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Phenibut (Β-Phenyl-Γ-Aminobutyric Acid): an Easily Obtainable “Dietary Supplement” with Propensities for Physical Dependence and Addiction

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Phenibut (Β-Phenyl-Γ-Aminobutyric Acid): an Easily Obtainable “Dietary Supplement” with Propensities for Physical Dependence and Addiction Current Psychiatry Reports (2019) 21: 23 https://doi.org/10.1007/s11920-019-1009-0 COMPLEX MEDICAL-PSYCHIATRIC ISSUES (MB RIBA, SECTION EDITOR) Phenibut (β-Phenyl-γ-Aminobutyric Acid): an Easily Obtainable “Dietary Supplement” With Propensities for Physical Dependence and Addiction Edward A. Jouney1 Published online: 9 March 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose of Review Phenibut (β-phenyl-γ-aminobutyric acid) is a psychoactive GABA analogue currently being marketed online as an anxiolytic and nootropic dietary supplement. Its use is growing in popularity, but its pharmacological activity is well beyond that of a conventional nutritional supplement, and similar to that of a prescription strength sedative. This review will focus on the potential adversities of phenibut use and will discuss what treatment options may be beneficial to afflicted patients. Recent Findings Over the last several years, multiple case reports have highlighted phenibut’s potential to produce the conditions of physical dependence, withdrawal, and addiction. In cases involving intoxication, patients have presented with a varying degree of mental status changes, from being minimally responsive to manifesting symptoms of an agitated delirium. Summary Phenibut is a potent psychoactive substance with GABAB agonist properties, which is emerging as a drug of misuse through growing internet sales. Its marketing as a “dietary supplement” is inaccurate and misleading, given its pharmacological profile and ability to induce the physiological changes associated with withdrawal and physical dependence. Keywords Phenibut . Nootropic . New psychoactive substance . Baclofen . GABAB agonist . Dietary supplement Introduction Outside of Russia and the former Soviet Republics, phenibut was relatively unknown until 2011, when a quantity Phenibut (β-phenyl-γ-aminobutyric acid) is an analog of the of the drug was seized in Sweden, and the European authorities inhibitory neurotransmitter GABA (γ-aminobutyric acid), were alerted [2, 3•]. Due to concerns for potential misuse, with potent psychotropic effects. It was first synthesized in phenibut was reported to the European Monitoring Centre for St. Petersburg, Russia, in the early 1960s, and was at one time Drugs and Drug Addiction (EMCDDA) and Europol in 2012 placed in the medical kits provided to Soviet cosmonauts [1]. [2]. In the EMCDDA–Europol 2012 Annual Report on the The drug has been sold under the brand names of Noofen and implementation of Council Decision, it was noted that phenibut Anvifen, and produces a wide range of psychological effects, was “being sold both as a ‘dietary supplement’ and ‘research including sedation and purported nootropic (cognitive en- chemical’ in a number of EU Member State” [4]. Since that hancing) effects. Phenibut is not available for prescribed use time, the availability of the drug through online procurement in the USA, European Union, or Australia, although it can be has increased, and reports regarding phenibut misuse, legally purchased as a dietary supplement through a variety of intoxication, and physical dependence have been published. online vendors [2]. The drug acts predominately as a GABAB Following the notification to EMCDDA, phenibut was agonist, although other receptor systems may be involved [1]. classified as a new psychoactive substance (NPS) in 2012 by the United Nations Office of Drug and Crime (UNODC). NPS This article is part of the Topical Collection on Complex Medical- is defined by UNODC as: “a substances of abuse, either in a Psychiatric Issues pure form or a preparation, that are not controlled by the 1961 Single Convention on Narcotic Drugs or the 1971 Convention * Edward A. Jouney on Psychotropic Substances, but which may pose a public [email protected] health threat” [2, 3•]. The term NPS, however, can be mislead- “ ” 1 Department of Psychiatry, University of Michigan, ing, given that the term new does not necessarily infer a new Ann Arbor, MI, USA drug discovery, and may indicate the emergence of a 23 Page 2 of 6 Curr Psychiatry Rep (2019) 21: 23 previously known substance into the arena of drug misuse. & For most claims made in the labeling of dietary supple- Many drugs classified as NPS were first synthesized several ments, the law does not require the manufacturer or seller decades ago, including phenibut [5]. to prove to FDA’s satisfaction that the claim is accurate or The appearance of NPS has been rapidly growing over the truthful before it appears on the product [11]. last several years. According to a 2018 report by UNODC, & Dietary supplement