Instances of party drug overdoses and excessive use or abuse of recreational drugs continue to hog headlines. GHB, acronym for Gamma hydroxybutyric acid, belongs to the category of therapeutic drugs, and is banned in various nations. However, it is available for specific purposes in the US and is labelled as a designated Schedule I drug. Available under different names as a street drug, the substance is responsible for many side effects and adverse outcomes. Subsequent sections offer a detailed view, including documented 4-hydroxybutanoic acid side effects apart from possible undesirable outcomes of the medication.

Overview of 4-hydroxybutanoic acid

A naturally occurring neurotransmitter, 4-hydroxybutanoic acid is also known as GHB or gamma-hydroxybutyric acid. As mentioned above, it is known by different street names such as liquid ecstasy, G or juice. It also has the dubious distinction of being used as a date rape drug, which makes it dangerous for women and girls attending parties or gatherings when participants have perverted motives or intent. One of the reasons for its abuse is the purpose of intake of the drug. For instance, it is taken to improve sexual performance and to help participants in dances to perform with greater energy or enthusiasm.

Despite being a depressant, it actually helps stimulate individuals and it is this virtue that makes individuals use and later abuse the banned substance.  As a scheduled drug with a specific clinical purpose, it is used to help individuals reduce the amount of time spent sleeping in the day. The central nervous system depressant is also used as a treatment option for patients diagnosed with narcolepsy.

The mechanism of action of GHB

By virtue of being a naturally occurring substance, an understanding of how it works in the body helps to understand the mechanism of action of 4-hydroxybutanoic acid. It is known to activate GABA-B receptors and this is in turn responsible for the sedative properties or action. It is available in higher concentrations in the brain and binds to receptors, thereby activating the receptors. This triggers release of the neurotransmitter glutamate apart from dopamine release that occurs when there are lower levels of GHB.

The substance is known to have reactions or actions that are dependent on the concentration levels. For instance, dopamine release is inhibited at higher concentrations, while being stimulated at lower concentrations. This is precisely why it offers both stimulating as well as sedative properties. For instance, when it is taken in lower levels, the individual feels stimulated and energetic, taking part in parties with gusto. However, when taken in higher levels, the individuals experience the sedative properties, and this is when criminals and individuals with malice exploit women and girls. Another reason for its use, abuse and possible inadvertent overdose is the inability to know the precise levels where it would exert sedative effects after the initial stimulating effects.

Generally followed dosage

It is now time to look at the typical dosage of 4-hydroxybutanoic acid, with a note of caution that actual dosage will differ among individuals and will entirely depend on a host of factors and the assessment made by the doctor. For patients diagnosed with narcolepsy, a dose of 25 mg for every kilo of body weight is typically prescribed. The dose may sometimes be repeated after a gap of three hours depending on the condition. Remember, this is only a broad reference and is not the actual scenario of dosage. For individuals grappling with alcohol use disorder, the dose increases to anywhere between 50mg to 150 mg for every kilo of body weight, and the total dose is divided into multiple doses daily. For instance, if 50 mg per kilo is the prescribed amount, the number of doses is usually three per day. If the prescribed dose is 150 mg per kilo, the number of doses is usually six per day. The Schedule I drug is also administered intravenously for patients with alcohol use disorder, and the dose in such instances is between 50 mg to 100 mg per kilo of body weight, and the total dose is split into four doses daily. The medication is only to be administered under complete medical supervision, regardless of the mode of administration.

Possible effects of the drug on the individual

Without exception, all prescription and OTC medications come with the possibility of side effects or undesirable effects. This is all the more pronounced in drugs that belong to the category of Schedule 1. The possibility of undesirable effects is higher in drugs that work on the central nervous system. While the actual effects are still not very clear, there are indications of the possible undesirable effects. For instance, as mentioned above, dopamine levels are known to increase with the drug intake.

Excessive amounts of the neurotransmitter dopamine are known to trigger adverse effects. There are social effects, and physiological effects that are attributed to the mechanism of action and the properties of the drug. Social or behavioral changes include a clear loss of inhibition, increase euphoric feelings and makes the individual feel fully relaxed. It is also known to increase libido among individuals when taken in the appropriate quantities. The individual is likely to experience sudden loss of memory (pertaining to the period when under the influence of the drug), and drowsy feelings. The individual may also end up with a headache, or dizzy feelings, while some are known to be abnormally or unusually clumsy. Body temperature may reduce, while there is also the possibility of experiencing tremors or shivering. Other effects include feelings of nausea and possible bouts of diarrhea. Certain effects are known to amplify or change depending on the amount of intake. Possible undesirable effects may also change if the drug is consumed with alcohol.

