Herb & supplement monograph

1,4-butanediol Drug Interactions, Uses, Effectiveness, Safety & More

Medically reviewed by ·Updated July 2026
What is this page for?

First and foremost: how 1,4-butanediol interacts with medications. The heart of this page is the interaction list — every drug 1,4-butanediol is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what 1,4-butanediol is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy

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Interaction report

Drugs that interact with 1,4-butanediol

271 medications have a known interaction with 1,4-butanediol, graded by severity. Select any drug for the full evidence-based detail.

250 major interactions. These combinations can be clinically significant — best avoided, or used only with close professional supervision. Always check with your pharmacist before combining them with 1,4-butanediol.

2,830 drugs
AcepromazineAtravet› Acetaminophen, Butalbital, Caffeine, CodeineEsgic with Codeine, Fioricet w/ Codeine› Acetaminophen, Butalbital, CodeineBancap w/ Codeine› Acetaminophen, Butalbital, Codeine PhosphatePhrenilin #3› Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, PhenylephrineHycomine Compound› Acetaminophen, Caffeine, CodeineGesic C15, Gesic C30, Gesic C8, Lenoltec 1, Lenoltec 2, Lenoltec 3 +1 more› Acetaminophen, Caffeine, Codeine, SalicylamideCodalan No.1, Codalan No.2, Codalan No.3› Acetaminophen, Caffeine, DihydrocodeineDHC Plus, Panlor DC, Panlor SS› Acetaminophen, Chlorpheniramine, Codeine, PhenylephrineColrex› Acetaminophen, Chlorpheniramine, Phenylpropanolamine, OpiumHista-Derfule› Acetaminophen, Chlorzoxazone, CodeineAcetazone Forte C8, Parafon Forte C8› Acetaminophen, CodeineTylenol No.3, Tylenol w/ Codeine› Acetaminophen, Codeine, DoxylamineMersyndol› Acetaminophen, Codeine, MethocarbamolAcetaminophen, Codeine, Methocarbamol, Robaxacet 8› Acetaminophen, Dichloralantipyrine, IsomethepteneAmidrine, Midchlor, Migquin, Migratine› Acetaminophen, Dichloralphenazone, IsomethepteneMidrin› Acetaminophen, Dichlorophenazone, IsometheptaneIsocom› Acetaminophen, DiphenhydramineTylenol PM, Tylenol PM Ex Strength› Acetaminophen, Diphenhydramine, PseudoephedrineChildren's Tylenol Allergy, Cold Control, Contac Night Allergy Relief› Acetaminophen, HydrocodoneAnexsia, Anodynos DHC, Azdone, Co-Gesic, Doucet, Lorcet +9 more› Acetaminophen, MeperidineDemerol APAP› Acetaminophen, OxycodonePercocet, Roxicet, Tylox, Xartemis XR› Acetaminophen, PentazocineTalacen› Acetaminophen, PropoxypheneDarvocet-N 100, Darvocet-N 50, E-Lor, Wygesic› AcetazolamideAk-Zol, Diamox› AlfentanilAlfenta› AlprazolamNiravam, Xanax› Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium HydroxideAscriptin Codeine #2› AminoglutethimideCytadren› Aminophylline, Amobarbital, EphedrineAmesec›
Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

  • Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
  • Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
  • Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
  • No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

  • Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
  • Probable. Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • Possible. Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
  • Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

  • Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
  • Each drug listed above links to the full report for that exact 1,4-butanediol combination — clinical detail, likelihood, evidence level, and citations.
  • Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.
The big picture

The kinds of drugs 1,4-butanediol affects

Every type of medication (drug category) 1,4-butanediol is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 10 drug categories 1,4-butanediol interacts with
Alcohol (ethanol)Cns DepressantsNarcotic DrugsAmphetaminesAnticonvulsantsDivalproex Sodium (depakote)Naloxone (narcan)Ritonavir (norvir)Saquinavir (fortovase, Invirase)Topiramate (topamax)
Alcohol (Ethanol)

