![]() Phenibut (β-phenyl-γ-aminobutyric acid) is a synthetic GABA-mimetic developed in Russia in the 1960s. He was discharged to the intensive outpatient program for substance use disorders at the time of writing this report. He was placed on a symptom-triggered alcohol withdrawal protocol, receiving as much as 13 mg of lorazepam in 24 hours, which was tapered at our hospital along with pregabalin. Less than 24 hours after last use, he experienced withdrawal symptoms including hot flashes, restlessness, nausea, insomnia, and cravings to use.ĭuring his admission at an outside hospital, he developed tachycardia, hypertension, diaphoresis, visual hallucinations, and paranoid delusions. He noted several unpleasant effects with intoxication including increased emotionality (particularly irritability) and blackout periods. He liked that phenibut increased his libido and helped him “come down off cocaine.” He found that co-ingestion reduced the tolerance he experienced with pregabalin. Seeking analgesia and anxiolysis after he developed tolerance to pregabalin, this patient first purchased the powder form of phenibut online and initially used <2 g daily, noticed tolerance after three consecutive days of use, and soon took ≥4 g daily (“just to feel normal”).
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