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1 | Author/Year | Phenibut Dose & duration of use | Baclofen Starting Dose (mg/day) | Baclofen Max Dose (mg/day) | Duration of Baclofen Therapy | Baclofen Taper Strategy | Patient Age (Years) & Sex | Co-ingestions | Delayed Decompensation | Multi-Model Treatment Utilization (including baclofen) | Length of stay | ICU Admission | Intubation | Seizure | Time from last dose to withdrawal symptoms | |||||||||||
2 | Joshi 2017 | 8-10 g/day plus ~16 g/day the week prior to admission; unknown duration of use | 10 mg TID; titrated to 30 mg TID over 2 days | 90 mg/day | >10 weeks | 10 mg per week | 32; Male | Testosterone and nandrolone injected 6 weeks prior to admission | Agitation, aggression, worsening mental status | Antipsychotics, olanzapine, diazepam, ramelteon, lorazepam | At least 9 days (full length not reported) | 0 | 0 | 0 | ||||||||||||
3 | Hardman 2019 | 4 g every 6 hours (16 g daily); unknown duration of use | Unknown (not reported) | Unknown (not reported) | As needed | Unknown (not reported) | 23; Male | SSRI, PHB | Tremulousness, insomnia, nausea, vomiting, anxiety, psychomotor agitation | Lorazepam, dexmedetomidine, cyproheptadine, gabapentin, haloperidol, melatonin, olanzapine | At least 9 days (full length not reported) | 1 | 0 | 0 | ||||||||||||
4 | Coenen 2019 | 11-12 g TID (max of 34.5 g/day) for 2 years | 25 mg 4 times daily with 5 mg prn if withdrawal | 100 mg/day plus 5 mg/day additional if needed | 1 year+ | 10 mg every 2 days (~50% per week) | 25; Male | Diazepam, pregabalin | Sadness, irritability, insomnia, psychomotor agitation, anxiety, tension, flulike symptoms (headache, myalgia) | Olanzapine, diazepam, pregabalin | 6 weeks | Unknown (not reported) | Unknown (not reported) | 0 | ||||||||||||
5 | Ahuja 20181 | 100-300 mg every few days for several months; increased quantity but exact dose unknown | 5 mg TID for 2 days | 15 mg/day | 1 week | 5 mg 3 times/day for 2 days, then 5 mg twice/day for 1 day, then 5 mg in the morning and 2.5 mg in the evening for 1 day, then 2.5 mg twice/day, and, finally, 2.5 mg once/day | 21; Male | Alcohol | No | Chlordiazepoxide | 5 days | 0 | 0 | 0 | ||||||||||||
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7 | Sethi 20211 | 200-500 mg for a few months. Increased to 1-1.5 g/day for 1 year | 5 mg TID for 2 days | 15 mg/day | 6 days | 5 mg 3 times/day for 2 days, then 5 mg twice/day for 1 day, then 5 mg in the morning and 2.5 mg in the evening for 1 day, then 2.5 mg twice/day, and, finally, 2.5 mg once/day | 26; Male | Unknown (not reported) | Unknown (not reported) | Clonazepam | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | 0 | ||||||||||||
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9 | Samokhvalov 2013 | 8 g/day for 10 months | 15 mg/day for 1 week. | 60 mg/day | 24 weeks | Cross tapered phenibut dose from 8 g daily to 1 g daily and baclofen from 0 mg to 60 mg over 7 weeks, then tapered baclofen to 0 mg over 13 weeks | 35; Male | Kratom | Aggression, irritation | Citalopram | Unknown (not reported) | 0 | 0 | 0 | ||||||||||||
10 | McCabe 2019 | 1 g/day; duration unknown | 10 mg every 8h; increased to 20 mg every 8h on day 3 | 60 mg/day | 25 days | Tapered over 12 days | 27; Male | None | Severe agitation, tachycardia hyperthermia, rigidity, myoclonus | Fentanyl, midazolam, valproic acid, phenobarbital, hydromorphone, gabapentin, olanzapine, dexmedetomidine, clonidine and methadone | At least 13 days (full length of stay not reported) | 1 | 1 | 0 | ||||||||||||
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13 | 20-30 g/day 2 months prior to ED admission | |||||||||||||||||||||||||
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15 | Ingested 30 g day of admission | |||||||||||||||||||||||||
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17 | Thalambedu 2020 | 200 g; unknown duration of use | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | 42; Male | Methadone | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | 1 | 1 | 0 | ||||||||||||
