Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010 Feb 17;2010(2):CD006266.
doi: 10.1002/14651858.CD006266.pub2.

Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses

Maurizio A Leone  1 , Federica Vigna-Taglianti, Giancarlo Avanzi, Romeo Brambilla, Fabrizio Faggiano
Affiliations
Meta-Analysis

Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses

Maurizio A Leone et al. Cochrane Database Syst Rev. .

Abstract

Background: Chronic excessive alcohol consumption may lead to dependence, and to alcohol withdrawal syndrome (AWS) in case of abrupt drinking cessation. Gamma-hydroxybutyric acid (GHB) can prevent and suppress withdrawal symptoms, and improve the medium-term abstinence rate. A clear balance between effectiveness and harmfulness has not been yet established.

Objectives: To evaluate the efficacy and safety of GHB for treatment of AWS and prevention of relapse

Search strategy: We searched Cochrane Drugs and Alcohol Group' Register of Trials (October 2008), PubMed, EMBASE, CINAHL (January 2005 - October 2008), EconLIT (1969 to February 2008), reference list of retrieved articles

Selection criteria: Randomized controlled trials (RCTs) and Controlled Prospective Studies (CPS) evaluating the efficacy and the safety of GHB vs placebo or other pharmacological treatments.

Data collection and analysis: Three authors independently extracted data and assessed the methodological quality of studies.

Main results: Thirteen RCTs were included. Eleven studies were conducted in Italy.For withdrawal syndrome, comparing GHB 50mg with placebo, results from 1 study, 23 participants favour GHB for withdrawal symptoms: WMD -12.1 (95% CI, -15.9 to -8.29) and side effects were more frequent in the placebo group: RR 16.2 (95% CI, 1.04 to 254.9).In the comparison with Chlormetiazole, for GHB 50mg, results from 1 study, 21 participants favour GHB for withdrawal symptoms: MD -3.40 (95% CI -5.09 to -1.71), for GHB 100mg, results from 1 study, 98 participants favour anticonvulsants for side effects: RR 1.84 (95% CI 1.19 to 2.85).At mid-term, comparing GHB with placebo, results favour GHB for abstinence rate (RR 5.35; 1.28-22.4), controlled drinking (RR 2.13; 1.07-5.54), relapses (RR 0.36; 0.21-0.63), and number of daily drinks (WMD -4.60; -6.18 to -3.02). GHB performed better than NTX and Disulfiram on abstinence (RR 2.59; 1.35-4.98, RR 1.66; 0.99-2.80 respectively). The association of GHB and NTX was better than NTX on abstinence (RR 12.2; 1.79-83.9), as well was the association of NTX, GHB and Escitalopram versus Escitalopram alone (RR 4.58; 1.28-16.5). For Alcohol Craving Scale results favour GHB versus placebo (WMD -1.90; -2.45 to 1.35) and Disulfiram (WMD -1.40; -1.86 to-0.94).

Authors' conclusions: GHB 50mg is effective compared to placebo in the treatment of AWS, and in preventing relapses in previously detoxified alcoholics at 3 months follow-up, but the results of this review do not provide sufficient evidence in favour of GHB compared to benzodiazepines and Chlormethiazole for AWS prevention. GHB is better than NTX and Disulfiram in maintaining abstinence and it has a better effect on craving than placebo and Disulfiram. Side effects of GHB are not statistically different from those with BZD, NTX or Disulfiram. However, concern has been raised regarding the risk of developing addiction, misuse or abuse, especially in polydrug abusers.

PubMed Disclaimer

Conflict of interest statement

MA Leone, F Vigna‐Taglianti, GC Avanzi, R Brambilla, and F Faggiano have no conflict of interest

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
1.1
1.1. Analysis
Comparison 1 GHB 50mg vs placebo: withdrawal syndrome, Outcome 1 drop‐outs.
1.2
1.2. Analysis
Comparison 1 GHB 50mg vs placebo: withdrawal syndrome, Outcome 2 withdrawal score.
1.3
1.3. Analysis
Comparison 1 GHB 50mg vs placebo: withdrawal syndrome, Outcome 3 side‐effects.
2.1
2.1. Analysis
Comparison 2 GHB 50mg vs diazepam: withdrawal syndrome, Outcome 1 drop‐outs.
2.2
2.2. Analysis
Comparison 2 GHB 50mg vs diazepam: withdrawal syndrome, Outcome 2 CIWA‐Ar score.
2.3
2.3. Analysis
Comparison 2 GHB 50mg vs diazepam: withdrawal syndrome, Outcome 3 CIWA‐Ar subscore: tremor.
2.4
2.4. Analysis
Comparison 2 GHB 50mg vs diazepam: withdrawal syndrome, Outcome 4 CIWA‐Ar subscore: paroxysmal sweats.
2.5
2.5. Analysis
Comparison 2 GHB 50mg vs diazepam: withdrawal syndrome, Outcome 5 CIWA‐Ar subscore: anxiety.
2.6
2.6. Analysis
Comparison 2 GHB 50mg vs diazepam: withdrawal syndrome, Outcome 6 CIWA‐Ar subscore: agitation.
2.7
2.7. Analysis
Comparison 2 GHB 50mg vs diazepam: withdrawal syndrome, Outcome 7 STAI‐y1 score.
2.8
2.8. Analysis
Comparison 2 GHB 50mg vs diazepam: withdrawal syndrome, Outcome 8 SDS Zung test score.
2.9
2.9. Analysis
Comparison 2 GHB 50mg vs diazepam: withdrawal syndrome, Outcome 9 side‐effects.
3.1
3.1. Analysis
Comparison 3 GHB 50mg vs clomethiazole: withdrawal syndrome, Outcome 1 drop‐outs.
3.2
3.2. Analysis
Comparison 3 GHB 50mg vs clomethiazole: withdrawal syndrome, Outcome 2 4 points withdrawal scale.
3.3
3.3. Analysis
Comparison 3 GHB 50mg vs clomethiazole: withdrawal syndrome, Outcome 3 CIWA‐Ar score.
3.4
3.4. Analysis
Comparison 3 GHB 50mg vs clomethiazole: withdrawal syndrome, Outcome 4 CIWA‐Ar subscore: tremor.
3.5
3.5. Analysis
Comparison 3 GHB 50mg vs clomethiazole: withdrawal syndrome, Outcome 5 CIWA‐Ar subscore: hyperhydrosis.
3.6
3.6. Analysis
Comparison 3 GHB 50mg vs clomethiazole: withdrawal syndrome, Outcome 6 CIWA‐Ar subscore: anxiety.
3.7
3.7. Analysis
Comparison 3 GHB 50mg vs clomethiazole: withdrawal syndrome, Outcome 7 side‐effects.
4.1
4.1. Analysis
Comparison 4 GHB 100mg vs clomethiazole: withdrawal syndrome, Outcome 1 drop‐outs.
4.2
4.2. Analysis
Comparison 4 GHB 100mg vs clomethiazole: withdrawal syndrome, Outcome 2 CIWA‐Ar score.
4.3
4.3. Analysis
Comparison 4 GHB 100mg vs clomethiazole: withdrawal syndrome, Outcome 3 CIWA‐Ar subscore: tremor.
4.4
4.4. Analysis
Comparison 4 GHB 100mg vs clomethiazole: withdrawal syndrome, Outcome 4 CIWA‐Ar subscore: hyperhydrosis.
4.5
4.5. Analysis
Comparison 4 GHB 100mg vs clomethiazole: withdrawal syndrome, Outcome 5 CIWA‐Ar subscore: anxiety.
4.6
4.6. Analysis
Comparison 4 GHB 100mg vs clomethiazole: withdrawal syndrome, Outcome 6 side‐effects.
5.1
5.1. Analysis
Comparison 5 GHB 50mg vs GHB 100mg: withdrawal syndrome, Outcome 1 drop‐outs.
5.2
5.2. Analysis
Comparison 5 GHB 50mg vs GHB 100mg: withdrawal syndrome, Outcome 2 CIWA‐Ar score.
5.3
5.3. Analysis
Comparison 5 GHB 50mg vs GHB 100mg: withdrawal syndrome, Outcome 3 CIWA‐Ar subscore: tremor.
5.4
5.4. Analysis
Comparison 5 GHB 50mg vs GHB 100mg: withdrawal syndrome, Outcome 4 CIWA‐Ar subscore: hyperhydrosis.
5.5
5.5. Analysis
Comparison 5 GHB 50mg vs GHB 100mg: withdrawal syndrome, Outcome 5 CIWA‐Ar subscore: anxiety.
5.6
5.6. Analysis
Comparison 5 GHB 50mg vs GHB 100mg: withdrawal syndrome, Outcome 6 side‐effects.
6.1
6.1. Analysis
Comparison 6 GHB 50mg vs placebo: maintaining abstinence, Outcome 1 drop‐outs.
6.2
6.2. Analysis
Comparison 6 GHB 50mg vs placebo: maintaining abstinence, Outcome 2 average stay in program (weeks).
6.3
6.3. Analysis
Comparison 6 GHB 50mg vs placebo: maintaining abstinence, Outcome 3 abstinence.
6.4
6.4. Analysis
Comparison 6 GHB 50mg vs placebo: maintaining abstinence, Outcome 4 controlled drinking.
6.5
6.5. Analysis
Comparison 6 GHB 50mg vs placebo: maintaining abstinence, Outcome 5 relapse to heavy drinking.