Theoretically, alcohol may increase or decrease the therapeutic and adverse effects of 1,4-butanediol.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB) by hepatic alcohol dehydrogenase enzymes. Alcohol competitively inhibits alcohol dehydrogenase, which leads to higher blood levels of 1,4-butanediol and lower blood levels of GHB. The clinical effects of this change are not well understood. Most researchers believe that the pharmacologic activity of 1,4-butanediol is dependent on conversion to GHB; however, animal research shows that 1,4-butanediol may also act independently. Also, in humans, concomitant use of GHB and alcohol increases the adverse effects of GHB, possibly by reducing the elimination of GHB. Concomitant use of GHB and alcohol may also cause additive respiratory and central nervous system depression. Therefore, concomitant use of 1,4-butanediol and alcohol may either increase or decrease the risk of adverse effects.

Likelihood Probable Evidence C
Cns Depressants

Theoretically, concomitant use of 1,4-butanediol with CNS depressants may potentiate respiratory and CNS depression.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Concomitant use of CNS depressants with GHB may cause serious CNS and respiratory depression.

Likelihood Probable Evidence D
Narcotic Drugs

Theoretically, concomitant use of 1,4-butanediol with narcotic drugs may potentiate respiratory and central nervous system (CNS) depression. 1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB).
Concomitant use of narcotic drugs with GHB may cause serious CNS and respiratory depression. In one case report, concurrent use of GHB and heroin was fatal.

Likelihood Probable Evidence D
Amphetamines

Theoretically, amphetamines may increase or decrease the therapeutic and adverse effects of 1,4-butanediol.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Although some researchers have suggested that amphetamines may antagonize the effects of GHB, this has not been well studied. Also, some case reports suggest that concomitant use might increase the risk of severe side effects, including CNS and respiratory depression.

Likelihood Possible Evidence D
Anticonvulsants

Theoretically, concomitant use of 1,4-butanediol with certain anticonvulsants may potentiate respiratory and central nervous system (CNS) depression or increase the risk of seizures.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Concomitant use of anticonvulsants that have sedative effects with GHB may cause serious CNS and respiratory depression. GHB might also reduce the effectiveness of anticonvulsants since it also can cause seizures.

Likelihood Possible Evidence D
Divalproex Sodium (Depakote)

Theoretically, concomitant use of 1,4-butanediol with divalproex sodium may potentiate adverse effects.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Concomitant use of divalproex sodium with GHB may increases plasma GHB levels by approximately 25% and may increase the risk of adverse effects.

Likelihood Possible Evidence D
Naloxone (Narcan)

Theoretically, concomitant use of 1,4-butanediol with naloxone may antagonize the effects of 1,4-butanediol.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Theoretically, naloxone may antagonize the effects of GHB, but anecdotally, naloxone is not effective for treating GHB poisoning.

Likelihood Possible Evidence D
Ritonavir (Norvir)

Concomitant use of 1,4-butanediol with ritonavir may potentiate adverse effects.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Concomitant use of a small dose of GHB with the antiretroviral drugs ritonavir and saquinavir reportedly caused a near-fatal reaction, likely due to inhibition of GHB metabolism.

Likelihood Possible Evidence D
Saquinavir (Fortovase, Invirase)

Concomitant use of 1,4-butanediol with saquinavir may potentiate adverse effects.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Concomitant use of a small dose of GHB with the antiretroviral drugs ritonavir and saquinavir reportedly caused a near-fatal reaction, likely due to inhibition of GHB metabolism.

Likelihood Possible Evidence D
Topiramate (Topamax)

Concomitant use of 1,4-butanediol with topiramate may potentiate adverse effects.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Concomitant use of topiramate with GHB may increases blood levels of GHB. In one case report, a patient regularly taking GHB 4.5 grams twice nightly was hospitalized after initiating treatment with topiramate 25 mg daily. Symptoms included confusion, muscle jerking, miosis, and coma. Plasma levels of GHB were 2.5-fold higher than when GHB was given alone. Potential mechanisms might include decreased GHB breakdown, increased absorption, and/or increased activity.

