Herb & supplement monograph

Gamma-hydroxybutyrate (ghb) Drug Interactions, Uses, Effectiveness, Safety & More

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

First and foremost: how Gamma-hydroxybutyrate (ghb) interacts with medications. The heart of this page is the interaction list — every drug Gamma-hydroxybutyrate (ghb) is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what Gamma-hydroxybutyrate (ghb) 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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Gamma-hydroxybutyrate (ghb) Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Based on the available evidence, Gamma-hydroxybutyrate (ghb) drug interactions carry a high risk of being clinically significant for most people, and the danger with sedating medications is well documented. The great majority of listed interactions are rated major, and the most serious ones are backed by human evidence rather than theory alone.

Interactions deserving the most attention

The biggest concern is combining GHB with alcohol or other CNS depressants, which can cause dangerous levels of sedation and slowed breathing, along with low blood pressure and reduced oxygen levels. Divalproex sodium (Depakote) is also well documented to raise GHB levels in the body, strengthening its effects. A near-fatal reaction has been reported when GHB was taken with the HIV medicines ritonavir and saquinavir, likely because they slow the body's clearance of GHB, and there are concerns it may worsen seizure control in people on anticonvulsants.

What the rest of the list means

The long list of interacting medications largely reflects how many drugs have sedating effects, since each shares the same core risk of added CNS and breathing depression. A smaller number of moderate interactions rest on limited case reports or theory, so their real-world impact is less certain, but the central risk with sedating medicines is well established.

Check your medications against Gamma-hydroxybutyrate (ghb)

Based on HelloPharmacist’s Gamma-hydroxybutyrate (ghb) interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with Gamma-hydroxybutyrate (ghb)

275 medications have a known interaction with Gamma-hydroxybutyrate (ghb), graded by severity. Select any drug for the full evidence-based detail.

249 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 Gamma-hydroxybutyrate (ghb).

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 Gamma-hydroxybutyrate (ghb) 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 Gamma-hydroxybutyrate (ghb) affects

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

All 10 drug categories Gamma-hydroxybutyrate (ghb) interacts with
Alcohol (ethanol)Cns DepressantsDivalprox Sodium (depakote)AmphetaminesAnticonvulsantsNaloxone (narcan)Ritonavir (norvir)Saquinavir (fortovase, Invirase)Topiramate (topamax)Diclofenac (voltaren, Others)
Alcohol (Ethanol)

Concomitant use of alcohol and GHB can increase the risk of severe adverse effects.
Concomitant use of GHB with alcohol can increase the risk of serious CNS and respiratory depression, as well as gastrointestinal disturbances, hypotension, and decreased oxygen saturation. Ethanol may also inhibit the clearance of GHB.

Likelihood Likely Evidence A
Cns Depressants

GHB may increase the risk of serious CNS and respiratory depression.
Concomitant use of GHB with CNS depressants may increase the risk of serious CNS and respiratory depression.

Likelihood Probable Evidence D
Divalprox Sodium (Depakote)

Divalproex sodium can increase the levels and clinical effects of GHB.
Concomitant use of GHB with divalproex sodium may increase the plasma levels and clinical effects of GHB. Concomitant use of the prescription form of GHB (sodium oxybate) with valproic acid results in approximately 25% increased exposure to GHB. It is recommended that the dose of the prescription form of GHB (sodium oxybate) be decreased by at least 20% if divalproex sodium is initiated in patients already receiving GHB (sodium oxybate) and that a lower starting dosage of GHB (sodium oxybate) is used in patients who are already receiving divalproex sodium.

Likelihood Likely Evidence A
Amphetamines

Concomitant use of amphetamines and GHB can increase the risk of severe adverse effects.
Concomitant use of GHB with amphetamines has been associated with severe adverse effects. Theoretically, concomitant use of GHB with amphetamines may also antagonize the effects of GHB. Conversely, concomitant use of GHB with amphetamines is reported to mask the symptoms of amphetamine intoxication.