6.6
6.6. Analysis
Comparison 6 GHB 50mg vs placebo: maintaining abstinence, Outcome 6 number of daily drinks.
6.7
6.7. Analysis
Comparison 6 GHB 50mg vs placebo: maintaining abstinence, Outcome 7 craving score.
6.8
6.8. Analysis
Comparison 6 GHB 50mg vs placebo: maintaining abstinence, Outcome 8 side‐effects.
7.1
7.1. Analysis
Comparison 7 GHB 50mg vs NTX: maintaining abstinence, Outcome 1 drop‐outs.
7.2
7.2. Analysis
Comparison 7 GHB 50mg vs NTX: maintaining abstinence, Outcome 2 abstinence.
7.3
7.3. Analysis
Comparison 7 GHB 50mg vs NTX: maintaining abstinence, Outcome 3 relapses to heavy drinking.
7.4
7.4. Analysis
Comparison 7 GHB 50mg vs NTX: maintaining abstinence, Outcome 4 number of daily drinks.
7.5
7.5. Analysis
Comparison 7 GHB 50mg vs NTX: maintaining abstinence, Outcome 5 controlled drinking.
7.6
7.6. Analysis
Comparison 7 GHB 50mg vs NTX: maintaining abstinence, Outcome 6 Alcohol Craving Scale.
7.7
7.7. Analysis
Comparison 7 GHB 50mg vs NTX: maintaining abstinence, Outcome 7 side‐effects.
8.1
8.1. Analysis
Comparison 8 GHB 50mg vs disulfiram: maintaining abstinence, Outcome 1 drop‐outs.
8.2
8.2. Analysis
Comparison 8 GHB 50mg vs disulfiram: maintaining abstinence, Outcome 2 abstinence.
8.3
8.3. Analysis
Comparison 8 GHB 50mg vs disulfiram: maintaining abstinence, Outcome 3 relapses to heavy drinking.
8.4
8.4. Analysis
Comparison 8 GHB 50mg vs disulfiram: maintaining abstinence, Outcome 4 number of daily drinks.
8.5
8.5. Analysis
Comparison 8 GHB 50mg vs disulfiram: maintaining abstinence, Outcome 5 controlled drinking.
8.6
8.6. Analysis
Comparison 8 GHB 50mg vs disulfiram: maintaining abstinence, Outcome 6 Alcohol Craving Scale.
8.7
8.7. Analysis
Comparison 8 GHB 50mg vs disulfiram: maintaining abstinence, Outcome 7 side‐effects.
9.1
9.1. Analysis
Comparison 9 GHB 50mg + NTX vs NTX: maintaining abstinence, Outcome 1 drop‐outs.
9.2
9.2. Analysis
Comparison 9 GHB 50mg + NTX vs NTX: maintaining abstinence, Outcome 2 abstinence.
9.3
9.3. Analysis
Comparison 9 GHB 50mg + NTX vs NTX: maintaining abstinence, Outcome 3 relapses to heavy drinking.
9.4
9.4. Analysis
Comparison 9 GHB 50mg + NTX vs NTX: maintaining abstinence, Outcome 4 side effects.
10.1
10.1. Analysis
Comparison 10 GHB 50mg + disulfiram vs disulfiram + placebo: maintaining abstinence, Outcome 1 drop‐outs.
11.1
11.1. Analysis
Comparison 11 GHB 75mg + escitalopram vs escitalopram: maintaining abstinence, Outcome 1 abstinence.
12.1
12.1. Analysis
Comparison 12 GHB 75mg + escitalopram vs NTX + escitalopram: maintaining abstinence, Outcome 1 abstinence.
13.1
13.1. Analysis
Comparison 13 GHB 75mg + NTX + Escitalopram vs escitalopram: maintaining abstinence, Outcome 1 abstinence.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Addolorato 1999a {published data only}
    1. Addolorato G, Balducci G, Capristo E, Attilia ML, Taggi F, Gasbarrini G, et al. Gamma‐hydroxybutyric acid (GHB) in the treatment of alcohol withdrawal syndrome: a randomized comparative study versus benzodiazepine. Alcohol Clin Exp Res 1999;23(10):1596‐604. - PubMed
Caputo 2003 {published data only}
    1. Caputo F, Addolorato G, Lorenzini F, Domenicali, Greco G, RE A, et al. Gamma‐hydroxybutyric acid versus naltrexone in maintaining alcohol abstinence: an open randomized comparative study. Drug and Alcohol Dependence 2003;70:85‐91. - PubMed
Caputo 2007 {published data only}
    1. Caputo F, Addolorato G, Stoppo M, Francini S, Vignoli T, Lorenzini F, et al. Comparing and combining gamma‐hydroxybutyric acid (GHB) and naltrexone in maintaining abstinence from alcohol: an open randomised comparative study. Eur Neuropsychopharmacology 2007;17(12):781‐9. - PubMed
Ceccanti 1996 {published data only}
