Merck Manual

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Gamma Hydroxybutyrate

(GHB; "G")


Gerald F. O’Malley

, DO, Grand Strand Regional Medical Center;

Rika O’Malley

, MD, Grand Strand Medical Center

Reviewed/Revised Dec 2022

Gamma hydroxybutyrate (GHB) is similar to the neurotransmitter gamma-aminobutyric acid (GABA), but it can cross the blood-brain barrier and can be taken by mouth. It is similar to ketamine Ketamine and Phencyclidine (PCP) Ketamine and phencyclidine are N-methyl-D-aspartate receptor antagonists and dissociative anesthetics that can cause intoxication, sometimes with confusion or a catatonic state. Overdose can... read more in its effects but lasts longer and is far more dangerous.

Body builders may abuse GHB and its analogs as anabolic agents Anabolic Steroids Anabolic steroids (anabolic-androgenic steroids) are often used to enhance physical performance and promote muscle growth. When used inappropriately, chronically at high doses and without medical... read more because it releases growth hormone. GHB and its analogs have been used for their sedative and amnesic effects to facilitate sexual assaults.

Symptoms of GHB Use

GHB produces feelings of relaxation and tranquility. It may also cause fatigue and disinhibition.

At higher doses, GHB may cause dizziness, loss of coordination, nausea, and vomiting. Coma and respiratory depression may also occur. Combining GHB and any other sedative, especially alcohol, is extremely dangerous, causing decreased mental status and episodes of apnea. Most deaths have occurred when GHB was taken with alcohol.

Tolerance and dependence can develop in frequent users.

Withdrawal symptoms occur if GHB is not taken for several hours after previous frequent use of large amounts. These symptoms, which are similar to those of alcohol withdrawal Withdrawal Alcohol (ethanol) is a central nervous system depressant. Large amounts consumed rapidly can cause respiratory depression, coma, and death. Large amounts chronically consumed damage the liver... read more and benzodiazepine withdrawal, can be life-threatening.

Diagnosis of GHB Use

  • Usually a clinical diagnosis

  • Sometimes urine testing

Diagnosis of GHB intoxication is made from clinical signs and symptoms. GHB is not detected on routine urine drug screens. After its use, GHB can be detected in urine for up to 12 hours by gas chromatography/mass spectrometry.

Treatment of GHB Use

  • Management of symptoms

  • Sometimes mechanical ventilation

Treatment of GHB intoxication is directed at symptoms. Mechanical ventilation may be needed if breathing is affected or to protect the airway. Most people recover rapidly, although effects may not fade for 6 to 8 hours.

Treatment of GHB withdrawal is also similar to that for alcohol or sedative withdrawal. Administration of benzodiazepines and supportive care are the core elements of treatment.

Drugs Mentioned In This Article

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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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