GHB salt (CNS depressant)
Sodium oxybate
Brand names: Xyrem
Adult dose
Dose: 2.25g PO at bedtime + 2.25g 2.5–4h later; titrate weekly to 3–4.5g per dose (max 9g/night)
Route: PO
Frequency: BD (nocturnal)
Clinical pearls
- Narcolepsy with cataplexy
- Highly controlled (CD2); risk-management programme; lower-sodium alternatives available
Contraindications
- Major depressive disorder
- Concurrent sedative-hypnotics or alcohol
- Succinic semialdehyde dehydrogenase deficiency
- Severe hepatic impairment
Side effects
- Respiratory depression
- Sleepwalking
- Confusion
- Seizures
- