Gamma-butyrolactone and 1,4-butanediol: abused analogues of gamma-hydroxybutyrate.
gamma-Hydroxybutyrate (GHB) is a GABA-active CNS depressant, commonly used as a drug of abuse. In the early 1990s, the US Drug Enforcement Administration (DEA) warned against the use of GHB and restricted its sale. This diminished availability of GHB caused a shift toward GHB analogues such as gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) as precursors and surrogates. Both GBL and 1,4-BD are metabolically converted to GHB. Furthermore, GBL is commonly used as a starting material for chemical conversion to GHB. As such, the clinical presentation and management of GBL and 1,4-BD intoxication shares a great deal of common ground with that for GHB. This similarity exists not only for acute intoxication but also for withdrawal in those patients with a history of extended high-dose abuse. This review examines the history of GHB analogue abuse as well as the clinical presentation and management of acute intoxication and withdrawal associated with abuse of these compounds.
Toxicology Associates, Prof LLC, Denver, Colorado, USA. RPalmer@ToxicologyAssoc.com
Robert B
RB
Palmer
D015107:4-Butyrolactone / Q000494:pharmacology / Q000633:toxicity*; D001833:Body Temperature Regulation; D002072:Butylene Glycols / Q000494:pharmacology / Q000633:toxicity*; D018757:GABA Modulators / Q000494:pharmacology / Q000633:toxicity*; D006801:Humans; D013287:Illicit Drugs / Q000494:pharmacology / Q000633:toxicity*; D012640:Seizures / Q000139:chemically induced; D012978:Sodium Oxybate / Q000031:analogs & derivatives* / Q000633:toxicity*; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
D002072:Butylene Glycols; D018757:GABA Modulators; D013287:Illicit Drugs; D012978:Sodium Oxybate; C039681:1,4-butanediol; D015107:4-Butyrolactone