Likelihood Possible Evidence D
Anticonvulsants

Theoretically, GHB may reduce the effects of anticonvulsant medications.
GHB has been reported to cause seizures, and may theoretically reduce the effectiveness of anticonvulsants. Also, concomitant use of GHB with sedative anticonvulsants may increase the risk of serious CNS and respiratory depression.

Likelihood Possible Evidence D
Naloxone (Narcan)

Theoretically, naloxone may antagonize the effects of 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 ritonavir and GHB may increase the risk of serious adverse effects.
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 saquinavir and GHB may increase the risk of serious adverse effects.
Concomitant use 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)

Topiramate might increase the levels and clinical effects of GHB.
Concomitant use of GHB with topiramate might increase the blood levels and adverse effects of GHB. In one case report, a female regularly taking prescription GHB (sodium oxybate, Xyrem) 4.5 grams twice nightly for nocturnal headaches and insomnia experienced a worsening cluster headache requiring hospitalization after initiating treatment with topiramate 25 mg, 5 hours prior to the GHB dose. Symptoms included confusion, muscle jerking, miosis, and coma, with recovery within a few hours. 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
Diclofenac (Voltaren, Others)

Diclofenac might decrease the levels and clinical effects of GHB.
In an animal study, concomitant use of GHB with diclofenac reduces GHB plasma and brain concentrations, and the brain-to-plasma concentration ratio, when compared with administration of GHB alone. Concomitant administration also increased GHB-induced respiratory depression. These effects may have been due to inhibition of monocarboxylate transporters at the blood-brain barrier. However, one clinical study in healthy adults shows that concomitant use of the sodium salt of GHB, sodium oxybate, has no effect on GHB exposure or diclofenac pharmacokinetics.

Likelihood Unlikely Evidence A
Monograph

Gamma-hydroxybutyrate (ghb): Uses, Safety & Side Effects

Medically reviewed by · Reviewed July 2026 ·
The bottom line

GHB (gamma-hydroxybutyrate) is a powerful central nervous system depressant that is NOT a safe dietary supplement. In the U.S. it is a controlled substance, and only a tightly regulated prescription form (sodium oxybate) is legal for narcolepsy. Non-prescription GHB can cause coma, breathing failure, and death, and it is also a known 'date-rape' drug — it should not be taken outside of medical supervision.

Common forms
Liquid solution, powder, prescription oral solution (sodium oxybate)
People commonly use it for
  • Narcolepsy (cataplexy and excessive daytime sleepiness)
  • Sleep aid
  • Misused as a recreational 'party drug'
  • Bodybuilding/muscle building (unproven)
  • Alcohol withdrawal (in some countries)

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

Safety at a glance
OverallBest avoided

GHB is a controlled substance with a high risk of overdose, coma, and death; it is not a safe supplement.

PregnancyUnsafe

When used orally. GHB has been associated with life-threatening toxicities.

Read the full pregnancy detail
BreastfeedingUnsafe

When used orally. GHB has been associated with life-threatening toxicities.

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

Gamma-hydroxybutyrate (GHB) is a chemical that occurs naturally in the body in tiny amounts and acts on the brain and nervous system. It is not a plant or herb. Despite sometimes being sold or marketed as a 'supplement,' GHB is a powerful drug that slows down the central nervous system.

In the United States, GHB is a Schedule I controlled substance when sold illegally. A purified prescription version, called sodium oxybate, is approved and tightly regulated for treating narcolepsy. Products sold over the internet or at clubs as GHB or its 'precursors' (chemicals the body turns into GHB) are illegal and dangerous.

GHB has been misused recreationally for its sedative and euphoric effects and, tragically, as a 'date-rape' drug because it can be slipped into drinks and cause sedation and memory loss.

How it works

GHB acts on the brain in two main ways. It binds to its own GHB receptors and also affects GABA-B receptors, which are involved in calming and slowing down nerve activity. This is why GHB causes sedation, relaxation, and sleep.