Likelihood Possible Evidence D
Monograph

1,4-butanediol: Uses, Safety & Side Effects

Medically reviewed by · Reviewed July 2026 ·
The bottom line

1,4-butanediol is a toxic industrial chemical, not a safe dietary supplement. Once swallowed, the body converts it into GHB, a powerful central nervous system depressant that can cause coma, dangerous breathing problems, addiction, and death. It should never be taken as a supplement or recreational substance.

Part used
Synthetic industrial chemical (not a plant)
Common forms
Liquid solvent (sometimes sold illegally as a 'supplement,' cleaner, or party drug)
People commonly use it for
  • Marketed illegally as a 'recreational' or party substance
  • Falsely sold as a sleep aid
  • Falsely promoted for bodybuilding or muscle growth
  • Industrial solvent and chemical manufacturing

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance
OverallBest avoided

This is a toxic chemical that turns into GHB in the body and can be life-threatening.

PregnancyUnsafe

When used orally.

Read the full pregnancy detail
BreastfeedingUnsafe

When used orally.

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Jump to a section

Overview

1,4-butanediol (often shortened to BDO or BD) is a man-made industrial chemical. It is not an herb, plant, or natural dietary supplement. In factories it is used as a solvent and as a building block to make plastics, spandex fibers, and other chemicals.

Despite this, 1,4-butanediol has at times been sold online or in stores—falsely labeled as a 'supplement,' sleep aid, or party product. This is dangerous and illegal in many places. Once swallowed, the body quickly turns it into gamma-hydroxybutyrate (GHB), a controlled substance and powerful nervous system depressant.

Because of its serious risks, regulators such as the U.S. Food and Drug Administration have warned the public against using 1,4-butanediol and related products. It is not a legitimate health supplement.

How it works

When a person swallows 1,4-butanediol, enzymes in the body (including alcohol dehydrogenase) convert it into gamma-hydroxybutyrate (GHB). GHB acts on the brain and slows down the central nervous system.

GHB affects certain brain chemical systems, including GABA receptors, which control sedation and breathing. This is why it can cause deep sedation, loss of consciousness, and slowed or stopped breathing.

Because each person converts the chemical at a different rate, the amount that causes mild effects and the amount that causes a life-threatening overdose can be very close together. This narrow margin makes 1,4-butanediol especially dangerous.

Effectiveness

Does 1,4-butanediol work?

Here’s what the research actually shows for each use — graded by Natural Medicines and reviewed by .

Evidence overview · 4 uses evaluated
4 Insufficient evidence
How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.
2Likely EffectiveGood evidence, though not yet conclusive.
3Possibly EffectiveSome evidence suggests a benefit.
4Possibly IneffectiveSome evidence it may not help.
5Likely IneffectiveFairly strong evidence it doesn’t help.
6IneffectiveStrong evidence it doesn’t work.
7Insufficient Reliable Evidence to RateToo little research to say either way.

For 1,4-butanediol, current evidence isn’t strong enough to rate any specific use. The conditions it has been studied for are listed below.

Also studied for 4 conditions — evidence insufficient to rate
Insufficient Reliable Evidence To Rate Depression
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral 1,4-butanediol for depression, there is insufficient reliable information about the clinical effects of 1,4-butanediol for this purpose.

Insufficient Reliable Evidence To Rate Insomnia
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral 1,4-butanediol for insomnia, there is insufficient reliable information about the clinical effects of 1,4-butanediol for this purpose.

Insufficient Reliable Evidence To Rate Muscle strength
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral 1,4-butanediol to increase muscle strength, there is insufficient reliable information about the clinical effects of 1,4-butanediol for this purpose.

Insufficient Reliable Evidence To Rate Obesity
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral 1,4-butanediol for weight loss, there is insufficient reliable information about the clinical effects of 1,4-butanediol for this purpose.

Source & disclaimer. Effectiveness ratings and evidence summaries are provided by Natural Medicines (Therapeutic Research Center) and shown as licensed. Where Natural Medicines hasn’t rated a use, HelloPharmacist’s pharmacists may add their own reviewed rating and evidence (each such entry is labeled). This is educational information, not medical advice — talk with your pharmacist or doctor before starting, stopping, or changing a supplement.

