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gamma-hydroxybutyrate; sodium oxybate (Xyrem, Xywav, Anetamin, Somsanit, Lumryz, date rape drug)

Street Drug. Prescription form is Na+ oxybate, Tradenames: Xyrem, Xywav, Anetamin, Somsanit, Lumryz Occurrence: - naturally-occurring substance - found in the central nervous system, wine, beef, small citrus fruits, & almost all animals in small amounts Indications: 1) cataplexy in patients with narcolepsy - Lumryz FDA-approved for treatment of cataplexy in children with narcolepsy (>= 7 years of age) [8] 2) idiopathic hypersomnia (FDA-approved) [6] 3) fibromylagia 4) used in treatment of insomnia in schizophrenics 5) used in treatment of alcoholism & alcohol withdrawal available through a restricted distribution program [7] Contraindications: 1) euphoria & disinhibition (date rape drug) 2) used by body builders to increase growth hormone during sleep (no evidence it works) Dosage: - Lumryz (extended release): once nightly, 6 g, 7.5 g, & 9 g effective - available June 2023 [7] - earlier formulations: twice-nightly with 2nd dose 2.5-4 hours after 1st Adverse effects: 1) most common: (> 5%) - nausea/vomiting, dizziness, enuresis, headache 2) less common - depression 3) serious a) coma b) death 4) new-onset hypertension [9] * Boxed warning - central nervous system depressant - potential for abuse & misuse [7] Overdose: - respiratory support [4] Drug interactions: - concurrent use of alcohol or sedatives may result in reduced level of consciousness or respiratory depression Laboratory: - gamma-hydroxybutyrate in specimen - gamma-hydroxybutyrate in hair - gamma-hydroxybutyrate in body fluid - gamma-hydroxybutyrate in amniotic fluid - gamma-hydroxybutyrate in CSF - gamma-hydroxybutyrate in gastric fluid - gamma-hydroxybutyrate in serum/plasma/blood - gamma-hydroxybutyrate in blood - gamma-hydroxybutyrate in serum/plasma - gamma-hydroxybutyrate in urine Mechanism of action: 1) CNS depressant 2) agonist at its own recepor, GHB receptor [3], which is excitatory 3) weak agonist at GABA-B receptor, which is inhibitory [3] 4) may reduce fibromyalgia-associated pain, fatigue, & alpha sleep anomaly Pathology: - 4-hydroxybutyricaciduria is an inborn error of GABA & gamma-hydroxybutyrate metabolism

Interactions

drug adverse effects (more general classes)

Related

4-hydroxybutyricaciduria

General

alcohol carboxylate sedative/hypnotic (tranquilizer)

Properties

Database Correlations

PUBCHEM correlations

References

  1. Prescriber's Letter 8(2):11 2001
  2. Prescriber's Letter 12(1): 3 2005 Fibromylagia Update Detail-Document#: 210103 (subscription needed) http://www.prescribersletter.com
  3. Wikipedia: gamma-Hydroxybutyrate http://en.wikipedia.org/wiki/Gamma-Hydroxybutyric_acid
  4. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
  5. FDA MedWatch: 12/17/2012 Xyrem (sodium oxybate): Drug Safety Communication - Warning Against Use With Alcohol or Drugs Causing Respiratory Depression. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm332430.htm
  6. George J First Drug OK'd for Idiopathic Hypersomnia. Sleep drug Xywav gains a new indication MedPage Today August 12, 2021 https://www.medpagetoday.com/neurology/sleepdisorders/94024
  7. Brooks M FDA OKs Once-Nightly Sodium Oxybate for Narcolepsy. Medscape. May 2, 2023 https://www.medscape.com/viewarticle/991464?
  8. Brooks M FDA OKs Once-Nightly Lumryz for Children With Narcolepsy. Medscape. October 17, 2024 https://www.medscape.com/viewarticle/fda-oks-once-nightly-lumryz-children-narcolepsy-2024a1000j18
  9. Ben-Joseph RH, Somers VK, Black J et al Increased Risk of New-Onset Hypertension in Patients With Narcolepsy Initiating Sodium Oxybate: A Real-World Study. Mayo Clin Proc. 2024 Aug 22:S0025-6196(24)00304-5. PMID: 39177543 Free article. https://www.mayoclinicproceedings.org/article/S0025-6196(24)00304-5/fulltext - Bala S, Valerio J, Ayas NT New-Onset Hypertension and Sodium Oxybate - Something to Think About. Mayo Clin Proc. 2024, 99(11):1684-1686. Nov https://www.mayoclinicproceedings.org/article/S0025-6196(24)00478-6/fulltext

Component-of

ca+2/gamma hydroxybutyrate/k+/mg+2/na+