Because it strongly depresses the central nervous system, even a slightly higher dose can dangerously slow breathing and heart rate, leading to deep unconsciousness or coma. The difference between a dose that causes effects and a dose that causes overdose is small and unpredictable, especially when mixed with alcohol or other sedatives.

Effectiveness

Does Gamma-hydroxybutyrate (ghb) work?

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

Evidence overview · 8 uses evaluated
1 Effective 1 Possibly effective 6 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.
Effective Narcolepsy
Rating & evidence shown verbatim from Natural Medicines

A specific prescription product containing the sodium salt of GHB, known as sodium oxybate (Xyrem, Jazz Pharmaceuticals), is FDA-approved for use in the treatment of cataplexy or excessive daytime sleepiness in patients with narcolepsy. It is unclear if GHB supplements are beneficial for this condition.

Possibly Effective Alcohol use disorder
Rating & evidence shown verbatim from Natural Medicines

Intravenous GHB seems to be beneficial in patients with alcohol use disorder. The benefits of oral GHB for this purpose are unclear.

Also studied for 6 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 GHB for depression, there is insufficient reliable information about the clinical effects of GHB for this purpose.

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

It is unclear if oral GHB is beneficial in patients with fibromyalgia.

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

Although there has been interest in using oral or intravenous GHB for intracranial hypertension, there is insufficient reliable information about the clinical effects of GHB 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 GHB for muscle strength, there is insufficient reliable information about the clinical effects of GHB for this purpose.

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

Although there has been interest in using oral GHB for weight loss in patients with obesity, there is insufficient reliable information about the clinical effects of GHB for this purpose.

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

It is unclear if oral GHB is beneficial in patients with opioid use disorder.

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

GHB is not safe to use as a supplement. It carries a high risk of accidental overdose, coma, seizures, and death. The amount in homemade or illicit products can vary widely, making safe dosing nearly impossible.

People who use GHB regularly can become physically dependent. Stopping suddenly can cause a severe, potentially life-threatening withdrawal that may include anxiety, tremors, rapid heartbeat, confusion, and seizures — sometimes requiring hospital care.

GHB should be completely avoided during pregnancy and breastfeeding, as it can reach and sedate the baby. It is especially dangerous for anyone who drinks alcohol, takes sedatives or sleep medicines, or has breathing problems. If you suspect a GHB overdose, call emergency services immediately.

Side effects

Common side effects include drowsiness, dizziness, nausea, vomiting, headache, confusion, and bed-wetting. GHB can also cause memory loss, which is part of why it has been misused as a 'date-rape' drug.

Serious and potentially deadly effects include slowed or stopped breathing, very low heart rate, seizures, deep coma, and death. Vomiting while unconscious can lead to choking. Combining GHB with alcohol or other depressants greatly increases these dangers.

Gamma-hydroxybutyrate (ghb): Reported Adverse Effects

Documented safety reports on Gamma-hydroxybutyrate (ghb) from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.

When used orally without medical supervision, GHB is generally regarded as unsafe for any use. A specific oral solution containing the sodium salt of GHB, known as sodium oxybate, seems to be safe when used appropriately under medical supervision.

Most Common Adverse Effects:

Orally: Agitation, confusion, dependence, diarrhea, dizziness, drowsiness, enuresis, hallucinations, headaches, nausea, numbing of the legs, rhinitis, somnolence, tremor, and vomiting.

Serious Adverse Effects (Rare):

Orally: Ataxia, bradycardia or tachycardia, chest tightness, depressed respiration, eosinophilia-myalgia syndrome, loss of peripheral vision, numbing of the legs, nystagmus, seizures, and sexual arousal.

Symptoms of acute toxicity or poisoning include agitation, cardiac arrest, coma, hypoxia, memory loss, pale skin, reduced or altered levels of consciousness, seizures, and slow or fast heart and respiratory rates.

