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Withdrawal symptoms: case report A 21-year-old man developed withdrawal symptoms after discontinuing the dietary supplement 4-amino-3-phenylbutyric acid [phenibut] for restless leg syndrome. The man had been prescribed pramipexole and zolpidem for restless leg syndrome but had not experienced any relief of his symptoms. He then self-prescribed 4-amino-3-phenylbutyric acid, obtained via the internet as a powder, and took 1g/day in a glass of water for 10 days. Within 2-4 hours of stopping the medication he developed anxiety, psychomotor agitation, heart pounding and racing, nausea, fatigue and insomnia. He suspected that this was due to withdrawal from 4-amino-3-phenylbutyric acid and ingested 0.5g. He experienced an almost immediate relief of his symptoms and continued to take 0.5g/day over 4 days. He then stopped taking the supplement and consulted his primary care physician. He was referred to an outpatient psychiatric clinic with mild anxiety. After evaluation of his symptoms, he was found to meet the criteria for a substance-induced anxiety disorder with onset occurring during the withdrawal of 4-amino-3-phenylbutyric acid. He was advised to stop taking the 4-amino-3-phenylbutyric acid and he received education regarding the adverse effects associated with use of the drug. Magsalin RMM, et al. Withdrawal symptoms after internet purchase of phenibut (beta-phenyl-gamma-aminobutyric acid HCL). Journal of Clinical Psychopharmacology 30: 648-649, No. 5, Oct 2010. Available from: URL: http:// 803043044 dx.doi.org/10.1097/jcp.0b013e3181f057c8 - USA

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Reactions 30 Oct 2010 No. 1325