Safety & precautions

1,4-butanediol is not safe to take by mouth. It is considered a toxic substance and, because it converts to GHB, it is treated as a controlled substance in many countries. Combining it with alcohol or other sedating substances greatly increases the risk of coma and death.

Regular use can lead to physical dependence and addiction. Stopping suddenly after heavy use can trigger a severe and potentially dangerous withdrawal that may include anxiety, tremors, rapid heartbeat, hallucinations, and seizures—sometimes requiring hospital care.

Pregnancy and breastfeeding: Avoid completely. There is no safe dose, and the substance can harm both the parent and the developing baby. People with liver, heart, or breathing problems, and anyone with a history of substance use, are at especially high risk.

If you suspect an overdose—signs include extreme drowsiness, slow or stopped breathing, vomiting while unconscious, or unresponsiveness—call emergency services (911 in the U.S.) right away.

Side effects

Even small amounts of 1,4-butanediol can cause serious harm. Reported effects include:

  • Drowsiness, dizziness, and confusion
  • Nausea and vomiting
  • Slowed heart rate and low blood pressure
  • Slowed or stopped breathing
  • Loss of consciousness and coma
  • Seizures

Serious overdose, death, and dangerous withdrawal have all been reported. There is no 'safe' recreational dose, and the risk of accidental overdose is high.

1,4-butanediol: Reported Adverse Effects

Documented safety reports on 1,4-butanediol from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.

1,4-butanediol is generally considered unsafe for any use. Any benefits do not outweigh the risks of toxicity.

Most Common Adverse Effects:

Orally: Agitation, amnesia, anxiety, bradycardia, chest tightness, confusion, hallucinations, nausea, tremor, vomiting.

Serious Adverse Effects (Rare):

Orally: Cardiac arrest, coma, death, respiratory depression.

Reports by condition
Anxiety Neurologic/CNS

Orally, 1,4-butanediol is metabolized to gamma-hydroxybutyrate (GHB), and its psychoactive effects are primarily due to GHB. 1,4-Butanediol also causes similar CNS toxic effects to GHB, including amnesia, combativeness, confusion, agitation, coma, seizures, and death. After 1,4-butanediol overdoses, sedation gradually increases, consistent with gradual conversion to GHB. 1,4-Butanediol overdose can also present with features suggesting toxic alcohol poisoning. Neurologic and CNS withdrawal symptoms of 1,4-butanediol, GHB, and GBL include insomnia, tremor, anxiety, hallucinations, and delirium.

  1. Stefani M, Roberts DM. 1,4-Butanediol overdose mimicking toxic alcohol exposure. Clin Toxicol (Phila) 2020;58(3):204-7. doi: 10.1080/15563650.2019.1617419.
  2. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
  3. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
  4. Anon. Important message for health professionals: Report serious adverse events associated with dietary supplements containing GBL, GHB or BD. Food and Drug Administration, Rockville, MD. August 25, 1999. Available at: http://vm.cfsan.fda.gov/~dms/mwg
  5. Zvosec DL, Smith SW, McCutcheon JR, et al. Adverse events, including death, associated with the use of 1,4-butanediol. N Engl J Med. 2001;344:87-94..
  6. Thai, D., Dyer, J. E., Jacob, P., and Haller, C. A. Clinical pharmacology of 1,4-butanediol and gamma-hydroxybutyrate after oral 1,4-butanediol administration to healthy volunteers. Clin.Pharmacol Ther. 2007;81(2):178-184.
  7. Anon. Adverse events associated with ingestion of gamma-butyrolactone--Minnesota, New Mexico, and Texas, 1998-1999. MMWR Morb Mortal Wkly Rep 1999;48:137-40.
  8. Schneir AB, Ly BT, Clark RF. A case of withdrawal from the GHB precursors gamma-butyrolactone and 1,4-butanediol. J Emerg Med 2001;21:31-3..
Cardiac arrest Cardiovascular

Orally, 1,4-butanediol and its metabolite, gamma-hydroxybutyrate (GHB), can cause chest tightness, bradycardia, and cardiac arrest.