Indicative symptoms of overdose

Individuals who have overdosed on the drug may exhibit certain symptoms such as vomiting, or agitated feelings. Other symptoms include profuse sweating and abnormally shallow breathing. Overdose can also result in feelings of hallucination, and possible seizures. Other overdose related 4-hydroxybutanoic acid side effects include possible blackouts and individuals ending up unconscious for many hours.

A dangerous outcome of extended unconsciousness is the inability of others to understand possible consequences. Many fatalities have been reported from drug overdose as the individuals who have fallen unconscious were wrongly assumed to be asleep. The unconscious individuals are then known to have stopped breathing and eventually dying.

Dangers linked to the drug

There are clear dangers linked to the drug, and individuals are advised to be fully aware of the possibilities that this drug offers to the individual in possession of this. It has been repeatedly used to spike drinks, following which unsuspecting women have been raped.  Victims of these actions are known to lose the ability to resist any exploitation or sexual acts. Additionally, the presence of the drug can be ascertained only from urine samples that are tested, within four hours of the intake of the drug. Consequently, the drug possesses the ability to exit the body of the victim after the perpetrator has committed the offence, with no trace of the substance.

Cautionary information regarding GHB

The drug is known to have addictive properties if it has been used repetitively. By virtue of the stimulating potential or action, the drug may result in individuals getting addicted to the substance. Additionally, it also comes with the possibility of strong or potent withdrawal effects. For instance, individuals repeatedly taking the substance may experience insomnia, profuse sweating, and anxious feelings. These effects are known to be intense in nature and may also make the individual incapable of certain routine actions.

As a result of it being used or abused in parties or settings that are celebratory in nature, there is a likelihood of it being mixed with other sedatives, alcohol or hypnotic substances. As a result of the possible central nervous system depressant properties of other substances, there is a possibility of the drug causing respiratory complications. Additionally, there could also be vomiting sensations and possible feelings of nausea.

Pregnant women and 4-hydroxybutanoic acid

Pregnant women or women planning a pregnancy are not to use the drug under any circumstances, despite the lack of information about possible adverse effects. In the event that it is intended to be used for treating any medical condition that is critical in nature, it is important to seek explicit medical advise regarding its use. It is also important that individuals on the substance are constantly monitored to prevent any adverse outcome.

Dealing with withdrawal symptoms

Individuals who require detoxification of the substance are likely to experience serious withdrawal symptoms. It is to be performed under close medical supervision, in addition to constant monitoring in a healthcare setting. The duration of hospitalization may extend anywhere between one week to a fortnight, depending on the condition.  In many instances, patients are known to try detoxification themselves, outside of hospital settings. This may involve the use of alcohol or benzodiazepines. It is necessary to add that use of these substances is likely to aggravate the condition, and may result in possible respiratory complications. Detoxification is only to be performed under medical supervision, as this requires constant monitoring of vitals and parameters of the patient.

Interactions with other medications and substances

The drug is known to trigger interactions with other substances or medications. It is therefore necessary to seek medical advice and clearly intimate the treating specialists about use of medications for other conditions. GHB or 4-hydroxybutanoic acid is known to react with alcohol and trigger drowsy feelings. Pain medications belonging to the category of narcotic medications are also known to interact with 4-hydroxybutanoic acid, by causing excessive drowsy feelings. Common interactions of the medication or possible 4-hydroxybutanoic acid side effects include increased sedative effects. The drug is also known to interact with anticonvulsant medications prescribed for seizures, and may result in drowsy feelings. Additionally, anticonvulsants are likely to lose some of their efficacy when taken with GHB.

By virtue of its natural sedative effects, the drug will amplify the sedative effects of other medications prescribed for sleep. Individuals on any medications for sleep are to avoid taking the two together as this may result in possible undesirable consequences. The drug is also known to cause side effects when patients are administered anesthesia prior to surgical procedures. Patients are advised to inform the surgeon and anesthesiologist about use of the drug, as this will help the team to make suitable modifications or postpone the surgery till such time as required.


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