The strategy used to treat people admitted to hospital emergency departments intoxicated with GHB/GBL/BD is essentially supportive and requires monitoring vital signs and ensuring the airways are clear, because emesis is common. Physicians should pay particular attention to cardiovascular and respiratory symptoms and if the patients are unconscious then intubation should be considered for the first few hours of recovery. According to different studies the prevalence of intubation of GHB poisoned patients varies from 10 to 57%, whereas the mean duration of intubation ranges from 80 to 210 minutes [
157,
164].
Cardiovascular symptoms resulting from overdosing with GHB don't normally require invasive therapy although the bradycardia might be treated by administration of atropine. ECG anomalies are not typical of GHB intoxication and if they do occur are probably caused by co-ingestion of other drugs [
19].
Table
1010 gives examples of the types of drugs used in attempts to reverse the intoxication and sedative effects of GHB in emergency department patients and also in various animal studies. In one study, physostigmine showed some promise in reversing GHB-induced altered states of consciousness [
165,
166], although its efficacy was later challenged [
167].
Neither naloxone, a pure opiate antagonist [168], nor the selective benzodiazepine receptor antagonist flumazenil [169] were effective in reversing GHB sedation. A novel GABA-B antagonist was tested in mice as a way of lowering mortality caused by massive doses of GHB, but it did not seem to have any beneficial effects [
170]. Taken together, these investigations and the types of drugs used have so far not provided a practically useful antidote to treat patients heavily intoxicated with GHB.
Table 10
Examples of drugs used in the treatment and reversal of acute GHB intoxication.
Drug (Trade Name in USA) Class of Medication Limitations/Comments
Phenytoin (Dilantin®)
Phenobarbital (Luminal®) Anticonvulsant/antiepileptic. No apparent effect on coma induced by GHB.
Clonazepam (Klonopin®) Diazepam (Valium®)
Lorazepam (Ativan®) GABA-A receptor agonists. Effective to treat withdrawal effects of GHB.
Flumazenil (Anexate®) GABA-A receptor antagonist. No influence on CNS depression.
Naloxone (Narcan®) Pure µ-opiate receptor antagonist. No effect on GHB-induced respiratory depression.
Physostigmine (Antilirium®) Cholinesterase inhibitor and thus a potential antidote to reverse effects of anticholinergic agents. No major benefit and after GHB overdose and this treatment might precipitate seizures or cardiac arrhythmias.