Reports by condition
Anxiety Psychiatric

Orally, GHB can cause confusion, hallucinations, agitation, and amnesia. In people who are dependent on GHB, withdrawal can cause auditory and visual hallucinations, anxiety, delirium, panic, psychoses, and terror.

  1. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518.
  2. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39..
  3. Kuiper MA, Peikert N, Boerma EC. Gamma-hydroxybutyrate withdrawal syndrome: a case report. Cases J. 2009 Mar 25;2:6530.
  4. Leone MA, Vigna-Taglianti F, Avanzi G, Brambilla R, Faggiano F. Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses. Cochrane Database Syst Rev. 2010 Feb 17;(2):CD006266.
  5. Nimmerrichter AA, Walter H, Gutierrez-Lobos KE, Lesch OM. Double-blind controlled trial of gamma-hydroxybutyrate and clomethiazole in the treatment of alcohol withdrawal. Alcohol Alcohol. 2002 Jan-Feb;37(1):67-73.
  6. Stomberg MW, Knudsen K, Stomberg H, Skärsäter I. Symptoms and signs in interpreting gamma-hydroxybutyrate (GHB) intoxication - an explorative study. Scand J Trauma Resusc Emerg Med. 2014 Apr 23;22:27.
  7. Galloway GP, Frederick SL, Staggers FE Jr, et al. Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence. Addiction 1997;92:89-96.
  8. Price G. In-patient detoxification after GHB dependence. Br J Psychiatry 2000;177:181.
  9. Dyer J, Roth B, Hyma B. Gamma-Hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37:147-53..
  10. Wolf CJH, Beurmanjer H, Dijkstra BAG, et al. Characterization of the GHB Withdrawal Syndrome. J Clin Med 2021;10(11):2333.
  11. Siefried KJ, Freeman G, Roberts DM, et al. Inpatient GHB withdrawal management in an inner-city hospital in Sydney, Australia: a retrospective medical record review. Psychopharmacology (Berl) 2022.
Anxiety Neurologic/CNS

Orally, GHB can cause headache, hallucinations, dizziness, confusion, amnesia, drowsiness, somnolence, tremor, and agitation. It can also cause ataxia, eosinophilia-myalgia syndrome, memory loss, reduced or altered levels of consciousness, seizures, and coma. In pediatric patients, the sodium salt of GHB, known as sodium oxybate, can cause sleepwalking.

In people who are dependent on GHB, withdrawal can cause agitation, anxiety, diaphoresis, delirium with auditory and visual hallucinations, insomnia, panic, psychoses, terror, and tremor. Treatment of GHB withdrawal is largely supportive. A moderate-sized observational study in hospitalized adults admitted for GHB withdrawal suggests that early treatment with oral baclofen and diazepam might limit delirium and the rate of discharge against medical advice.