    1. Ceccanti M, Attilia M, Ceccanti B, Sebastiani G, Cavalieri G, Devito R, et al. Efficacy of therapeutic protocols for the treatment of alcohol withdrawal syndrome (AWS) [Efficacia di vari protocolli terapeutici nel trattamento della Sindrome da Astinenza Alcolica (SAA)]. Alcologia. 1996; Vol. 8, issue suppl2:72.
    1. Ceccanti M, Attilia M, Ceccanti B, Sebastiani G, Cavalieri G, Devito R, et al. Efficacy of various therapeutic protocols for the tratment of alcohol withdrawal (AW). The GHB in the treatment of alcohol dependence. State of the art [Efficacia di vari protocolli terapeutici nel trattamento della sindrome di astinenza alcolica (SAA). Il sale sodico dell'acido 4‐idrossibutirrico (GHB) nel trattamento dell'alcol‐dipendenza. Stato dell'arte.]. Relazioni, comunicazioni e posters presentati al XIV Congresso della Società Italiana di Alcologia, Castel S.Pietro 10‐12 Ottobre 1996. 1996:21‐4.
Di Bello 1995 {published data only}
    1. Bello MG, Gambassi F, Mugnai L, Masini E, Mannaioni PF. Gamma‐hydroxybutyric acid induced suppression and prevention of alcohol withdrawal syndrome and relief of craving in alcohol dependent patients. Alcologia 1995;7(2):111‐8.
    1. Moncini M, Masini E, Gambassi F, Mannaioni PF. Gamma‐hydroxybutyric acid and alcohol‐related syndromes. Alcohol 2000;20:285‐95. - PubMed
Elsing 1996 {unpublished data only}
    1. Elsing C, Schimanski U, Stremmel W. Randomized controlled trial for the treatment of alcohol withdrawal syndrome: clomethiazole vs. gamma‐hydroxybutyric acid. Eur J Clin Investig. 1996; Vol. 26S:A17.
Ferri 1991 {unpublished data only}
    1. Ferri M. Association between GHB and disulfiram for the treatment of alcohol dependence [L'associazione GHB‐Disulfiram nel trattamento della dipendenza alcolica]. Primo Congresso Nazionale SITD, Roma 25‐27 Ottobre 1991. October 1991.
Gallimberti 1989 {published data only}
    1. Gallimberti L, Canton G, Gentile N, Ferri M, Cibin M, Ferrara SD, et al. Gamma‐hydroxybutyric acid for treatment of alcohol withdrawal syndrome. Lancet 1989;2:787‐9. - PubMed
Gallimberti 1992 {published data only}
    1. Gallimberti L, Ferri M, Ferrara S, Fadda F, Gessa GL. Gamma‐hydroxybutyric acid in the treatment of alcohol dependence: a double‐blind study. Alcoholism Clin Exp Res 1992;16:673‐6. - PubMed
    1. Gessa GL, Gallimberti L. Gamma‐hydroxybutyric acid in the treatment of alcohol dependence. Neuropharmacol Alcohol. 1992; Vol. 15, issue suppl1:303‐4A. - PubMed
Nava 2006 {published data only}
    1. Nava F, Premi S, Manzato E, Lucchini A. Comparing treatments of alcoholism on craving and biochemical measures of alcohol consumptions. J Psychoactive Drugs 2006;38(3):211‐7. - PubMed
Nava 2007 {published data only}
    1. Nava F, Premi S, Manzato E, Campagnola W, Lucchini A, Gessa GL. Gamma‐hydroxybutyrate reduces both withdrawal syndrome and hypercortisolism in severe abstinent alcoholics: an open study vs diazepam. Am J Drug Alcohol Abuse 2007;33:379‐92. - PubMed
Nimmerrichter 2002 {published data only}
    1. Lesch OM, Walter H, Grunhut C, Gutierrez K, Benda N, Semler B, et al. GHB efficacy in the therapy of alcoholism: clinical evidence. Fundamental Clin Pharmacology. 1999; Vol. 13, issue Suppl 1:21S.
    1. Nimmerrichter AA, Beckmann E, Gazso E, Mader R, Marx B, Plech A, et al. Double blind controlled trial of GHB in two dosages and clomethiazole in the treatment of alcohol withdrawal syndrome. Alcohol Clin Exp Res. 1997; Vol. 21, issue suppl:32A.
    1. Nimmerrichter AA, Walter H, Gutierrez‐Lobos KE, Lesch OM. Double blind controlled trial of gamma‐hydroxybutyrate and clomethiazole in the treatment of alcohol withdrawal. Alcohol Alcohol 2002;37:67‐73. - PubMed
Stella 2008 {published data only}
    1. Stella L, Addolorato G, Rinaldi B, Capuano A, Berrino L, Rossi F, et al. An open randomized study of the treatment of escitalopram alone and combined with gamma‐hydroxybutyric acid and naltrexone in alcoholic patients. Pharmacological Research 2008;57:312‐7. - PubMed