manufacturers do not have to get the between 2009 and 2016, 106 countries and territories reported agency’s approval before producing or selling these prod- the emergence of 739 different NPS to their office [6]. Since ucts [11]. the monitoring of NPS began by UNODC in 2009, new sub- stances have been emerging at a rate one per week [6]. Currently, phenibut can be easily purchased through sever- To date, it appears that Australia has been the only country al online vendors, in the USA and abroad. Sellers offer the that has taken legal action against the sales of phenibut. In drug in several forms: powder, capsules, and “fine crystals.” February of 2018, the Therapeutic Goods Administration of In a 2016 study from the UK, 48 unrelated online retailers Australia officially listed phenibut as a prohibited substance were identified as vendors for phenibut [3•]. Similar data re- [7]. lated to quantifying phenibut availability and sales in the USA Despite the modern concerns for misuse, the prescribed could not be located. therapeutic benefits of phenibut have been shown in Russia, where the drug has been predominately studied since the mid- 1960s. In a 2001 review, Lapin described that “phenibut is Pharmacology widely used in Russia” to treat multiple conditions, including anxiety, insomnia, PTSD, stuttering, and vestibular disorders A thorough review of phenibut’spharmacologywaspub- [1]. lished by Lapin in 2001, who noted that the drug had similar pharmacological activity as GABA, and described it as “GABA-mimetic” [1]. Its primary mechanism of action has been reported as a GABAB receptor agonist, although its in- A Dietary Supplement? teraction with multiple other receptor systems has been de- scribed [1]. Due to its structural similarities to GABA (an amino acid), Structurally, phenibut is a GABA molecule with a phenyl phenibut is technically a “food” in the eyes of the US Food group attached at the beta carbon (Fig. 1). The addition of this and Drug Administration (FDA), and is therefore not regulat- phenyl group gives the drug a greater permeability through the ed as a drug or even as an over the counter (OTC) medication. blood brain barrier compared to GABA; however, it does not Based on the Dietary Supplement Health and Education Act provide more potent pharmacological effects [1]. The addition (DSHEA) of 1994, amino acids are considered dietary supple- of a single chlorine atom to the phenyl ring of phenibut pro- ments (food) and can thus circumvent the scrutiny of FDA duces the spasmolytic drug baclofen (β-p-Cl-phenyl-γ- drug regulations [8]. aminobutyric acid). Thus, strong structural commonalities ex- The DSHSEA defines a dietary supplement as: “aproduct ist between GABA, baclofen, and phenibut [1]. (other than tobacco) intended to supplement the diet that bears GABA is the primary inhibitory neurotransmitter in the or contains one or more of the following dietary ingredients: CNS and produces effects through the activation of two me- (A) a vitamin; (B) a mineral; (C) an herb or botanical; (D) an chanically different receptors: GABAA and GABAB [12, 13]. amino acid; (E) a dietary substance used by man to supple- The GABAA receptor is an ionotropic ligand-gated chloride ment the diet by increasing the total dietary intake; or (F) a channel and provides rapid neuronal inhibition [12]. The re- concentrate metabolite, constituent, extract, or combination of ceptor is the target for many sedative/hypnotic drugs, includ- any ingredient described in clause (A), (B), (C), (D), or (E)” ing benzodiazepine, barbiturates, and the non-benzodiazepine [8, 9]. Some FDA policies regarding dietary supplements can be accessed through the FDA’s website. Some relevant points are listed below: & The FDA is not authorized to review dietary supplement products for safety and effectiveness before they are marketed [10]. & Federal law does not require dietary supplements to be proven safe to FDA’s satisfaction before they are marketed [11]. Fig. 1 Molecular structures of GABA and phenibut Curr Psychiatry Rep (2019) 21: 23 Page 3 of 6 23 Table 1 Comparison of the reported symptoms associated with Z drugs, such as zolpidem. The GABAB receptor, contrarily, is a metabotropic G protein–coupled receptor, which mediates phenibut intoxication and withdrawal slow and protracted inhibitory neurotransmission in the CNS, Phenibut intoxication/overdose Phenibut withdrawal and maintains an inhibitory tone [12]. Baclofen, which is used to treat muscle spasticity in several neurological disorders Sedation Anxiety Decreased level of consciousness Agitation such as multiple sclerosis, is a GABAB receptor agonist [12, 13]. Agitation Tremulousness Lapin described other potential pharmacological activity, Combativeness Heart palpitations including activation of GABAA receptors, activation of dopa- Delirium Decreased appetite mine metabolism, and antagonism of phenylethylamine Psychosis Insomnia
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