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Doyno CR, White CM. Sedative-Hypnotic Agents That Impact Gamma-Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma-Hydroxybutyric Acid, Phenibut, and Selank. J Clin Pharmacol. 2021;61:S114-S128doi: 10.1002/jcph.1922.
Doyno, C. R., & White, C. M. (2021). Sedative-Hypnotic Agents That Impact Gamma-Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma-Hydroxybutyric Acid, Phenibut, and Selank. Journal of clinical pharmacology, 61S114-S128. https://doi.org/10.1002/jcph.1922
Doyno, Cassandra R, and White, C Michael. "Sedative-Hypnotic Agents That Impact Gamma-Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma-Hydroxybutyric Acid, Phenibut, and Selank." Journal of clinical pharmacology vol. 61 (2021): S114-S128. doi: https://doi.org/10.1002/jcph.1922
Doyno CR, White CM. Sedative-Hypnotic Agents That Impact Gamma-Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma-Hydroxybutyric Acid, Phenibut, and Selank. J Clin Pharmacol. 2021 Aug;61:S114-S128. doi: 10.1002/jcph.1922. PMID: 34396551.
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J Clin Pharmacol. 2021 Aug;61:S114-S128. doi: 10.1002/jcph.1922.

Sedative-Hypnotic Agents That Impact Gamma-Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma-Hydroxybutyric Acid, Phenibut, and Selank.

Journal of clinical pharmacology

Cassandra R Doyno, C Michael White

Affiliations

  1. Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA.
  2. John Dempsey Hospital, University of Connecticut, Farmington, Connecticut, USA.
  3. Department of Research Administration, Hartford Hospital, Hartford, Connecticut, USA.

PMID: 34396551 DOI: 10.1002/jcph.1922

Abstract

There are many nonopioid central nervous system depressant substances that share a gamma-aminobutyric acid (GABA) receptor-related mechanism of action. These sedatives-hypnotics can be indicated to treat anxiety, seizures, depression, and insomnia but are also used as substances of abuse and used to facilitate sexual assault. Barbiturates, methaqualone, and glutethimide were among the first type A GABA receptor-mediated sedative-hypnotics. Their clinical use was limited for most indications by serious adverse events and strong abuse potential but continue to be used illicitly around the world. The benzodiazepines supplanted barbiturates for most indications because they were less likely to cause severe adverse events in monotherapy. Flunitrazepam is a newer benzodiazepine that is preferentially used recreationally and to facilitate sexual assault. Flunitrazepam has greater potency and higher affinity for the type A GABA receptor than most benzodiazepines. Gamma-hydroxybutyric acid is sought illicitly for its hypnotic, euphoric and anabolic effects as well as to facilitate sexual assault. When any of these GABAergic drugs are used in high doses or with other sedative hypnotic agents, respiratory depression, coma, and death have occurred. Chronic use of these GABAergic drugs can lead to significant withdrawal syndromes. Phenibut and selank are poorly studied Russian drugs with GABAergic mechanisms that are inexplicably sold to US consumers as dietary supplements. Poison control center calls regarding phenibut have increased substantially over the past 5 years. Desired euphoriant effects account for the recreational and illicit use of many GABA-modulating agents. However, illicit use can lead to significant toxicities related to abuse, dependence, and subsequent withdrawal syndromes. Significant evaluation of developing agents with GABA properties should be conducted to determine abuse potential before public access ensues.

© 2021, The American College of Clinical Pharmacology.

Keywords: GABA; barbiturate; dependence; drugs of abuse; flunitrazepam; gamma-hydroxybutyrate (GHB); withdrawal

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