References to studies excluded from this review

Addolorato 1996 {published data only}
    1. Addolorato G, Castelli E, Stefanini GF, Casella G, Caputo F, Marsigli L, et al. An open multicentric study evaluating 4‐hydroxybutyric acid sodium salt in the medium‐term treatment of 179 alcohol dependent subjects. Alcohol Alcohol 1996;4:341‐5. - PubMed
    1. Addolorato G, Stefanini GF, Casella G, Marsigli L, Caputo F, Gasbarrini G, and Study Group. Evaluation of the therapeutic efficacy of gamma‐hydroxybutyric acid in the medium‐term treatment of alcoholic outpatients. Alcologia 1995;7(3):233‐6.
    1. Addolorato G, Stefanini GF, Gasbarrini G. Manageability and tolerability of gamma‐hydroxybutyric acid in the medium term outpatient treatment of alcoholism. Alcohol Clin Exp Res 1997;21(2):380‐1. - PubMed
Addolorato 1998 {published data only}
    1. Addolorato G, Cibin M, Caprista E, Beghè F, Gessa GL, Stefanini GF, et al. Maintaining abstinence from alcohol with gamma‐hydroxybutyric acid. Lancet 1998;351:38. - PubMed
    1. Addolorato G, Cibin M, Caputo F, Capristo E, Gessa GL, Stefanini GF, et al. Gamma‐hydroxybutyric acid in the treatment of alcoholism: dosage fractioning utility in non‐responder alcoholic patients. Drug Alcohol Dep 1998;53:7‐10. - PubMed
Avanzi 1996 {published data only}
    1. Avanzi M, Bonomini M, Federici F, Spotti R, Bonfà F. Utility of the association GHB and disulfiram in the treatment of alcohol dependence [Utilità dell'associazione GHB e disulfiram nel trattamento della dipendenza da alcol]. Alcologia. 1996; Vol. 8, issue suppl2:73.
Baldelli 1993 {published data only}
    1. Baldelli C, Luca AM, Conte M, Spedo C, Carabini P, Amato L, et al. Use of GHB for the treatment of opiate and alcohol withdrawal syndrome [Impiego dell'acido gamma‐idrossibutirrico (GHB) nel trattamento contemporaneo della sindrome di astinenza da alcol e oppioidi]. Atti dell'XI Congresso Nazionale SIA, Bari 14‐16 Ottobre. 1993:38.
Balducci 1993 {published data only}
    1. Balducci G, Attilia ML, Cavalieri G, Romeo M, Santini P, Devito R, et al. Alcohol dependence and GHB: valuation of the anti craving efficacy in chronic alcoholism [Dipendenza alcolica e GHB: valutazione dell'efficacia anticraving in corso di alcolismo cronico]. Atti dell'XI Congresso Nazionale SIA, Bari 14‐16 Ottobre. 1993.
Caputo 2006 {published data only}
    1. Caputo F, Stoppo M, Vignoli T, Lorenzini F, Re A, Andreone P, et al. Alcoholism Treatment Study Group. Gamma‐idroxybutyric GHB acid plus naltrexone in the treatment of non‐responder alcoholics to GHB therapy. an open randomized comparative study. Alcohol Clin Experim Res. 2006; Vol. 30, issue suppl 6:107A.
Ceccanti 1995 {published data only}
    1. Ceccanti M, Attilia ML, Blum K, Cavaleri G, Franzese A, Sasso GF, et al. Gamma‐hydroxybutyric acid versus benzodiazepines: a clinical study in chronic alcoholics. Acta Toxicol Ther. 1995; Vol. XVI, issue 4:231‐242.
Cibin 1995 {published data only}
    1. Cibin M, Zavan V. GHB and multimodal treatment of alcohol dependence: a clinical experience [GHB e trattamento multimodale dell'alcoldipendenza: una esperienza clinica]. Alcologia. 1995; Vol. 7, issue suppl2:43.
De Rosa 1997 {published data only}
    1. Rosa MGL, Pierini C, Leali G, Marchesi GF. GHB and multimodal treatment in alcohol dependents with prevalent psychiatric comorbidity [GHB e trattamento multimodale in alcol‐dipendenti a prevalente comorbilità psichiatrica]. Alcologia. 1997; Vol. 9, issue suppl2:73.
Korninger 2003 {published data only}
    1. Korninger C, Roller RE, Lesch OM. Gamma‐hydroxybutyric acid in the treatment of alcohol withdrawal syndrome in patients admitted to hospital. Acta Med Austriaca 2003;3:83‐6. - PubMed
Leder 1993 {published data only}
