurol Sci 1979;6:1-6. View abstract.
Cash CD. Gamma-hydroxybutyrate: an overview of the pros and cons for it being a neurotransmitter and/or a useful therapeutic agent (abstract). Neurosci Biobehav Rev 1994;18:291-304. View abstract.
Cash CD. What is the role of the gamma-hydroxybutyrate receptor? Med Hypotheses 1996;47:455-9. View abstract.
Dyer J, Roth B, Hyma B. Gamma-Hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37:147-53.. View abstract.
Dyer JE. Gamma-Hydroxybutyrate: a health-food product producing coma and seizure-like activity (abstract). Am J Emerg Med 1991;9:321-4. View abstract.
FDA Talk Paper. FDA Warns About GBL-Related Products. 1999. Available at: vm.cfsan.fda.gov/~lrd/tpgbl2.html
FDA Talk Paper. FDA Approves Xyrem for Cataplexy Attacks in Patients with Narcolepsy. Issued July 17, 2002. Availbale at: http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01157.html
Feigenbaum JJ, Howard SG. Gamma hydroxybutyrate is not a GABA agonist (abstract). Prog Neurobiol 1996;50:1-7. View abstract.
Ferrara SD, Tedeschi L, Frison G, Rossi A. Fatality due to gamma-hydroxybutyric acid (GHB) and heroin intoxication. J Forensic Sci 1995;40:501-4. View abstract.
Gallimberti L, Canton G, Gentile N, et al. Gamma-hydroxybutyric acid for treatment of alcohol withdrawal syndrome. Lancet 1989;2:787-9. View abstract.
Gallimberti L, Cibin M, Pagnin P, et al. Gamma-hydroxybutyric acid for treatment of opiate withdrawal syndrome. Neuropsychopharmacology 1993;9:77-81. View abstract.
Gallimberti L, Ferri M, Ferrara SD, et al. Gamma-Hydroxybutyric acid in the treatment of alcohol dependence: a double-blind study. Alcohol Clin Exp Res 1992;16:673-6. View abstract.
Gallimberti L, Schifano F, Forza G, et al. Clinical efficacy of gamma-hydroxybutyric acid in treatment of opiate withdrawal. Eur Arch Psychiatry Clin Neurosci 1994;244:113-4. View abstract.
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. View abstract.
Gerra G, Caccavari R, Fontanesi B, et al. Naloxone and metergoline effects on growth hormone response to gamma-hydroxybutyric acid. Int Clin Psychopharmacol 1995;10:245-50. View abstract.
Harrington RD, Woodward JA, Hooton TM, et al. Life-threatening interactions between HIV-1 protease inhibitors and the illicit drugs MDMA and gamma-hydroxybutyrate. Arch Intern Med 1999;159:2221-4. View abstract.
Hillory J. Farias and Samantha Reid date-rape drug prohibition act of 2000. 106th Congress of the United States of America. HR 2130.
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. View abstract.
Ingels M, Rangan C, Bellezzo J, Clark R. Coma and respiratory depression following the ingestion of GHB and its precursors: Three cases. J Emerg Med 2000;19:47-50.. View abstract.
Kalra MA, Hart LL. Gammahydroxybutyrate in narcolepsy. Ann Pharmacother 1992;26:647-8.
Maitre M. The gamma-hydroxybutyrate signaling system in brain: organization and functional implications (abstract). Prog Neurobiol 1997;51:337-61. View abstract.
Mamelak M. Gammahydroxybutyrate: an endogenous regulator of energy metabolism (abstract). Neurosci Biobehav Rev 1989;13:187-98. View abstract.
Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39.. View abstract.
Otto A. Acquaintance rape drug may one day help instead of hurt (news). Pharmacy Today. American Pharmaceutical Association, Washington, DC. April 2000:17.
Price G. In-patient detoxification after GHB dependence. Br J Psychiatry 2000;177:181.
Scharf MB, Brown D, Woods M, et al. The effects and effectiveness of gamma-hydroxybutyrate in patients with narcolepsy. J Clin Psychiatry 1985;46:222-5. View abstract.
Scharf MB, Hauck M, Stover R, et al. Effect of gamma-hydroxybutyrate on pain, fatigue, and the alpha sleep anomaly in patients with fibromyalgia. Preliminary report. J Rheumatol 1998;25:1986-90. View abstract.
Scrima L, Hartman PG, Johnson FH Jr, et al. The effects of gamma-hydroxybutyrate on the sleep of narcolepsy patients: a double-blind study. Sleep 1990;13:479-90. View abstract.
Scrima L, Hartman PG, Johnson FH Jr, Hiller FC. Efficacy of gamma-hydroxybutyrate versus placebo in treating narcolepsy-cataplexy: double-blind subjective measures. Biol Psychiatry 1989;26:331-43. View abstract.
Smith KM. Drugs used in acquaintance rape. J Am Pharm Assoc 1999;39:519-25. View abstract.
Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518.
Tunnicliff G. Significance of gamma-hydroxybutyric acid in the brain. Gen Pharmacol 1992;23:1027-34. View abstract.
Tunnicliff, G. Sites of action of gamma-hydroxybutyrate (GHB)-a neuroactive drug with abuse potential. J Toxicol Clin Toxicol 1997;35:581-90. View abstract.
Van Cauter E, Plat L, Scharf MB, et al. Simultaneous stimulation of slow-wave sleep and growth hormone secretion by gamma-hydroxybutyrate in normal young Men (abstract). J Clin Invest 1997;100:745-53. View abstract.