Sodium Oxybate

What is Sodium Oxybate

Sodium oxybate is the sodium salt of gamma hydroxybutyric acid (GHB), a naturally occurring central nervous system transmitter with sedative and anesthetic properties.

In Europe, sodium oxybate has been used for various medical purposes including narcolepsy, intravenous anesthesia, alcohol dependence, and opiate dependence. In the U.S., sodium oxybate is used for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients with narcolepsy.

Sodium oxybate differs from modafinil and other stimulant treatments for narcolepsy in that it significantly decreases cataplexy episodes in addition to EDS; the drug is frequently prescribed along with stimulant therapies for narcolepsy. A median decrease in the total number of weekly cataplexy episodes of nearly 70% has been reported in clinical trials in adult patients receiving a dose of 9 grams/night.

Historically, GHB was commonly used as a dietary supplement for enhancing athletic performance and as a sleep aid. As a result of serious adverse events associated with GHB use as a dietary supplement, the FDA intervened in 1991 to prohibit the marketing of GHB.

Commonly known by slang terms such as Liquid Ecstasy or Liquid E, GHB can produce euphoria, making it a popular but dangerous party drug of abuse. GHB has not been approved for any medical use and has gained notoriety as a date rape drug due to its sedative and amnestic properties.

Brand Name

Xyrem

Indications & Dosage

  • cataplexy
  • narcolepsy

For the treatment of cataplexy and excessive daytime sleepiness in patients with narcolepsy

Side Effects

  1. abdominal pain
  2. agitation
  3. anorexia
  4. anxiety
  5. apnea
  6. arthralgia
  7. blurred vision
  8. cataplexy
  9. Cheyne-Stokes respiration
  10. coma
  11. complex sleep-related behaviors
  12. confusion
  13. delirium
  14. depression
  15. diarrhea
  16. dizziness
  17. drowsiness
  18. edema
  19. euphoria
  20. hallucinations
  21. headache
  22. hyperhidrosis
  23. hypertension
  24. impaired cognition
  25. irritability
  26. libido increase
  27. memory impairment
  28. muscle cramps
  29. nausea
  30. nocturia
  31. nystagmus
  32. obtundation
  33. paranoia
  34. paresthesias
  35. peripheral edema
  36. physiological dependence
  37. psychological dependence
  38. psychosis
  39. respiratory depression
  40. seizures
  41. serotonin syndrome
  42. sleep paralysis
  43. somnambulism
  44. suicidal ideation
  45. tolerance
  46. tremor
  47. urinary incontinence
  48. vomiting
  49. weight loss
  50. withdrawal
  51. xerostomia

Monitoring Parameters

  • LFTs
  • neurologic function
  • serum potassium
  • serum sodium

Contraindications

  • alcoholism
  • behavioral changes
  • breast-feeding
  • cardiac disease
  • CNS depression
  • coadministration with other CNS depressants
  • complex sleep-related behaviors
  • depression
  • driving or operating machinery
  • ethanol ingestion
  • geriatric
  • heart failure
  • hepatic disease
  • hypertension
  • hypoxemia
  • labor
  • neonates
  • obesity
  • obstetric delivery
  • pregnancy
  • pulmonary disease
  • renal disease
  • respiratory depression
  • respiratory insufficiency
  • seizure disorder
  • seizures
  • sleep apnea
  • substance abuse
  • succinic semialdehyde dehydrogenase deficiency
  • suicidal ideation
  • surgery

Interactions

  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Tramadol
  • Alprazolam
  • Amitriptyline; Chlordiazepoxide
  • Amobarbital
  • Amphetamine
  • Amphetamine; Dextroamphetamine
  • Amphetamine; Dextroamphetamine Salts
  • Anxiolytics; Sedatives; and Hypnotics
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Baclofen
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Benzhydrocodone; Acetaminophen
  • Benzodiazepines
  • Benzphetamine
  • Bupropion
  • Bupropion; Naltrexone
  • Buspirone
  • Butabarbital
  • Caffeine
  • Caffeine; Ergotamine
  • Cannabidiol
  • Capsaicin; Metaxalone
  • Carisoprodol
  • Cenobamate
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chlorpromazine
  • Chlorzoxazone
  • Clobazam
  • Clonazepam
  • Clorazepate
  • Cocaine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • COMT inhibitors
  • Cyclobenzaprine
  • Dantrolene
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Deutetrabenazine
  • Dexmethylphenidate
  • Dextroamphetamine
  • Dextromethorphan; Promethazine
  • Diazepam
  • Doxylamine
  • Doxylamine; Pyridoxine
  • Dronabinol
  • Droperidol
  • Esketamine
  • Estazolam
  • Ethanol
  • Fluphenazine
  • Flurazepam
  • food
  • Gabapentin
  • General anesthetics
  • Green Tea
  • Hydroxyzine
  • Iohexol
  • Iopamidol
  • Iopromide
  • Ioversol
  • Isosulfan Blue
  • Lasmiditan
  • Lemborexant
  • Levocetirizine
  • Lisdexamfetamine
  • Lofexidine
  • Lopinavir; Ritonavir
  • Lorazepam
  • Lumateperone
  • Meperidine; Promethazine
  • Mephobarbital
  • Mesoridazine
  • Metaxalone
  • Methamphetamine
  • Methohexital
  • Methylphenidate
  • Midazolam
  • Monoamine oxidase inhibitors
  • Nabilone
  • Non-Ionic Contrast Media
  • Ombitasvir; Paritaprevir; Ritonavir
  • Opiate Agonists
  • Orphenadrine
  • Oxazepam
  • Ozanimod
  • Pemoline
  • Pentobarbital
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phendimetrazine
  • Phenobarbital
  • Phenothiazines
  • Phentermine
  • Phentermine; Topiramate
  • Phenylephrine; Promethazine
  • Phenytoin
  • Pregabalin
  • Primidone
  • Procarbazine
  • Prochlorperazine
  • Promethazine
  • Quazepam
  • Rasagiline
  • Ritonavir
  • Saquinavir
  • Secobarbital
  • Skeletal Muscle Relaxants
  • St. John’s Wort, Hypericum perforatum
  • Temazepam
  • Thiethylperazine
  • Thiopental
  • Thioridazine
  • Tramadol
  • Triazolam
  • Trifluoperazine
  • Trimethobenzamide
  • Valproic Acid, Divalproex Sodium
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