  1. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518.
  2. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39..
  3. Kuiper MA, Peikert N, Boerma EC. Gamma-hydroxybutyrate withdrawal syndrome: a case report. Cases J. 2009 Mar 25;2:6530.
  4. Leone MA, Vigna-Taglianti F, Avanzi G, Brambilla R, Faggiano F. Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses. Cochrane Database Syst Rev. 2010 Feb 17;(2):CD006266.
  5. Nimmerrichter AA, Walter H, Gutierrez-Lobos KE, Lesch OM. Double-blind controlled trial of gamma-hydroxybutyrate and clomethiazole in the treatment of alcohol withdrawal. Alcohol Alcohol. 2002 Jan-Feb;37(1):67-73.
  6. Stomberg MW, Knudsen K, Stomberg H, Skärsäter I. Symptoms and signs in interpreting gamma-hydroxybutyrate (GHB) intoxication - an explorative study. Scand J Trauma Resusc Emerg Med. 2014 Apr 23;22:27.
  7. Product information for Xyrem. Jazz Pharmaceuticals, Inc. Palo Alto, CA. March 2022.
  8. Aronsen AC, Brekke M, Vallersnes OM. Acute poisoning with gamma-hydroxybutyrate. Tidsskr Nor Laegeforen 2020;140(10).
  9. Lee S, Boyce SL, Southwell J. Case of gamma-hydroxybutyrate poisoning in an infant. J Paediatr Child Health 2022;58(5):909-910.
  10. Galloway GP, Frederick SL, Staggers FE Jr, et al. Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence. Addiction 1997;92:89-96.
  11. Price G. In-patient detoxification after GHB dependence. Br J Psychiatry 2000;177:181.
  12. Dyer J, Roth B, Hyma B. Gamma-Hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37:147-53..
  13. Wolf CJH, Beurmanjer H, Dijkstra BAG, et al. Characterization of the GHB Withdrawal Syndrome. J Clin Med 2021;10(11):2333.
  14. Siefried KJ, Freeman G, Roberts DM, et al. Inpatient GHB withdrawal management in an inner-city hospital in Sydney, Australia: a retrospective medical record review. Psychopharmacology (Berl) 2022.
Cardiac arrest Cardiovascular

Orally, GHB can cause chest tightness, bradycardia or tachycardia, and cardiac arrest. In people who are dependent on GHB, withdrawal can cause tachycardia and hypertension.

  1. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518.
  2. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39..
  3. 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.
  4. Aronsen AC, Brekke M, Vallersnes OM. Acute poisoning with gamma-hydroxybutyrate. Tidsskr Nor Laegeforen 2020;140(10).
  5. Lee S, Boyce SL, Southwell J. Case of gamma-hydroxybutyrate poisoning in an infant. J Paediatr Child Health 2022;58(5):909-910.
  6. Galloway GP, Frederick SL, Staggers FE Jr, et al. Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence. Addiction 1997;92:89-96.
  7. Price G. In-patient detoxification after GHB dependence. Br J Psychiatry 2000;177:181.
  8. Dyer J, Roth B, Hyma B. Gamma-Hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37:147-53..
  9. Kuiper MA, Peikert N, Boerma EC. Gamma-hydroxybutyrate withdrawal syndrome: a case report. Cases J. 2009 Mar 25;2:6530.
  10. Siefried KJ, Freeman G, Roberts DM, et al. Inpatient GHB withdrawal management in an inner-city hospital in Sydney, Australia: a retrospective medical record review. Psychopharmacology (Berl) 2022.
Diarrhea Gastrointestinal

Orally, GHB can cause nausea, vomiting, and diarrhea. In pediatric patients, the sodium salt of GHB, known as sodium oxybate, can cause decreased appetite.

  1. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518.
  2. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39..
  3. Abanades S, Farré M, Segura M, et al. Gamma-hydroxybutyrate (GHB) in humans: pharmacodynamics and pharmacokinetics. Ann N Y Acad Sci. 2006 Aug;1074:559-76.
  4. Nimmerrichter AA, Walter H, Gutierrez-Lobos KE, Lesch OM. Double-blind controlled trial of gamma-hydroxybutyrate and clomethiazole in the treatment of alcohol withdrawal. Alcohol Alcohol. 2002 Jan-Feb;37(1):67-73.
  5. Thai D, Dyer JE, Benowitz NL, Haller CA. Gamma-hydroxybutyrate and ethanol effects and interactions in humans. J Clin Psychopharmacol. 2006 Oct;26(5):524-9.
  6. Xu XM, Wei YD, Liu Y, Li ZX. Gamma-hydroxybutyrate (GHB) for narcolepsy in adults: an updated systematic review and meta-analysis. Sleep Med 2019;64:62-70. doi: 10.1016/j.sleep.2019.06.017.
  7. Product information for Xyrem. Jazz Pharmaceuticals, Inc. Palo Alto, CA. March 2022.
Muscle breakdown Musculoskeletal

Orally, GHB can cause numbing of the legs and eosinophilia-myalgia syndrome. In people who are dependent on GHB, withdrawal has been associated with rhabdomyolysis.

