Abstract：
β-Phenyl-γ-aminobutyric acid (phenibut) is an analog of the inhibitory neurotransmitter γ-aminobutyric acid (GABA) that was first synthesized in Russia in the early 1960s. It is marketed as a nootropic (smart drug) to improve cognitive performance, and to treat generalized and social anxiety, insomnia, and alcohol withdrawal. The use of phenibut is legal in the USA and it is widely available online without a prescription. Increased public awareness of phenibut has led to a growing number of reports of acute intoxication and withdrawal. In this review, we describe the pharmacology of phenibut, the presentation and management of acute intoxication, and regulatory issues, placing particular emphasis on the treatment of acute withdrawal, for which there are no comparative studies. Among 29 cases of phenibut withdrawal, patients were successfully treated with baclofen, benzodiazepines, and phenobarbital, as individual agents or in various combinations. Ancillary medications included antipsychotics, dexmedetomidine, gabapentin, and pregabalin. After stabilization, a number of patients did well on baclofen tapers, whereas others were weaned off benzodiazepines or phenobarbital. Phenobarbital may be preferred over baclofen, or used as an added agent, in patients at risk for seizures. As long as phenibut remains legal, cases of phenibut intoxication and withdrawal are likely to increase. As urine or plasma drug screening for phenibut is not widely available, it is vital that clinicians obtain a detailed medication history in patients presenting to the emergency department with nonspecific symptoms that may represent phenibut intoxication or withdrawal. Further, clinicians may wish to consult an addiction specialist or toxicologist in these situations.
摘要：
β-苯基-γ-氨基丁酸（phenibut）是抑制性神经递质γ-氨基丁酸（GABA）的类似物，于1960年代初在俄罗斯首次合成。它作为一种促智药（智能药物）销售，以提高认知能力，治疗广泛性和社交焦虑，失眠,酒精戒断。在美国，使用phenibut是合法的，并且无需处方即可在网上广泛使用。公众对斑鱼的认识提高导致越来越多的急性中毒和戒断报告。在这次审查中,我们描述了Phenibut的药理学，急性中毒的表现和管理，和监管问题，特别强调急性戒断的治疗，没有比较研究。在29例患者戒断中，患者成功接受了巴氯芬治疗，苯二氮卓类药物,还有苯巴比妥,作为单独的代理人或各种组合。辅助药物包括抗精神病药，右美托咪定,加巴喷丁,还有普瑞巴林.稳定后,许多患者在巴氯芬锥度上表现良好，而其他人则断奶了苯二氮卓类药物或苯巴比妥。苯巴比妥可能优于巴氯芬，或用作添加剂，有癫痫发作风险的患者。只要菲尼比仍然合法，苯布中毒和戒断的病例可能会增加。由于尿液或血浆中的苯类药物筛查并不广泛，重要的是,临床医师在急诊就诊的患者中获得详细的用药史,这些患者的非特异性症状可能代表苯并钠中毒或戒断.Further,在这些情况下，临床医生可能希望咨询成瘾专家或毒理学家。
