GHB
γ-hydroxybutyric acid
Standing risks
| Risk | Recorded values | Confidence | Article section |
|---|---|---|---|
| Dangerous withdrawal, taper carefully |
| high | View in article: Dangerous withdrawal, taper carefully |
| High overdose risk, use caution |
| high | View in article: High overdose risk, use caution |
| Compulsive use risk, monitor frequency |
| high | View in article: Compulsive use risk, monitor frequency |
| High dependence, taper carefully |
| high | View in article: High dependence, taper carefully |
Lethal interactions
| Combination | Type | Severity | Mechanisms | Confidence |
|---|---|---|---|---|
| Baclofen | Substance | lethal | — | — |
| Buprenorphine | Substance | lethal | — | — |
| Kratom | Substance | lethal | — | — |
| Tramadol | Substance | lethal | — | — |
| GHB, GBL | Drug class | lethal | 2 | high |
| Ketamine, DXM, PCP | Drug class | lethal | 2 | medium |
| Opioids | Drug class | lethal | 2 | high |
Dangerous interactions
36 dangerous interactions recorded for this substance.
See the full interactions tableContraindications
| Condition | Severity | Note |
|---|---|---|
| Respiratory | ||
| respiratory compromise | absolute | Any condition impairing baseline respiratory function increases the risk of GHB-induced respiratory failure. This includes COPD, obstructive sleep apnea, and respiratory muscle weakness. |
| Hepatic | ||
| patients on valproate | relative | Patients taking valproate, salicylates, or phenylacetate may experience enhanced GHB effects due to inhibition of GHB dehydrogenase. This represents a relative contraindication requiring dose adjustment awareness. |
| Metabolic | ||
| succinic semialdehyde dehydrogenase deficiency | absolute | Patients with SSADH deficiency have elevated endogenous GHB. Exogenous administration is absolutely contraindicated. |
| Pregnancy & Breastfeeding | ||
| pregnancy | absolute | No evidence-based guidelines exist for GHB use in pregnancy. A single case report describes withdrawal management in a pregnant patient. Given the complete absence of safety data, pregnancy is an absolute contraindication. |
| Other | ||
| concurrent CNS depressant use | absolute | Concurrent use of any CNS depressant (alcohol, opioids, benzodiazepines, barbiturates, ketamine, other sedative-hypnotics) with GHB is absolutely contraindicated. This is the leading cause of GHB-related death. |
| concurrent GBL or 1,4-butanediol use | absolute | Use of GHB prodrugs (GBL, 1,4-BD) concurrently with GHB is an absolute contraindication equivalent to overdosing. |
| concurrent HIV protease inhibitor use | relative | HIV patients on cobicistat- or ritonavir-containing regimens who use recreational GHB/GBL face elevated overdose risk from metabolic inhibition of GHB clearance. |