Gamma-hydroxybutyric acid, gamma-butyrolactone, and 1,4-butanediol addiction: a serious health threat

  • Renata Beck Department of Anesthesia, Santa Maria Hospital, GVM Care & Reasearch, Bari
  • Suzana Mimica Matanović Department of Pharmacology, Faculty of Medicine, University Josip Juraj Strossmayer Osijek
  • Lada Zibar Department for Pathophysiology, Faculty of Medicine, University Josip Juraj Strossmayer Osijek
Keywords: -


Elliott SP Nonfatal instances of intoxication with gamma-hydroxybutyrate in the United Kingdom. Ther Drug Monit 2004;26(4):432–40. PMID:15257074

Raposo Pereira F, McMaster MTB, Polderman N, de Vries YDAT, van den Brink W, van Wingen GA. Effect of GHB-use and GHB-induced comas on dorsolateral prefrontal cortex functioning in humans. Neuroimage Clin 2018;20:923–30. doi: 10.1016/j.nicl.2018.09.022

Busardò FP, Jones AW. GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome. Curr Neuropharmacol 2015;13:47–70. doi: 10.2174/1570159X13666141210215423.

Busardò FP, Vaiano F, Mannocchi G, Bertol E, Zaami S, Marinelli E. Twelve months monitoring of hair GHB decay following a single dose administration in a case of facilitated sexual assault. Drug Test Anal 2017;9:953–6. doi: 10.1002/dta.2100

Giorgetti R, Tagliabracci A, Schifano F, Zaami S, Marinelli E, Busardò FP. When "Chems" meet sex: a rising phenomenon called "ChemSex". Curr Neuropharmacol 2017;15:762–70. doi: 10.2174/1570159X15666161117151148

Castro AL, Dias M, Reis F, Teixeira HM. Gamma-hydroxybutyric acid endogenous production and post-mortem behaviour - the importance of different biological matrices, cut-off reference values, sample collection and storage conditions. J Forensic Leg Med 2014;27:17–24. doi: 10.1016/j.jflm.2014.07.008

Busardò FP, Kyriakou C, Napoletano S, Marinelli E, Zaami S. Clinical applications of sodium oxybate (GHB): from narcolepsy to alcohol withdrawal syndrome. Eur Rev Med Pharmacol Sci 2015;19:4654–63. PMID: 26698265

Corkery JM, Loi B, Claridge H, Goodair C, Schifano F. Deaths in the lesbian, gay, bisexual and transgender United Kingdom communities associated with GHB and precursors. Curr Drug Metab 2018;19:1086–99. doi: 10.2174/1389200218666171108163817

Frati P, Kyriakou C, Del Rio A, Marinelli E, Vergallo GM, Zaami S, Busardò FP. Smart drugs and synthetic androgens for cognitive and physical enhancement: revolving doors of cosmetic neurology. Curr Neuropharmacol 2015;13:5–11. doi: 10.2174/1570159X13666141210221750

Carlier J, Giorgetti R, Varì MR, Pirani F, Ricci G, Busardò FP. Use of cognitive enhancers: methylphenidate and analogs. Eur Rev Med Pharmacol Sci 2019;23:3–15. doi: 10.26355/eurrev_201901_16741

Gentili S, Mortali C, Mastrobattista L, Berretta P, Zaami S. Determination of different recreational drugs in sweat by headspace solid-phase microextraction gas chromatography mass spectrometry (HS-SPME GC/MS): Application to drugged drivers. J Pharm Biomed Anal 2016;129:282–7. doi: 10.1016/j.jpba.2016.07.018

Zaami S, Giorgetti R, Pichini S, Pantano F, Marinelli E, Busardò FP. Synthetic cathinones related fatalities: an update. Eur Rev Med Pharmacol Sci 2018;22:268–74. doi: 10.26355/eurrev_201801_14129

Pichini S, Marchei E, Pacifici R, Marinelli E, Busardò FP. Chemsex intoxication involving sildenafil as an adulterant of GHB. Drug Test Anal 2017;9:956–9. doi: 10.1002/dta.2054

Karch SB, Busardò FP, Vaiano F, Portelli F, Zaami S, Bertol E. Levamisole adulterated cocaine and pulmonary vasculitis: Presentation of two lethal cases and brief literature review. Forensic Sci Int 2016;265:96–102. doi: 10.1016/j.forsciint.2016.01.015

Petersen IN, Tortzen C, Kristensen JL, Pedersen DS, Breindahl TJ. Identification of a new metabolite of GHB: gamma-hydroxybutyric acid glucuronide. J Anal Toxicol 2013;37:291–7. doi: 10.1093/jat/bkt027

Busardò FP, Pichini S, Zaami S, Pacifici R, Kintz P. Hair testing of GHB: an everlasting issue in forensic toxicology. Clin Chem Lab Med 2018;56:198–208. doi: 10.1515/cclm-2017-0397

Busardò FP, Kyriakou C, Marchei E, Pacifici R, Pedersen DS, Pichini S. Ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) for determination of GHB, precursors and metabolites in different specimens: Application to clinical and forensic cases. J Pharm Biomed Anal 2017;137:123–31. doi: 10.1016/j.jpba.2017.01.022.

Busardò FP, Bertol E, Vaiano F, Baglio G, Montana A, Barbera N, Zaami S, Romano G. Post mortem concentrations of endogenous gamma hydroxybutyric acid (GHB) and in vitro formation in stored blood and urine samples. Forensic Sci Int 2014;243:144–8. doi: 10.1016/j.forsciint.2014.07.019

Wang X, Linnet K, Johansen SS. Development of a UPLC-MS/MS method for determining γ-hydroxybutyric acid (GHB) and GHB glucuronide concentrations in hair and application to forensic cases. Forensic Toxicol 2016;34:51–60.

Mehling LM, Wang X, Johansen SS, Spottke A, Heidbreder A, Young P, Madea B, Hess C. Determination of GHB and GHB-β-O-glucuronide in hair of three narcoleptic patients – Comparison between single and chronic GHB exposure. Forensic Sci Int 2017;278:e8–13.

E. Marchei, A. Tini, F. Pirani, A.F. Lo Faro, S. Marinelli. Is GHB-glucuronide useful as a biomarker for the exogenous use of GHB? Eur Rev Med Pharmacol Sci 2019;23:2311–3. doi: 10.26355/eurrev_201903_17369

Steuer AE, Raeber J, Steuer C, Boxler MI, Dornbierer DA, Bosch OG, Quednow BB, Seifritz E, Kraemer T. Identification of new urinary gamma-hydroxybutyric acid markers applying untargeted metabolomics analysis following placebo-controlled administration to humans. Drug Test Anal 2018 Dec 12. doi: 10.1002/dta.2558. [Epub ahead of print]

How to Cite
Beck R, Mimica Matanović S, Zibar L. Gamma-hydroxybutyric acid, gamma-butyrolactone, and 1,4-butanediol addiction: a serious health threat. Arh Hig Rada Toksikol [Internet]. 2019Jun.7 [cited 2021Jul.31];70(2). Available from:
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