    1. Leder F, Galimberti G, Strepparola G, Lucchini A. Use of GHB in the treatment of chronic alcoholism: results on 22 subjects [Impiego dell'acido gamma‐idrossibutirrico (GHB) nel trattamento dell'alcolismo cronico: i risultati su 22 soggetti]. Atti dell'XI Congresso Nazionale SIA, Bari 14‐16 Ottobre. 1993:34.
Lenzenhuber 1999 {published data only}
    1. Lenzenhuber E, Muller C, Rommelspacher H, Spies C. Gamma‐hydroxybutyrate for treatment of alcohol withdrawal syndrome in intensive care patients. A comparison between with two symptom‐oriented therapeutic concepts. Anaesthesist 1999;48(2):89‐96. - PubMed
Liboni 1995 {published data only}
    1. Liboni W, Cipolla U, Oddenino E, Pasquero G. Outpatient experience of treatment with GHB for alcohol dependence [Esperienza ambulatoriale di trattamento con acido gamma idrossibutirrico della dipendenza alcolica]. Gazz Med Ital ‐ Arch Sci Med 1995;154(1):9‐17.
Manzato 1995 {published data only}
    1. Manzato E, Cantiero D, Faccini M. Day hospital treatment with GHB for alcohol dependence [Il GHB nel trattamento della dipendenza alcolica in pazienti ambulatoriali (day hospital)]. Alcologia. 1995; Vol. 7, issue suppl2:59.
Marcelli 1996 {published data only}
    1. Marcelli G, Cenci M, Casacchia M. The control of the craving using GHB in outpatient setting in the alcohol treatment centre of psychiatric clinic of the University of l'Aquila [Il controllo ambulatoriale del craving con GHB nel centro alcologico della clinica psichiatrica universitaria di L'Aquila]. Alcologia. 1996; Vol. 8, issue suppl2:73.
Maremmani 1998 {published data only}
    1. Maremmani I, Balestri C, Lamanna F, Tagliamonte A. Efficacy of split doses of GHB as anticraving in the treatment of alcohol dependence, preliminary results. Alcoholism 1998;34(1‐2):73‐80.
Maremmani 2001 {published data only}
    1. Maremmani I, Lamanna F, Tagliamonte A. Long‐term therapy using GHB (sodium gamma hydroxybutyrate) for treatment‐resistant chronic alcoholics. J Psychoactive Drugs 2001;33(2):135‐42. - PubMed
    1. Maremmani I, Raimondi F, Castrogiovanni P. The GHB in the treatment of alcoholism: from abstinence to craving. New Trends Exp Clin Psychiatry. 1996; Vol. XII, issue 3:189‐96.
Montesano 1997 {published data only}
    1. Montesano F, Montesano S, Mellace V, Battaglia E. Our experience in the rational use of GHB in alcoholists [L'uso razionale dell'acido gammaidrossibutirrico (GHB) nei soggetti alcolisti secondo la nostra esperienza]. Alcologia. 1997; Vol. 9, issue suppl2:73.
Mosti 1995 {published data only}
    1. Mosti A, Zurla R. The GHB in territorial clinical practice: preliminary analysis of 100 cases [L'acido 4‐idrossibutirrico (GHB) nella pratica clinica territoriale: analisi preliminare di 100 casi]. Alcologia. 1995; Vol. 7, issue suppl2:63.
Strepparola 1995 {published data only}
    1. Strepparola G, Alietti M, Mascherpa M, Galimberti G, Tosi M, Leder F, et al. Is possible to treat craving? Our experince with GHB [E' possibile il trattamento del craving? La nostra esperienza con l'acido gamma‐idrossibutirrico]. Alcologia. 1995; Vol. 7, issue suppl2:73.
Vendramin 1995 {published data only}
    1. Vendramin A, Bertuola C. Contribute of the use of GHB alone or with SSRI for the treatment of alcoholism associated with psychopathological disorders. Benfits for a psychotherapeutic integrate approach [Contributo del GHB da solo o in associazione con SSRI nel trattamento dell'alcolismo correlato a disturbi psicopatologici. Benefici per l'approccio psicoterapeutico integrato]. Alcologia. 1995; Vol. 7, issue suppl2:75.
Vittadini 1993 {published data only}
    1. Vittadini G, Gabanelli P, Giorgi I. Effects of a brief therapy with GHB on absinence, one, three, six months follow up study [Studio degli effetti di una terapia a breve termine con GHB sull'astinenza in un follow‐up a uno, tre, sei mesi.]. Atti dell'XI Congresso Nazionale SIA, Bari 14‐16 Ottobre. 1993:52.

