1,4-Butanediol

Butanediol/Drug Interactions:

  • AlcoholAlcohol: Based on animal study, 1,4-butanediol is metabolized by alcoholdehydrogenase. Ingesting 1,4-butanediol concurrently with ethanolmay potentiate the effects of ethanol (17) and increase the risk of CNS and respiratory depression and renal and hepatic damage (18).
  • Analgesics, narcoticAnalgesics, narcotic: Concurrent use of narcotic analgesics and butanediol may cause additive CNS depressant effects. Based on animal study, GHB further decreased morphine's effects on threat and attack behavior without impairing motor activity and, in addition, increased time spent in social contact (19). Furthermore, GHB was found to counteract hyperactivity induced by morphine.
  • AnestheticsAnesthetics: According anecdotal information, GHB (an active metabolite of butanediol) was initially developed as an anesthetic. Theoretically, concurrent use of butanediol and anesthetics may have additive effects.
  • Anticonvulsant agentsAnticonvulsant agents: Based on in vitro study, systemic injection of GHB may elicit spike and wave discharges (SWDs), which are the EEG hallmark of absence seizures (20). In animal study, GHB has been shown to produce weak myoclonic seizures accompanied by electrocortical synchrony and spikes (21). Theoretically, butanediol may antagonize the effects of anticonvulsant agents.
  • Antipsychotic agentsAntipsychotic agents: According to case reports, ingestion of supplements containing butanediol may induce aggression, agitation, flailing episodes, treatment-resistant psychoses, hallucinations, agitation, anxiety, delusions, and combativeness (11). Theoretically, antipsychotic agents may potentiate the effects of GHB.
  • Antiretroviral agents, protease inhibitorsAntiretroviral agents, protease inhibitors: Concomitant use of the protease inhibitors, including ritonavir and saquinavir, with small amounts of GHB reportedly caused a near-fatal reaction, possibly due to inhibition of GHB metabolism (22).
  • BenzodiazepinesBenzodiazepines: Based on animal study and human case reports, GHB (an active metabolite of butanediol) and supplements containing butanediol may exhibit antianxiety effects (23; 11). Theoretically, concurrent use of GHB and antianxiety agents may cause additive effects.
  • CNS depressantsCNS depressants: Based on human case reports, GHB may cause severe sedation (24). Theoretically, concurrent use of butanediol and CNS depressants may cause additive sedation.
  • CNS stimulantsCNS stimulants: Anecdotal reports indicate that when depressants (e.g., GHB) are taken in combination with stimulants, the perceived side effects of taking stimulants can be muted by the depressant. Based on animal study, GHB (500mg/kg) reduced the hyperthermia and hyperactivity produced by coadministered doses of methamphetamine (1mg/kg) (25). According to secondary information, there is an increased risk of seizures when GHB is combined with methamphetamines.
  • Opiate antagonistsOpiate antagonists: Naltrexone reduced the craving for GHB in human case reports (26). The combination of GHB and naltrexone in human study was more effective than either drug given alone, suggesting the different actions of these drugs work synergistically and without suppressing favorable effects (27).
  • Skeletal muscle relaxantsSkeletal muscle relaxants: Theoretically, concurrent use of butanediol with skeletal muscle relaxants may result in severe adverse effects.

    • Butanediol/Herb/Supplement Interactions:

  • AlcoholAlcohol: Based on animal study, 1,4-butanediol is metabolized by alcoholdehydrogenase. Ingesting 1,4-butanediol concurrently with ethanolmay potentiate the effects of ethanol (17) and increase the risk of CNS and respiratory depression and renal and hepatic damage (18).
  • AnestheticsAnesthetics: According anecdotal information, GHB (an active metabolite of butanediol) was initially developed as an anesthetic. Theoretically, concurrent use of butanediol and anesthetics may have additive effects.
  • AnticonvulsantsAnticonvulsants: Based on in vitro study, systemic injection of GHB may elicit spike and wave discharges (SWDs), which are the EEG hallmark of absence seizures (20). In animal study, GHB has been shown to produce weak myoclonic seizures accompanied by electrocortical synchrony and spikes (21).
  • AntipsychoticsAntipsychotics: According to case reports, ingestion of supplements containing butanediol may induce aggression, agitation, flailing episodes, treatment-resistant psychoses, hallucinations, agitation, anxiety, delusions, and combativeness (11). Theoretically, antipsychotic agents may potentiate the effects of GHB.
  • AnxiolyticsAnxiolytics: Based on animal study and human case reports, GHB (an active metabolite of butanediol) and supplements containing butanediol may exhibit antianxiety effects (23; 11). Theoretically, concurrent use of GHB and antianxiety agents may cause additive effects.
  • SedativesSedatives: Based on human case reports, GHB may cause severe sedation (24). Theoretically, concurrent use of butanediol and CNS depressants may cause additive sedation.
  • StimulantsStimulants: Anecdotal reports indicate that when depressants (e.g., GHB) are taken in combination with stimulants, the perceived side effects of taking stimulants can be muted by the depressant. Based on animal study, GHB (500mg/kg) reduced the hyperthermia and hyperactivity produced by coadministered doses of methamphetamine (1mg/kg) (25). According to secondary information, there is an increased risk of seizures when GHB is combined with methamphetamines.

    • Butanediol/Food Interactions:

  • Insufficient available evidence.

    • Butanediol/Lab Interactions:

  • Blood pressureBlood pressure: In human study, transient increases in mean systolic and diastolic blood pressure were observed (1; 11).
  • Butanediol/GHB levelsButanediol/GHB levels: 1,4-Butanediol is rapidly converted to gamma-hydroxybutyrate (GHB) in the body (28), and therefore may not be identified.
  • Heart rateHeart rate: In human study, transient increases in heart rate were observed (1; 11)
  • Pulse oximetryPulse oximetry: Pulse oximetry readings have been shown to be lower 45 minutes after butanediol dosing, with a mean oxygen saturation of 98.5% with butanediol versus 99.6% with placebo (p=0.031); vital signs remained unchanged (1).