Management of GHB Withdrawal

Assessment and Treatment

• The American College of Hepatology recommends using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale adapted for sedative withdrawal to assess baseline severity, looking specifically for tremors, sweating, anxiety, agitation, tactile/auditory/visual disturbances, headache, and orientation 1
• The American Society of Intensive Care Medicine suggests documenting rationale for any dose adjustments or additional medications during GHB taper, with a focus on symptom-triggered dosing 2, 3, 4
• The American Academy of Family Physicians recommends calculating total benzodiazepine equivalents, incorporating baseline alprazolam into the total benzodiazepine taper schedule, and converting to a single long-acting benzodiazepine for smoother withdrawal management 6
• The Mayo Clinic advises educating patients about benzodiazepine risks and benefits of tapering, with a success rate of 27% in stopping benzodiazepines compared to 5% in controls 7

Pharmacological Management

• The Journal of Hepatology suggests using baclofen 10-20mg three times daily as an adjunct to pharmaceutical GHB tapering or benzodiazepine management, with a maximum dose not exceeding 80mg/day 1
• The Intensive Care Medicine journal recommends using barbiturates or propofol as second-line sedatives when benzodiazepines are ineffective 2, 3, 4

Patient Education and Support

• The Praxis Medical Insights guideline recommends implementing cognitive-behavioral therapy during and after detoxification, providing supportive psychotherapy, relaxation techniques, and sleep hygiene education, and addressing underlying psychiatric conditions 5