Gamma-Hydroxybutyric acid or γ-Hydroxybutyric acid (GHB),

also known as 4-hydroxybutanoic acid, is a naturally occurring neurotransmitter and a psychoactive drug. It is a precursor to GABA, glutamate, and glycine in certain brain areas. It acts on the GHB receptor and is a weak agonist at the GABAB receptor.

GHB has been used in a medical setting as a general anesthetic and as a treatment for cataplexy, narcolepsy, and alcoholism. It is also used illegally as an intoxicant, as an athletic performance enhancer, as a date rape drug, and as a recreational drug. It is commonly used in the form of a salt, such as sodium γ-hydroxybutyrate (Na.GHB, sodium oxybate, or Xyrem) or potassium γ-hydroxybutyrate (K.GHB, potassium oxybate).

GHB is also produced as a result of fermentation, and is found in small quantities in some beers and wines, beef and small citrus fruits.

Succinic semialdehyde dehydrogenase deficiency is a disease that causes GHB to accumulate in the blood.

Medical use

The only common medical uses for GHB today are in the treatment of narcolepsy and, more rarely, alcoholism, although its use for alcoholism is not supported by evidence from randomized controlled trials. It is sometimes used off-label for the treatment of fibromyalgia.

GHB is the active ingredient of the prescription medication sodium oxybate (Xyrem). Sodium oxybate is approved by U.S. Food and Drug Administration for the treatment of cataplexy associated with narcolepsy and excessive daytime sleepiness (EDS) associated with narcolepsy.

GHB has been shown to reliably increase slow-wave sleep and decrease the tendency for REM sleep in modified multiple sleep latency tests.

Party use

GHB has been used as a club drug, apparently starting in the 1990s, as small doses of GHB can act as a euphoriant and are believed to be aphrodisiac. Slang terms for GHB include liquid ecstasy, lollipops, liquid X or liquid E due to its tendency to produce euphoria and sociability and its use in the dance party scene.

By 2009 this use had diminished, possibly due to efforts to control distribution of GHB and its analogs, or to the narrow range of dosing and adverse effects of confusion, dizziness, blurred vision, hot/cold flushes, profuse sweating, vomiting, and loss of consciousness when overdosed. The downward trend was still apparent in 2012.