Hi all,
I'm in Italy and here it's officially approved by drug agency (AIFA) the medicinal product called Alcover®, the sodium salt of Gamma HydroxyButyrate Acid (GHB) in the treatment of alcoholism, to prevent relapse by restraining craving.
It's used to treating alcohol abstinence and alcohol withdrawal syndrome in alcohol-dependent adult patients.
Unlike Antabuse® and Etiltox® (disulfiram), sodium oxybate inherently affects the need and want for alcohol in addicted people, through stimulation of massive dopamine release in the brain.
It's not only dopamine, however, that is implicated in the neuromodulation enacted by sodium oxybate, but all neurotransmitters that can positively act on mood.
At the same time, GHB acts with sedative effect on the CNS, increasing GABA concentrations more than any other hormone whose release it facilitates; in particular, this molecule binds to GABAB receptors, the subunit also responsible for ethylene binding, not surprisingly, and extrasynaptic GABAA receptors, resulting in alcohol-mimetic effects.
Another drug that acts on GABAB receptors is Baclofene®, and in fact studies evidence its effectiveness in the treatment of alcohol addiction, even if lesser of sodium oxybate, while the receptor site of benzodiazepines (BDZs) is predominantly GABAA: this is why the latter class of drugs is mistakenly used on alcoholism as the first choice, while the choice of election should fall squarely on sodium oxybate. While it's true that benzodiazepines can reverse an ongoing withdrawal syndrome, even when there is the presence of delirium tremens or symptoms of overt criticality, they cannot act on the perception regarding the individual's appetite as to how much the patient feels like drinking, since BDZs can't target the receptors in the same way as alcohol (see AUDADIS scale).
GHB is allowed only in Italy and Austria, in Europe, and is used to date by about 15,000 patients, spread across these two states. Alcover® it's a 17,5% red oral solution (syrup) i.e. with concentration of 175 mg/ml, sold as cardboard cases with 12 vials of 10 ml (each), or 140 ml bottle. The optimal dosage range is from 50 mg/kg to 100 mg/kg of patient's bodyweight, divided in 3 daily intakes, at least 4 hours from each other.
In the USA, however, GHB it's sold under the name Xyrem® and it's a colorless, powder-derived oral solution with a concentration of 0,5 g/ml and the recommended starting dosage is 4.5 g divided into two daily intakes, but FDA-approved maximum dosage of Xyrem® is 9 g per night (as two 4.5 g doses). On the way round to Europe, the United States has granted the use of the sodium salt of gamma hydroxyaminobutyric acid as a treatment for narcolepsy and other sleep disorders unresponsive to other therapeutic routes, pharmacological or otherwise, when difficulties in falling asleep or maintaining sleep result in excessive daytime sleepiness or nodding off (at the wheel, especially, in view of its danger - drowsy driving) of such magnitude as to represent a pathological condition in which the patient suffers a major impairment in the routine activities.
Given all these assumptions, is it possible to stop the treatment with Alcover® after many years of consumption, without to suffer of withdrawal syndrome, in absence of this drug in the bloodstream, although several days since the last intake?
I've heard anything under the sun about this longstanding issue, but the truth is still out there. Let's start looking for it!
From: https://oxfordtreatment.com/substance-abuse/ghb/withdrawal/GHB Withdrawal: Symptoms and Timeline
Written by:Editorial Staff
Updated: Jan 09, 2023
Table of Contents
The drug GHB, or gamma-hydroxybutyrate, is a naturally occurring chemical produced by the human body, but when it is synthesized and consumed in large amounts, it can cause intense intoxication and lead to addiction.
This article will discuss the withdrawal syndrome that may occur when people abruptly stop using GHB and how to get help if you or a loved one has lost control of their GHB use.
GHB Withdrawal Symptoms
People who suddenly quit GHB after using the drug for months or years are at risk of experiencing withdrawal symptoms, which are likely to be uncomfortable. Intense cravings increase the risk of relapse back into drug abuse.
Typical withdrawal symptoms from GHB include:
- Anxiety.
- Insomnia.
- Increased heart rate.
- High blood pressure.
- Physical tremors.
- Hallucinations.
- Extreme confusion.
- Delirium.
- Psychosis.
- Changes in mood and aggression.
The discomfort caused by these symptoms can cause a person to begin abusing GHB again, in an effort to stop withdrawal. This puts a person at risk of overdose because their body will have a lower tolerance to the substance. Missing a dose can trigger withdrawal symptoms within just a few hours because GHB is metabolized rapidly. Sweating, anxiety attacks, rapid pulse, and high blood pressure are the first indications that one is experiencing GHB withdrawal.
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GHB Withdrawal Timeline
Most symptoms associated with GHB withdrawal will typically resolve after 2–3 days, but if a person has used GHB in large doses for a long time, they are more likely to develop post-acute withdrawal syndrome and experience different stages through the withdrawal process.
The second stage of GHB withdrawal may include hallucinations and an altered mental and emotional state. Changes in thinking and sleep can begin around day 4 or 5. These symptoms can mimic delirium tremens, which is a condition associated with long-term alcohol abuse that includes seizures, psychosis, and uncontrollable shaking.
Insomnia may be complicated by sleep deprivation, due to GHB intoxication before withdrawal. As this stage subsides, cravings, mood changes, exhaustion, and anxiety may linger for a few days more.
Mild GHB withdrawal takes fewer than 5 days; severe withdrawal may last up to 2 weeks.