  1. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
  2. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
  3. Anon. Important message for health professionals: Report serious adverse events associated with dietary supplements containing GBL, GHB or BD. Food and Drug Administration, Rockville, MD. August 25, 1999. Available at: http://vm.cfsan.fda.gov/~dms/mwg
  4. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518.
  5. Zvosec DL, Smith SW, McCutcheon JR, et al. Adverse events, including death, associated with the use of 1,4-butanediol. N Engl J Med. 2001;344:87-94..
  6. Thai, D., Dyer, J. E., Jacob, P., and Haller, C. A. Clinical pharmacology of 1,4-butanediol and gamma-hydroxybutyrate after oral 1,4-butanediol administration to healthy volunteers. Clin.Pharmacol Ther. 2007;81(2):178-184.
  7. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39..
  8. Boscolo-Berto R, Viel G, Montagnese S, Raduazzo DI, Ferrara SD, Dauvilliers Y. Narcolepsy and effectiveness of gamma-hydroxybutyrate (GHB): a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2012 Oct;16(5):431-43.
Depression Pulmonary/Respiratory

Orally, 1,4-butanediol, especially in overdose, can cause breathing problems and respiratory depression that can require intubation.

  1. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
  2. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
  3. Anon. Important message for health professionals: Report serious adverse events associated with dietary supplements containing GBL, GHB or BD. Food and Drug Administration, Rockville, MD. August 25, 1999. Available at: http://vm.cfsan.fda.gov/~dms/mwg
  4. Zvosec DL, Smith SW, McCutcheon JR, et al. Adverse events, including death, associated with the use of 1,4-butanediol. N Engl J Med. 2001;344:87-94..
  5. Thai, D., Dyer, J. E., Jacob, P., and Haller, C. A. Clinical pharmacology of 1,4-butanediol and gamma-hydroxybutyrate after oral 1,4-butanediol administration to healthy volunteers. Clin.Pharmacol Ther. 2007;81(2):178-184.
Diarrhea Gastrointestinal

Orally, 1,4-butanediol can cause nausea and vomiting, diarrhea, and fecal incontinence.

  1. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
  2. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
  3. Anon. Important message for health professionals: Report serious adverse events associated with dietary supplements containing GBL, GHB or BD. Food and Drug Administration, Rockville, MD. August 25, 1999. Available at: http://vm.cfsan.fda.gov/~dms/mwg
  4. Zvosec DL, Smith SW, McCutcheon JR, et al. Adverse events, including death, associated with the use of 1,4-butanediol. N Engl J Med. 2001;344:87-94..
  5. Thai, D., Dyer, J. E., Jacob, P., and Haller, C. A. Clinical pharmacology of 1,4-butanediol and gamma-hydroxybutyrate after oral 1,4-butanediol administration to healthy volunteers. Clin.Pharmacol Ther. 2007;81(2):178-184.
DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Adverse-effects data: Natural Medicines, Therapeutic Research Center

Dosing

There is no established or recommended dose of 1,4-butanediol, because it is not a legitimate supplement or medicine. It should not be taken in any amount.

If you have encountered a product that contains or is suspected to contain 1,4-butanediol, do not use it. Speak with a pharmacist, doctor, or poison control center for guidance. In the U.S., you can reach Poison Control at 1-800-222-1222.

Pregnancy & Breastfeeding

1,4-butanediol & Pregnancy

Unsafe

When used orally.

  1. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
  2. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.

1,4-butanediol & Breastfeeding

Unsafe

When used orally.

  1. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
  2. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

