Gamma Hydroxybutyrate

(GHB; "G")

ByGerald F. O’Malley, DO, Grand Strand Regional Medical Center;
Rika O’Malley, MD, Grand Strand Medical Center
Reviewed/Revised Dec 2022
View Patient Education

Gamma hydroxybutyrate causes intoxication resembling alcohol intoxication or and, especially when combined with alcohol, can lead to respiratory depression, seizures, and rarely death.

Gamma hydroxybutyrate (GHB) is similar to the neurotransmitter gamma-aminobutyric acid (GABA), but it can cross the blood-brain barrier and can be taken by mouth. It is similar to in its effects but lasts longer and is far more dangerous.

Body builders may abuse GHB and its analogs as anabolic agents because it releases growth hormone. GHB and its analogs have been used for their sedative and amnesic effects to facilitate sexual assaults.

GHB is sometimes used for treatment of narcolepsy.

Symptoms of GHB Use

GHB produces feelings of relaxation and tranquility. It may also cause fatigue and disinhibition.

At higher doses, GHB may cause dizziness, loss of coordination, nausea, and vomiting. Coma and respiratory depression may also occur. Combining GHB and any other sedative, especially alcohol, is extremely dangerous, causing decreased mental status and episodes of apnea. Most deaths have occurred when GHB was taken with alcohol.

Tolerance and dependence can develop in frequent users.

Withdrawal symptoms occur if GHB is not taken for several hours after previous frequent use of large amounts. These symptoms, which are similar to those of alcohol withdrawal and benzodiazepine withdrawal, can be life-threatening.

Diagnosis of GHB Use

  • Usually a clinical diagnosis

  • Sometimes urine testing

Diagnosis of GHB intoxication is made from clinical signs and symptoms. GHB is not detected on routine urine drug screens. After its use, GHB can be detected in urine for up to 12 hours by gas chromatography/mass spectrometry.

Treatment of GHB Use

  • Management of symptoms

  • Sometimes mechanical ventilation

Treatment of GHB intoxication is directed at symptoms. Mechanical ventilation may be needed if breathing is affected or to protect the airway. Most people recover rapidly, although effects may not fade for 6 to 8 hours.

Treatment of GHB withdrawal is also similar to that for alcohol or sedative withdrawal. Administration of benzodiazepines and supportive care are the core elements of treatment.

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