title: Clinical features and management of gamma-hydroxybutyrate (GHB) withdrawal: a review.
abstract: OBJECTIVE
  To examine the clinical course of gamma-hydroxybutyrate (GHB) withdrawal and generate management guidelines.
  
  
  METHODS
  Review and analysis of all published reports of GHB or GHB precursor withdrawal identified from electronic searches.
  
  
  RESULTS
  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.
authors.affiliation: Addictions Directorate, South London and Maudsley Trust and Institute of Psychiatry, King's College, London SE5 8AF, UK. mmcdonough@stpatsmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: McDonough
authors.forename: Noel
authors.initials: N
authors.lastname: Kennedy
authors.forename: Anthony
authors.initials: A
authors.lastname: Glasper
authors.forename: Jenny
authors.initials: J
authors.lastname: Bearn
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D012978:Sodium Oxybate / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000503:physiopathology / Q000628:therapy*
chemical_list: D012978:Sodium Oxybate