Rhabdomyolysis is associated with about 7% of people withdrawing from GHB, especially when the drug was used or misused as a dietary supplement. This condition begins with the breakdown of skeletal muscles, which releases toxins into the bloodstream.
These toxins can make their way to the kidneys, causing kidney failure. At its worst, rhabdomyolysis leads to death. More commonly, a person will become physically weaker due to muscle loss.
Although rare, some people have reported persistent, chronic health effects from GHB abuse. These can include:
- Neurologic damage to extremities, like fingers or hands, leading to tremors, numbness, or tingling.
- Persistent struggles with clear thinking or memory.
- Emotional changes, including triggered mood disorders like depression or anxiety.
- Occasional cravings, especially associated with stress from work, family, or change.
Treatment Medications for GHB Withdrawal
While there is disagreement in the medical community about specific protocols to treat GHB withdrawal, many detox facilities offer closely monitored, small doses of benzodiazepine drugs—especially long-acting Valium—to ease the initial symptoms of withdrawal.
Avoiding prolonged withdrawal and easing the body off this sedative-hypnotic drug can improve a person’s mood and physical experience, which may reduce the risk of relapse early in treatment.
Some medical detox specialists also use small doses of barbiturates, anticonvulsant medications, or antipsychotic medications to treat specific symptoms of GHB withdrawal like sleeplessness, seizures, and hallucinations. It is important to reduce psychological and physical distress as much as possible, so the person can safely detox and enter an evidence-based rehabilitation program.
Medications are typically combined and shown to be most effective when combined with behavioral therapy. Both inpatient and outpatient rehabilitation programs focus on changing thoughts and behaviors centered around drug use, which further reduces the risk of relapse, overdose, and subsequent addiction.
Medical Detox for GHB Withdrawal
Withdrawal from GHB may require medical detox at a professional addiction treatment facility.
Many of the relaxing and intoxicating effects that GHB can cause when it is misused are similar to alcohol and benzodiazepines, two of the most widely abused and addictive substances.
Because GHB acts on the GABA receptors like benzodiazepines and alcohol do, GHB has similar withdrawal symptoms. This also means withdrawal can be complicated, may lead to post-acute withdrawal syndrome, and can cause life-threatening symptoms.
From: Article Treatment of GHB Withdrawal Syndrome: Catch 22 or Challenge ...
LETTER TO THE EDITOR
Free Access
Treatment of GHB withdrawal syndrome: Catch 22 or challenge for addiction medicine?
Cornelis A. J. de jong, Rama Kamal, Martijn van Noorden, Barbara Broers
First published: 30 May 2013
https://doi.org/10.1111/add.12234
Citations: 9
The journal publishes both invited and unsolicited letters.
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Treatment of Ghb Withdrawal Syndrome: Catch 22 or Challenge for Addiction Medicine? The literature provides little information on the process of detoxification from gamma-hydroxybutyric acid (GHB). We have studied this topic and developed three guidelines that we thought might be of interest to your readers. These guidelines can be found at http://www.nispa.nl. We also wish to issue a call for action and sharing experiences in case of problems caused by the use of ‘less well known’ psychoactive substances.GHB is an endogenous neurotransmitter and a popular drug of abuse. The lifetime prevalence in 2009 in the Netherlands was 1.3% and in the last year 0.4% among the general population 1. From 2007 to 2011 an increase from 80 to 659 patients seeking treatment for GHB dependence was reported. In cases of dependence serious symptoms of acute GHB withdrawal can develop. Complications can be life-threatening and require intensive supportive care in a medical setting. The rapid increase in the number of GHB users combined with complicated withdrawal point to the need for expert medical knowledge. However, knowledge is only available from case reports that suggest the use of high doses of benzodiazepines, short-acting barbiturates or propofol, and sometimes general anesthesia in an intensive care unit setting, with limited effect.
From: https://psycnet.apa.org/record/2004-17140-001
Clinical features and management of gamma-hydroxybutyrate (GHB) withdrawal: A review.
Journal ArticleDatabase: APA PsycInfo
McDonough, Michael Kennedy, Noel Glasper, Anthony Bearn, Jenny
Citation -McDonough, M., Kennedy, N., Glasper, A., & Bearn, J. (2004).
Clinical features and management of gamma-hydroxybutyrate (GHB) withdrawal: A review. Drug and Alcohol Dependence, 75(1), 3–9. https://doi.org/10.1016/j.drugalcdep.2004.01.012
Abstract
Aim: To examine the clinical course of gamma-hydroxybutyrate (GHB) withdrawal and generate management guidelines. Design: Review and analysis of all published reports of GHB or GHB precursor withdrawal identified from electronic searches. Findings: In total, 38 cases of GHB (n=28) or GHB precursor (n=10) withdrawal were identified, 36 of which were from the US. A rapidly deteriorating course into delirium (53% of cases) was typical for heavily dependent users. Symptoms were broadly similar to alcohol withdrawal but often occurred earlier in usage with delirium being associated with severe dependence as determined by more frequent ingestion. High dose benzodiazepines were effective in pharmacological management of GHB withdrawal. In benzodiazepine refractory cases withdrawal responded to other sedative agents, mainly pentobarbital or chloral hydrate. No withdrawal seizures but one death was recorded. Conclusions: GHB withdrawal is potentially life threatening and requires vigorous clinical management, preferably as an inpatient for severe cases. A management algorithm is proposed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
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