References to ongoing studies

Lesch 2000a {published and unpublished data}
    1. Lesh OM. Double‐blind, double‐dummy evaluation of the efficacy of GHB versus benzodiazepine in the acute withdrawal detoxification (GATE 1). (GATE 1) 2000.
    1. Rotondo C, Prastaro A, Attilia ML, Ceccanti M. Detoxification and alcohol abstinence. The role of GHB [Disintossicazione e astinenza dall'alcol. Il ruolo del GHB]. Mission (FeDerSerD) 2007:13‐8.
Lesch 2000b {published and unpublished data}
    1. Lesh OM. Multinational, multicentre, double‐blind, placebo‐controlled evaluation of the efficacy of GHB in the long‐term maintenance of abstinence in alcoholic patients after the initial weaning phase, stratified by Lesch's taxonomy (GATE 2). GATE 2 2000.
    1. Rotondo C, Prastaro A, Attilia ML, Ceccanti M. Detoxification and alcohol withdrawal. The role of GHB [Disintossicazione e astinenza dall'alcol. Il ruolo del GHB]. Mission (FeDerSerD) 2007:13‐18.

Additional references

Addolorato 1997
    1. Addolorato G, Caputo F, Stefanini GF, Gasbarrini G. Gamma‐hydroxybutyric acid in the treatment of alcohol dependence: possible craving development for the drug.. Addiction 1997;92:1035‐6. - PubMed
Addolorato 1998
    1. Addolorato G, Cibin M, Capristo E, Beghè F, Gessa GL, Stefanini GF, et al. Maintaining abstinence from alcohol with gamma‐hydroxybutyric acid. The Lancet 1998;351:38. - PubMed
Addolorato 1999b
    1. Addolorato G, Caputo F, Capristo E, Bernardi M, Stefanini GF, Gasbarrini G. A case of gamma‐hydroxybutyric acid withdrawal syndrome during alcohol addiction treatment: utility of diazepam administration. Clin Neuropharmacol 1999;22:60‐2. - PubMed
Addolorato 2000
    1. Addolorato G, Caputo F, Capristo E, Stefanini F, Gasbarrini G. Gamma‐hydroxybutyric acid Efficacy, potential abuse, and dependence in the treatment of alcohol addiction. Alcohol 2000;20:217‐22. - PubMed
Agabio 1998
    1. Agabio R, Colombo G, Loche A, Lobina C, Pani ML, Reali R, et al. Gamma‐hydroxybutyric acid reducing effect on ethanol intake: evidence in favour of a substitution mechanism. Alcohol Alcohol 1998;33:1‐10. - PubMed
Beghè 2000
    1. Beghè F, Carpanini MT. Safety and tolerability of gamma‐hydroxybutyric acid in the treatment of alcohol‐dependent patients. Alcohol 2000;20:223‐5. - PubMed
Bender 2008
    1. Bender R, Bunce C, Clarke M, Gates S, Lange S, Pace NL, Thorlund K. Attention should be given to multiplicity issues in systematic reviews. J Clin Epidemiol 2008;61(9):857‐865. - PubMed
Caldicott 2004
    1. Caldicott DGE, Chow F, Burns BJ, Felgate P, Byard RW. Fatalities associated with use of gamma‐hydroxybutyrate and its analogues in Australasia. MJA 2004;181:310‐3. - PubMed
Caputo 2008
    1. Caputo F, Francini S, Stoppo M, Lorenzini F, Vignoli T, Re A, et al. Incidence of craving for and abuse of gamma‐hydroxybutyric acid (GHB) in different populations of treated alcoholics: an open comparative study. J Psychopharmacol 2008; Vol. [Epub ahead of print]. - PubMed
Caputo 2011
    1. Caputo F, Francini S, Brambilla R, Taglianti FV, Stoppo M, Re A, Leggio L, Addolorato G, Zoli G, Bernardi M. Sodium oxybate in maintaining alcohol abstinence in alcoholic patients with and without psychiatric comorbidity. Eur Neuropsychopharmacol 2011 Jan 26;doi: 10.1016/j.euroneuro.2010.12.005 . - PubMed
CDC 1997
    1. Center for Disease Control and Prevention. Gamma‐hydroxybutyrate use‐New York and Texas, 1995‐96. Morb Mortal Wkly Rep 1997;46:281‐3. - PubMed
Colombo 1995
    1. Colombo G, Agabio R, Lobina C, Reali R, Fadda F, Gessa GL. Symmetrical generalization between the discriminative stimulus effects of gamma‐hydroxybutyric acid and ethanol: occurrence within narrow dose ranges. Physiol Behav 1995;57:105‐11. - PubMed