  1. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518.
  2. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39..
  3. Kuiper MA, Peikert N, Boerma EC. Gamma-hydroxybutyrate withdrawal syndrome: a case report. Cases J. 2009 Mar 25;2:6530.
Obesity Other

In pediatric patients, the sodium salt of GHB, known as sodium oxybate, can cause weight loss.

GHB and the chemically-related products gamma butyrolactone (GBL) and 1,4-butanediol (BD), which are rapidly converted to GHB in the body, have been associated with at least 122 reports of serious adverse reactions.

  1. Product information for Xyrem. Jazz Pharmaceuticals, Inc. Palo Alto, CA. March 2022.
  2. Otto A. Acquaintance rape drug may one day help instead of hurt (news). Pharmacy Today. American Pharmaceutical Association, Washington, DC. April 2000:17.
  3. FDA Talk Paper. FDA Warns About GBL-Related Products. 1999. Available at: vm.cfsan.fda.gov/~lrd/tpgbl2.html
  4. Ingels M, Rangan C, Bellezzo J, Clark R. Coma and respiratory depression following the ingestion of GHB and its precursors: Three cases. J Emerg Med 2000;19:47-50..
  5. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39..
  6. Kuiper MA, Peikert N, Boerma EC. Gamma-hydroxybutyrate withdrawal syndrome: a case report. Cases J. 2009 Mar 25;2:6530.
  7. Aronsen AC, Brekke M, Vallersnes OM. Acute poisoning with gamma-hydroxybutyrate. Tidsskr Nor Laegeforen 2020;140(10).
  8. Abid M, Kietzerow J, Iwersen-Bergmann S, Schnitgerhans T, Andresen-Streichert H. Characteristics and dose-effect relationship of clinical gamma-hydroxybutyrate intoxication: A case series. J Forensic Sci 2022;67(1):416-427.
Sexual arousal Genitourinary

Orally, GHB can cause sexual arousal. It can also cause enuresis.

  1. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518.
  2. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39..
  3. Xu XM, Wei YD, Liu Y, Li ZX. Gamma-hydroxybutyrate (GHB) for narcolepsy in adults: an updated systematic review and meta-analysis. Sleep Med 2019;64:62-70. doi: 10.1016/j.sleep.2019.06.017.
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 safe over-the-counter or supplement dose of GHB. Because illicit products are not standardized, there is no reliable way to measure a safe amount, and small differences can cause overdose.

The only legitimate use is the prescription medication sodium oxybate, which is dosed and monitored by a doctor through a special safety program. Do not attempt to use GHB on your own. If you have narcolepsy or another condition, talk with your doctor or pharmacist about approved, monitored treatments.

Pregnancy & Breastfeeding

Gamma-hydroxybutyrate (ghb) & Pregnancy

Unsafe

When used orally. GHB has been associated with life-threatening toxicities.

  1. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
  2. 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
  3. Otto A. Acquaintance rape drug may one day help instead of hurt (news). Pharmacy Today. American Pharmaceutical Association, Washington, DC. April 2000:17.
  4. Dyer JE. Gamma-Hydroxybutyrate: a health-food product producing coma and seizure-like activity (abstract). Am J Emerg Med 1991;9:321-4.
  5. FDA Talk Paper. FDA Warns About GBL-Related Products. 1999. Available at: vm.cfsan.fda.gov/~lrd/tpgbl2.html
  6. Product information for Xyrem. Jazz Pharmaceuticals, Inc. Palo Alto, CA. March 2022.

Gamma-hydroxybutyrate (ghb) & Breastfeeding

Unsafe

When used orally. GHB has been associated with life-threatening toxicities.

