Phenibut misuse/withdrawal
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Various toxicities: case report A 34-year-old man developed acute onset auditory and visual hallucinations, tremor, agitation, altered mental status, diaphoresis, respiratory distress, tonic-clonic activity accompanied by incontinence, acute psychosis and encephalopathy following phenibut withdrawal, misuse and intoxication [duration of treatment to reaction onsets not stated]. The man, who had a psychiatric history of anxiety, depression, obsessive-compulsive disorder and antisocial personality disorder, had misused phenibut [4-amino-3-phenyl-butyric acid] up to 34 g/day. Subsequently, he was hospitalised with an acute onset auditory and visual hallucinations, tremor, agitation and altered mental status following phenibut withdrawal and intoxication. He was increasingly agitated at admission. The man was treated with haloperidol [Haldol], lorazepam [Ativan] and diphenhydramine [Benadryl], and required 4 point restraints. Thereafter, an electrocardiogram revealed normal sinus rhythm with QTc 484. A head CT scan was negative for acute process. Various laboratory tests such as ammonia, hepatic panel and HIV were negative. A urine drug test on hospital day 3 demonstrated acetaminophen, caffeine, diphenhydramine, escitalopram, hydroxyzine, and lorazepam. Due to his altered mental status, tremors, ankle clonus, tachycardia and agitation, there serotonin syndrome was initially considered. A psychiatric consultation was sought, and his home medications such as escitalopram [Lexapro], buspirone [BuSpar] and aripiprazole [Abilify] were stopped. He was then treated with benzodiazepines based on Clinical Institute Withdrawal Assessment (CIWA) scores due to the suspicion that phenibut could mimic the withdrawal from benzodiazepines or alcohol. Psychiatry also suggested the use of baclofen. He was then shifted to the ICU due to increasing tachycardia, diaphoresis, agitation and respiratory distress. He also experienced multiple episodes of tonic-clonic activity that lasted for few seconds at a time, one of which was accompanied by incontinence. Acute psychosis and encephalopathy were suspected secondary to severe phenibut withdrawal. During the ICU stay, dexmedetomidine was initiated. His mental status improved after an eventful 8 days of hospital course. Subsequently, he was discharged. At the time of discharge, he was not exhibiting withdrawal symptoms. Wolters W, et al. Severe phenibut withdrawal: A case report and literature review. American Journal on Addictions 29: 219-220 (plus poster) abstr. 42, No. 3, May 2020. 803516073 Available from: URL: http://doi.org/10.1111/ajad.13032 [abstract]
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Reactions 21 Nov 2020 No. 1831