Colombo 1998
    1. Colombo G, Agabio R, Diaz G, Reali R, Gessa GL. Gamma‐hydroxybutyric acid (GHB) intake in ethanol‐preferring (sP) and ‐nonpreferrig (sNP) rats. Physiol Behav 1998;64:197‐202. - PubMed
Craig 2000
    1. Craig K, Gomez HF, McManus JL, Bania T. Severe gamma‐hydroxybutyrate withdrawal: a case report and literature review.. J Emerg Med 2000;18:6‐70. - PubMed
DSM IV‐R 1994
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. IV Edition. Washington DC: American Psychiatric Association, 1994.
EMCDDA 2002
    1. European Monitoring Centre for Drugs and Drug Addiction. Report on the risk assessment of GHB in the framework of the joint action on new synthetic drugs. www.emcdda.europa.eu/html.cfm/index33345EN.html 2002.
FDA 2006
    1. US Food and Drug Administration. US Department of Health and Human Services http//www.fda.gov.
Frau 1995
    1. Frau M, Colombo G, Marchese G, Stefanini E, Gessa GL. Different affinity of cortical GHB binding site in sardinian alcohol‐preferring (sP) and ‐nonpreferring (sNP) rats. Alcohol Alcohol 1995;30:133‐7. - PubMed
Gallimberti 2000
    1. Gallimberti L, Spella MR, Soncini CA, Sessa GL. Gamma‐hydroxybutyric acid in the treatment of alcohol and heroin dependence. Alcohol 2000;20:257‐62. - PubMed
Gessa 2000
    1. Gessa GL, Agabio R, Carai M, Lobina C, Pani M, Reali R, et al. Mechanism of the anti‐alcohol effect of gamma‐hydroxybutyric acid (GHB). Alcohol 2000;20:271‐6. - PubMed
Higgins 2008
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration 2008; Vol. Available from www.cochrane‐handbook.org, issue ..
Hillbom 2003
    1. Hillbom M, Pieninkeroinen I, Leone M. Seizures in Alcohol‐Dependent Patients. Epidemiology, Pathophysiology and Management. CNS Drugs 2003;17:1013‐30. - PubMed
Johnson 2005
    1. Johnson BA, Swift R, Addolorato G, Ciraulo D, Myrick H. Safety and efficacy of GABAergic medications for treating alcoholism. Alcohol Clin Exp Res 2005;29:248‐54. - PubMed
Maremmani 2007
    1. Maremmani I, Pacini M. Use of sodium gamma‐hydroxybutyrate (GHB) i n alcoholic heroin addicts and polydrug‐abusers. Heroin Addict Relat Clin Probl 2007;9:55‐76.
Morton 1994
    1. Morton A, Laird LK, Crane DF, Partovi N, Frye LH. A prediction model for identifying alcohol withdrawal seizures. Am J Drug Alcohol Abuse 1994;20:75‐86. - PubMed
Nicholson 2001
    1. Nicholson KL, Balster RL. GHB: a new and novel drug of abuse. Drug and Alcohol Dependence 2001;63:1‐22. - PubMed
O'Connor 1998
    1. O'Connor PG, Schottenfeld RS. Patients with alcohol problems. N Engl J Med 1998;338:592‐602. - PubMed
Pieninkeroinen 1992
    1. Pieninkeroinen IP, Telakivi TM, Hillbom ME. Outcome in subjects with alcohol‐provoked seizures. Alcohol Clin Exp Res 1992;16:955‐9. - PubMed
Schuckit 1995
    1. Schuckit MA. Alcoholism acute treatment. In: MA Schuckit editor(s). Drug and alcohol abuse. A clinical guide to diagnosis and treatment. IV. New York‐London: Plenum Medical Book Co, 1995:97‐117.
SIGN 2003
    1. Scottish Intercollegiate Guidelines Network. The management of harmful drinking and alcohol dependence in primary care. A national clinical guideline. www.sign.ac.uk 2003.
Tan 1997
    1. Tan CY, Weaver DF. Molecular pathogenesis of alcohol withdrawal seizures: the modified lipid‐protein interaction mechanism. Seizure 1997;6:255‐74. - PubMed
WHO 2004
    1. WHO. WHO Global Status Report on Alcohol. www.who.int. Geneva: Department of Mental Health and Substance Abuse, WHO, 2004.
Wojtowicz 2008
    1. Wojtowicz JM, Yarema MC, Wax PM. Withdrawal from gamma‐hydroxybutyrate, 1,4‐butanediol and gamma‐butyrolactone: a case report and systematic review. CJEM 2008;10(1):69‐74. - PubMed

MeSH terms

LinkOut - more resources