  1. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
  2. 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
  3. Otto A. Acquaintance rape drug may one day help instead of hurt (news). Pharmacy Today. American Pharmaceutical Association, Washington, DC. April 2000:17.
  4. Dyer JE. Gamma-Hydroxybutyrate: a health-food product producing coma and seizure-like activity (abstract). Am J Emerg Med 1991;9:321-4.
  5. FDA Talk Paper. FDA Warns About GBL-Related Products. 1999. Available at: vm.cfsan.fda.gov/~lrd/tpgbl2.html
  6. Product information for Xyrem. Jazz Pharmaceuticals, Inc. Palo Alto, CA. March 2022.
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 31 references that drive our Gamma-hydroxybutyrate (ghb) 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. 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.
  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. Otto A. Acquaintance rape drug may one day help instead of hurt (news). Pharmacy Today. American Pharmaceutical Association, Washington, DC. April 2000:17.
  5. Anon. Multistate outbreak of poisonings associated with illicit use of gamma hydroxy butyrate. JAMA 1991;265:447-8. DOI
  6. Dyer JE. Gamma-Hydroxybutyrate: a health-food product producing coma and seizure-like activity (abstract). Am J Emerg Med 1991;9:321-4.
  7. FDA Talk Paper. FDA Warns About GBL-Related Products. 1999. Available at: vm.cfsan.fda.gov/~lrd/tpgbl2.html
  8. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518. PubMed
  9. Galloway GP, Frederick SL, Staggers FE Jr, et al. Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence. Addiction 1997;92:89-96. DOI
  10. Price G. In-patient detoxification after GHB dependence. Br J Psychiatry 2000;177:181. PubMed
  11. Dyer J, Roth B, Hyma B. Gamma-Hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37:147-53.. PubMed
  12. Ingels M, Rangan C, Bellezzo J, Clark R. Coma and respiratory depression following the ingestion of GHB and its precursors: Three cases. J Emerg Med 2000;19:47-50.. PubMed
  13. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39.. DOI
  14. Abanades S, Farré M, Segura M, et al. Gamma-hydroxybutyrate (GHB) in humans: pharmacodynamics and pharmacokinetics. Ann N Y Acad Sci. 2006 Aug;1074:559-76. 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

Gamma-hydroxybutyrate (ghb): Common Questions

What is Gamma-hydroxybutyrate (ghb) used for, and does it work?
People use Gamma-hydroxybutyrate (ghb) for many reasons, but the evidence varies by use. According to the Natural Medicines database, there is at least some clinical evidence supporting Gamma-hydroxybutyrate (ghb) for Narcolepsy and Alcohol use disorder. For most other uses it has been studied for, the evidence is currently insufficient to rate. See the graded list on this page, and always confirm with your pharmacist or doctor.
Does Gamma-hydroxybutyrate (ghb) interact with prescription medications?
Yes. We list 275 medications with a known interaction with Gamma-hydroxybutyrate (ghb), including 249 rated major. Use the checker above to see how Gamma-hydroxybutyrate (ghb) interacts with a specific drug.
How are Gamma-hydroxybutyrate (ghb) 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 Gamma-hydroxybutyrate (ghb) 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 Gamma-hydroxybutyrate (ghb) 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 GHB a safe dietary supplement?
No. GHB is a powerful nervous-system depressant and a controlled substance, not a safe supplement. Non-prescription GHB can cause coma, breathing failure, and death.
Is GHB legal?
In the United States, illegally sold GHB is a Schedule I controlled substance. Only a tightly regulated prescription form (sodium oxybate) is legal, and it is used for narcolepsy under a special safety program.
Why is GHB called a 'date-rape' drug?
GHB is odorless and nearly tasteless, so it can be secretly added to drinks. It causes strong sedation and memory loss, which is why it has been criminally misused. If you suspect you were drugged, seek emergency help right away.
Can you become addicted to GHB?
Yes. Regular use can lead to physical dependence, and stopping suddenly can cause a dangerous withdrawal that may include seizures and may require hospital treatment.

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

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