• Michael McDonough, Noel Kennedy, Anthony Glasper, and Jenny Bearn.
• Addictions Directorate, South London and Maudsley Trust and Institute of Psychiatry, King's College, London SE5 8AF, UK. mmcdonough@stpatsmail.com
• Drug Alcohol Depend. 2004 Jul 15; 75 (1): 3-9.

AimTo examine the clinical course of gamma-hydroxybutyrate (GHB) withdrawal and generate management guidelines.DesignReview and analysis of all published reports of GHB or GHB precursor withdrawal identified from electronic searches.FindingsIn 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.ConclusionsGHB withdrawal is potentially life threatening and requires vigorous clinical management, preferably as an inpatient for severe cases. A management algorithm is proposed.

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