© 2026 Therapeutic Research Center

Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center

References & further reading

The 20 references that drive our 1,4-butanediol monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
  2. Anon. Adverse events associated with ingestion of gamma-butyrolactone--Minnesota, New Mexico, and Texas, 1998-1999. MMWR Morb Mortal Wkly Rep 1999;48:137-40.
  3. Harrington RD, Woodward JA, Hooton TM, et al. Life-threatening interactions between HIV-1 protease inhibitors and the illicit drugs MDMA and gamma-hydroxybutyrate. Arch Intern Med 1999;159:2221-4.
  4. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
  5. Anon. Important message for health professionals: Report serious adverse events associated with dietary supplements containing GBL, GHB or BD. Food and Drug Administration, Rockville, MD. August 25, 1999. Available at: http://vm.cfsan.fda.gov/~dms/mwg
  6. Anon. Multistate outbreak of poisonings associated with illicit use of gamma hydroxy butyrate. JAMA 1991;265:447-8. DOI
  7. Carotenuto A, De Feo V, Fattorusso E, et al. The flavonoids of Allium ursinum. Phytochem 1996;41:531-6. PubMed
  8. Ferrara SD, Tedeschi L, Frison G, Rossi A. Fatality due to gamma-hydroxybutyric acid (GHB) and heroin intoxication. J Forensic Sci 1995;40:501-4. DOI
  9. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518. PubMed
  10. Schneir AB, Ly BT, Clark RF. A case of withdrawal from the GHB precursors gamma-butyrolactone and 1,4-butanediol. J Emerg Med 2001;21:31-3.. PubMed
  11. Zvosec DL, Smith SW, McCutcheon JR, et al. Adverse events, including death, associated with the use of 1,4-butanediol. N Engl J Med. 2001;344:87-94.. PubMed
  12. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39.. DOI
  13. Poldrugo, F., Barker, S., Basa, M., Mallardi, F., and Snead, O. C. Ethanol potentiates the toxic effects of 1,4-butanediol. Alcohol Clin.Exp.Res 1985;9(6):493-497. PubMed
  14. Thai, D., Dyer, J. E., Jacob, P., and Haller, C. A. Clinical pharmacology of 1,4-butanediol and gamma-hydroxybutyrate after oral 1,4-butanediol administration to healthy volunteers. Clin.Pharmacol Ther. 2007;81(2):178-184. PubMed
  15. Boscolo-Berto R, Viel G, Montagnese S, Raduazzo DI, Ferrara SD, Dauvilliers Y. Narcolepsy and effectiveness of gamma-hydroxybutyrate (GHB): a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2012 Oct;16(5):431-43. PubMed
Keep reading

This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Pharmacist Counseling Corner

1,4-butanediol: Common Questions

What is 1,4-butanediol used for, and does it work?
People use 1,4-butanediol for a range of reasons, but according to the Natural Medicines database the current clinical evidence is insufficient to confirm it works for the specific conditions it has been studied for. See the graded list on this page, and talk to your pharmacist or doctor before relying on it for any condition.
Does 1,4-butanediol interact with prescription medications?
Yes. We list 271 medications with a known interaction with 1,4-butanediol, including 250 rated major. Use the checker above to see how 1,4-butanediol interacts with a specific drug.
How are 1,4-butanediol interactions rated?
Each interaction is graded major, moderate, or minor based on how clinically significant it is and the strength of the evidence behind it. Major interactions are the most serious and are best avoided, or used only under close professional supervision.
Is it safe to take 1,4-butanediol with my medications?
It depends on the specific medication. Some combinations are fine, while others call for monitoring, timing changes, or should be avoided. Check your exact drug above and confirm with your pharmacist or doctor before starting, stopping, or changing anything.
Where does this 1,4-butanediol interaction information come from?
Our interaction data is built on the Natural Medicines database — an evidence-graded reference for vitamins, herbs, and supplements — and is reviewed by licensed HelloPharmacist pharmacists, who may add clinical context.
Is 1,4-butanediol a safe dietary supplement?
No. It is a toxic industrial chemical that the body turns into GHB, a powerful and dangerous nervous system depressant. It is not a safe or legal supplement and should never be taken.
Why is 1,4-butanediol so dangerous?
Once swallowed it converts into GHB, which can cause coma, stopped breathing, and death. The dose that causes mild effects is very close to the dose that can be fatal, and regular use can lead to addiction and severe withdrawal.
Can I use 1,4-butanediol for sleep or muscle building?
No. There is no reliable evidence it helps with sleep, muscle growth, or any health goal, and it carries a high risk of overdose and death. Talk to a pharmacist about safe, proven options instead.
What should I do if someone has taken 1,4-butanediol and seems very sleepy or unresponsive?
Treat it as a medical emergency. Call 911 (or your local emergency number) immediately, and do not leave the person alone, as their breathing can stop suddenly.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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