GHB is a natural product, newly available as a prescription drug. Approved by the FDA as a treatment for certain symptoms of narcolepsy, two double blind controlled studies suggest that GHB also has substantial benefits for fibromyalgia. If these two studies are on target, GHB may be one of the most effective medicines for fibromyalgia. GHB may also help improve quality of sleep.

However, GHB has a substantial potential for serious side effects, if not used correctly. Used correctly, there is still substantial potential for side effects, but, I believe that the benefit/risk ratio should be favorable--for well-selected individuals.

GHB tends to suppress the rate of respiration. At too high a dose GHB can stop breathing and cause death. At normal doses this should not normally be a problem. . However, persons with emphysema, other chronic lung conditions, liver impairment, or decreased kidney function are more susceptible to the respiratory depressant effects. These people should usually not use GHB. Similarly, persons who drink alcohol or who take respiratory depressant medicines are more vulnerable e.g. Valium, Klonopin, Xanax, phenobarbital. Don’t mix GHB with any alcohol at all, or with any medicines that depress breathing.

People with untreated sleep apnea - prolonged pauses in respiration during sleep - should not take GHB, since GHB might prolong the duration of breath-holding episodes. Sleep apnea patients who are well controlled on CPAP, can take GHB, so long as they use their CPAP. Observation for sleep apnea at home, or an overnight sleep test to rule out sleep apnea should most often be done.

GHB has been criminally abused as the “date rape” drug. Spiked into a drink, the victim falls asleep and does not know what happens. Therefore, the Food and Drug Administration has developed a program to allow medical use while closely controlling use to avoid abuse. GHB is also a potentially addictive, but this risk is small when it’s taken as directed.

GHB is available by mail from only one single pharmacy. That pharmacy assures that each patient understand how to use the drug properly. Any person who gives their GHB to anyone else for any reason is subject to criminal prosecution.

Other side effects: Among persons with narcolepsy about 7% of persons taking GHB experience confusion. However, fewer than 1% discontinued taking the drug for this reason. Six percent experienced depression; one percent discontinued treatment because of depression. Persons with a history of depression should be monitored closely for these symptoms. About 9% of narcoleptics taking GHB experienced one or more episodes of urinary incontinence, and a very few experienced fecal incontinence. Less than 1% of patients discontinued treatment because of incontinence. Seven percent of narcoleptics on GHB experienced sleep walking. A daily dose of GHB can contain up to 1.6 grams of sodium.

GHB is expensive, costing more the $450 a month at full doses. If your primary diagnosis is fibromyalgia, insomnia, or anything but narcolepsy, your insurance company might easily not pay for it. However, the pharmaceutical company, Orphan Medical is reported to be excellent at helping patients work with their insurance companies. (The brand name for prescription GHB is Xyrem).