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Management of Phenibut Use Disorder and Withdrawal in a Geriatric Patient

  • Ethan Wainblat
    Affiliations
    St. Rita's Medical Center (EW), Lima, OH
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  • Jeremy Weleff
    Affiliations
    Department of Psychiatry (JW), Yale University School of Medicine, New Haven, CT

    Department of Psychiatry and Psychology (JW, AA), Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH
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  • Akhil Anand
    Correspondence
    Send correspondence and reprint requests to Akhil Anand M.D., 1730 West 25th Street/2A, Cleveland, OH 44113.
    Affiliations
    Department of Psychiatry and Psychology (JW, AA), Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH

    Cleveland Clinic Lerner College of Medicine at Case Western Reserve University (AA), EC-=10 Cleveland Clinic, Cleveland, OH
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Published:September 23, 2022DOI:https://doi.org/10.1016/j.jagp.2022.09.008

      Highlights

      • What is the primary question addressed by this study?
      • This case details how to identify, manage and treat phenibut withdrawals and dependence in older-age adults.
      • What is the main finding of this study?
      • Phenibut is an easily obtainable CNS depressant that can result in serious adverse events such as developing tolerance, withdrawals, addiction, anxiety, psychosis, coma, and even death have been reported with its use. Elderly patients with pre-existing substance use disorders may be particularly at risk of phenibut dependence and adverse events.
      • What is the meaning of the finding?
      • Geriatric psychiatrists and geriatricians should be prepared to ask and educate their patients about phenibut use and its risks.

      ABSTRACT

      Phenibut is a misused substance which has shown an increase in use over the past decade. Marketed as a “dietary supplement,” it is not approved in the United States for use and is not regulated by the Food and Drug Administration. The substance, however, is readily available for purchase through online markets. It has a similar drug profile as alcohol, gabapentin and benzodiazepines. Clinical effects of this drug include physiologic dependence, euphoria, anxiolysis, antispasticity, sedation, and possible nootropic properties.
      While there are emerging new cases of managing phenibut withdrawal, no cases currently feature phenibut addiction and withdrawal management in the geriatric population. Here we discuss such a case of phenibut addiction and withdrawal in a 68-year-old male who initially began misusing phenibut to alleviate anxiety and insomnia precipitated by worsening affective disorder, sedative, hypnotic, or anxiolytic use disorder, and alcohol use disorder.

      Key Words

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