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35th AM (2025) - Poster Session
When a Supplement Turns Sinister A Complex Case of ...
When a Supplement Turns Sinister A Complex Case of Phenibut Withdrawal Delirium and Successful Management
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This report from Cleveland Clinic Foundation highlights the emerging clinical challenge of phenibut withdrawal, a serious and potentially life-threatening condition linked to an unregulated dietary supplement becoming increasingly popular online. Phenibut (β-phenyl-γ-aminobutyric acid) is a GABA-B receptor agonist promoted for anxiety, sleep, mood, and PTSD, but it carries risks of dependence, toxicity, and severe withdrawal syndromes that mimic alcohol withdrawal, including delirium, hallucinations, seizures, and psychosis.<br /><br />A detailed case study involves a 25-year-old male with multiple psychiatric comorbidities, including major depressive disorder, generalized anxiety disorder, ADHD, and alcohol use disorder in remission. The patient used phenibut as an alcohol substitute, escalating daily doses with unknown potency. Abrupt cessation led to severe withdrawal symptoms four days later: agitation, visual hallucinations, paranoid delusions, and psychosis requiring emergency care. Management involved phenobarbital loading, tapered over days, along with baclofen titration, resulting in marked symptom resolution and safe discharge.<br /><br />The report emphasizes the need for increased clinician awareness of phenibut’s pharmacologic profile and withdrawal presentation to avoid misdiagnosis or inadequate treatment. Phenobarbital combined with baclofen is identified as an effective therapeutic approach, necessitating multidisciplinary coordination and vigilant monitoring. Current research is limited to case reports, highlighting the urgent need for validated withdrawal assessment tools, standardized treatment protocols, and improved quality control of online psychoactive products.<br /><br />Policy gaps remain significant, as phenibut is unregulated in the U.S., despite clear risks of dependence and severe withdrawal. The authors advocate for stronger regulatory oversight of dietary supplements with psychoactive effects to mitigate public health risks.<br /><br />Overall, this work calls for enhanced clinical education, improved research, and stricter policy measures to address the rising burden of phenibut-related disorders in healthcare settings.
Keywords
Phenibut withdrawal
GABA-B receptor agonist
Dietary supplement regulation
Phenobarbital treatment
Baclofen titration
Psychiatric comorbidities
Severe withdrawal symptoms
Case study
Clinical awareness
Public health policy
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