Patt Amber, Fox Haley, Wells Lauren, Theobald Jillian, Feldman Ryan
School of Pharmacy, Medical College of Wisconsin.
Wisconsin Poison Center.
Clin Neuropharmacol. 2023;46(2):79-81. doi: 10.1097/WNF.0000000000000542. Epub 2023 Feb 4.
Phenibut is a widely available gamma-aminobutyric acid B receptor agonist. When taken chronically, phenibut causes dependence and subsequent withdrawal if stopped. Baclofen, a gamma-aminobutyric acid B receptor agonist structurally related to phenibut, has been used to manage phenibut withdrawal (PW), although baclofen doses for PW are not well defined and may exceed Food and Drug Administration-approved doses. Little data described outcomes from baclofen use.
This case details a patient who experienced a seizure while on baclofen 10 mg thrice daily as monotherapy for PW and highlights a potential risk of underdosing baclofen as monotherapy in the management of PW.
A man in his early 30s with anxiety, depression, and substance use disorder presented to the emergency department by family for lethargy and confusion starting earlier that day. He had been using 25-30 g of phenibut daily for the past 6 months. On arrival, he was hypertensive, tachycardic, tachypneic, and lethargic. The patient received 1 mg of intravenous lorazepam and was admitted to the hospital for presumed PW. His symptoms improved overnight, and he was discharged on 10 mg of baclofen thrice daily. He returned 28 hours later after having a seizure and required intensive care admission in addition to multimodal drug therapy.
Phenibut use is rising, and treatment options for PW, such as baclofen, warrant additional study. Potential risks of underdosing baclofen if used as monotherapy in PW may include seizures as withdrawal progresses. Baclofen's role in therapy may be more appropriate as an adjunct than a cornerstone of therapy. Treatment done in consultation with providers experienced in managing withdrawal such as a toxicologist may help reduce this risk.
苯乙胺酪酸是一种广泛可得的γ-氨基丁酸B受体激动剂。长期服用苯乙胺酪酸会导致成瘾，停药后会出现戒断症状。巴氯芬是一种在结构上与苯乙胺酪酸相关的γ-氨基丁酸B受体激动剂，已被用于处理苯乙胺酪酸戒断（PW），尽管用于PW的巴氯芬剂量尚未明确界定，且可能超过美国食品药品监督管理局批准的剂量。关于使用巴氯芬的结果的资料很少。
本病例详细介绍了一名患者，该患者在每日三次服用10毫克巴氯芬作为PW单一疗法时发生癫痫，突出了巴氯芬单一疗法在处理PW时剂量不足的潜在风险。
一名30岁出头、患有焦虑症、抑郁症和物质使用障碍的男性，当天早些时候因嗜睡和意识模糊被家人送往急诊科。在过去6个月里，他每天使用25 - 30克苯乙胺酪酸。到达时，他血压高、心动过速、呼吸急促且嗜睡。患者接受了1毫克静脉注射劳拉西泮，并因疑似PW入院。他的症状在一夜之间有所改善，出院时服用每日三次10毫克的巴氯芬。28小时后，他癫痫发作后返回，除了接受多模式药物治疗外，还需要入住重症监护病房。
苯乙胺酪酸的使用正在增加，对于PW的治疗选择，如巴氯芬，值得进一步研究。如果在PW中作为单一疗法使用，巴氯芬剂量不足的潜在风险可能包括随着戒断进展而出现癫痫发作。巴氯芬在治疗中的作用作为辅助药物可能比作为治疗基石更合适。与有处理戒断经验的医疗人员（如毒理学家）协商进行治疗可能有助于降低这种风险。