18 | Gilbert 2020 | 34 g/day | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | 34; Male | Acetaminophen, caffeine, diphenhydramine, escitalopram, hydroxyzine, lorazepam (UDS on hospital day #3; initial UDS unable to be obtained) | Altered mental status, tremors, ankle clonus, tachycardia, agitation, diaphoresis, respiratory distress, tonic-clonic activity, incontinence | Haloperidol, lorazepam, Benadryl, dexmedetomidine | Unknown (not reported) | 1 | Unknown (not reported) | 1 | ||||||||||||
19 | Case from this article | 25-30 g/day | 10 mg TID | 120 mg/day | Unknown (lost to follow up) | Unknown (lost to follow up) | 31; Male | No | Seizure, hallucination, tremors | Lorazepam, phenobarbital, clonidine, and gabapentin | 1 | 0 | 1 | |||||||||||||
20 | Zheng 2019 | 4-5 g/day for 1 month | None | None | None | None | 23; Male | Alcohol, marijuana | Unknown (not reported) | Benzodiazepines, bupropion, quetiapine, gabapentin | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | 0 | ||||||||||||
21 | VabDreese 2022 | 1g/day to 8-12g/day over 6 months; continued to use phenibut while receiving outpatient tx --> increased use to 28.5g/day over 3 years | 5 mg TID as initial outpatient tx; 10 mg dose x1 inpatient tx | 60 mg/day | >4 months (exact not reported) | 20 mg TID x1 month, then 15 mg TID x 3 months, then 10 mg TID (based on lack of reported withdrawal sx at follow up appointments) | 34; Male | baclofen, gabapetin, benzodiazepines, methamphetamines, amphetamines | agitation, sweating, hallucinations, confusion | Gabapentin, risperidone, lorazepam, olanzapine, haloperidol, diazepam, midazolam, dexmedetomidine, propofol, phenobarbital taper, acamprosate (outpatient) | 11 days | 1 | 1 | 0 | ||||||||||||
22 | Peterkin 2022 | "several teaspoons" 2 days prior to presentation, another unknown dose 24 hours prior to presentation | None | None | None | None | 38; Female | Fentanyl IV, clonazepam, gabapentin, diphenhydramine | Unknown (not reported) | Ketamine, dexmedetomidine, propofol, remifentanil, antipsychotics, methadone, diazepam | 9 days (left AMA) | 0 | 0 | 0 | ||||||||||||
23 | O'Connel 2014 | 3 g/day x4 days | None | None | None | None | 25; Male | None | None | None (patient refused treatment outside of home venlafaxine and mirtazapine) | Unknown (not reported) | 0 | 0 | 0 | ||||||||||||
24 | Magsalin 2010 | 1g/day x10 days; stopped x2 days and noticed withdrawal sx --> started phenibut self-taper (0.5 g/day x4 days) | None | None | None | None | 21; Male | none | Unknown (not reported) | None | Unknown (not reported) | 0 | 0 | 0 | ||||||||||||
25 | Wong 2015 | 2 g daily x1.5 months; 30 g prior to admission | None | None | None | None | 43; Male | None | Unknown (not reported) | Midazolam | Unknown (not reported) | 1 | 1 | 0 | ||||||||||||
26 | Downes 2015 | 25 g dose x1 day of admission | None | None | None | None | 20; Female | None | Unknown (not reported) | Venlafaxine | Unknown (not reported) | 0 | 0 | 0 | ||||||||||||
27 | Downes 2015 | Unknown (not reported) | None | None | None | None | 38; Male | Alcohol, THC | Unknown (not reported) | Droperidol, ketamine, morphine, midazolam | Unknown (not reported) | 1 | 1 | 0 | ||||||||||||
28 | Esteves 2019 | Unknown | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | 25; Male | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | At least 11 days (full length of stay not reported) | 1 | 1 | 1 | ||||||||||||
29 | Goldfine 2019 | 10 g/day x2 months; stopped using phenibut 5 days PTA | 5 mg TID | 15 mg/day | 8 days | 5 mg TID x72 hours with decreasing benzodiazepine requirements; then tapered baclofen over 5 days | 34; Male | Unknown (not reported) | Unknown (not reported) | Lorazepam, dexmedetomidine | Unknown (not reported) | 0 | 0 | 0 | ||||||||||||
30 | Hodgman 2019 | 5 g/day x 2 months (prior ICU admission for phenibut withdrawal of unknown dose) | 15 mg TID | 45 mg/day | 28 days | tapered over 4 weeks; decr by 5 mg/day every 4 days | 19; Male | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | 3 days | 0 | 0 | 0 | ||||||||||||
31 | Odujebe 2008 | 750-1000 mg/day for "months"; discontinued 3 days prior to presentation | None | None | None | None | 40; Male | Unknown (not reported) | Unknown (not reported) | lorazepam | at least 4 days (full length of stay not reported) | Unknown (not reported) | 1 | 0 | ||||||||||||
32 | RF JT 2021 | 25-30 g/day x6 months | 10 mg dose x2 over 8 hours in ED; 10 mg TID --> pt represented to ED after seizure, discharged on 40 mg TID | 120 mg/day | Unknown (not reported) | decr daily dose by 5 mg each week | 31; Male | Unknown (not reported) | seizure, nausea, tremors, hallucinations | lorazepam, phenobarbital | 5 days | 0 | 0 | 1 | "Shortly" | |||||||||||
33 | ROD 2018 | 2 g/day x12 months; reduced dose in week prior to presentation | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | 47; Male | EtOH, bupropion, duloxetine, gabapentin, kratom | Unknown (not reported) | lorazepam, chlordiazepoxide, phenobarbital | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | 0 | ||||||||||||
34 | Srihari 2020 | 2-3 g/day x 1 week | 130 mg initially while inpatient, discharged on 40 mg BID outpatient | 130 mg | 17 days | taper over 15 days | 24; Male | None | Unknown (not reported) | lorazepam, phenobarbital | 2 days | 0 | 0 | 0 | ||||||||||||
35 | Wolters 2019 | 34 g/day; duration of use unknown | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | 34; Male | tachycardia, diaphoresis, agitation, respiratory distress, tonic-clonic seizure | acetaminophen, caffeine, diphenhydramine, escitalopram, hydroxyzine, lorazepam | haloperidol, lorazepam, diphenhydramine, dexmedetomidine | 8 days | 1 | 0 | 1 | ||||||||||||
36 | Hodgman 2019 | unknown | N/A | N/A | N/A | N/A | 18; Male | Unknown (not reported) | Unknown (not reported) | Dexmedetomidine and benzodiazpines | Unknown (not reported) | 1 | Unknown (not reported) | Unknown (not reported) | Unknown (not reported) | |||||||||||
37 | Lai 2019 | 10 g/day | 5 mg TID | 15 mg/day | 8 days | Unknown (not reported) | 34; Male | Unknown (not reported) | worsening agitation from time of presentation | Dexmedetomidine and lorazepam | Unknown (not reported) | Unknown (not reported) | 0 | 0 | ||||||||||||
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52 | 1 | Hardman MI, Sprung J, Weingarten TN. Acute phenibut withdrawal: a comprehensive literature review and illustrative case report. Bosn J Basic Med Sci. 2019;19(2):125-129. doi:10.17305/bjbms.2018.4008 | ||||||||||||||||||||||||
53 | 2 | Joshi YB, Friend SF, Jimenez B, Steiger LR. Dissociative intoxication and prolonged withdrawal associated with phenibut: a case report. J Clin Psychopharmacol. 2017;37(4):478-480. doi:10.1097/JCP.0000000000000731 | ||||||||||||||||||||||||
54 | 3 | Ahuja T, Mgbako O, Katzman C, Grossman A. Phenibut (β-Phenyl-γ-aminobutyric Acid) dependence and management of withdrawal: emerging nootropics of abuse. Case Rep Psychiatry. Published online April 30, 2018. doi:10.1155/2018/9864285 | ||||||||||||||||||||||||
55 | 4 | Samokhvalov AV, Paton-Gay CL, Balchand K, Rehm J. Phenibut dependence. BMJ Case Rep. Published online February 6, 2013. doi:10.1136/bcr-2012-008381 | ||||||||||||||||||||||||
56 | 5 | McCabe DJ, Bangh SA, Arens AM, Cole JB. Phenibut exposures and clinical effects reported to a regional poison center. Am J Emerg Med. 2019;37(11):2066-2071. doi:10.1016/j.ajem.2019.02.044 | ||||||||||||||||||||||||
57 | 6 | VanDreese B, Holland A, Murray A. Chronic phenibut use: symptoms, severe withdrawal, and recovery. WMJ. 2022;121(1):E1-E4. | ||||||||||||||||||||||||
58 | 7 | Peterkin AF, Abraham R, Harris MT. A case of phenibut directed detoxification leading to toxicity during the COVID-19 pandemic. J Addict Med. Published online February 4, 2022. doi:10.1097/ADM.0000000000000966 | ||||||||||||||||||||||||
59 | 8 | Wong A, Little M, Caldicott D, Easton C, Andres D, Greene SL. Analytically confirmed recreational use of phenibut (β-phenyl-γ-aminobutyric acid) bought over the internet. Clin Toxicol (Phila). 2015;53(7):783-784. doi:10.3109/15563650.2015.1059944 | ||||||||||||||||||||||||
60 | 9 | Downes MA, Berling IL, Mostafa A, Grice J, Roberts MS, Isbister GK. Acute behavioural disturbance associated with phenibut purchased via an internet supplier. Clin Toxicol (Phila). 2015;53(7):636-638. doi:10.3109/15563650.2015.1059945 | ||||||||||||||||||||||||
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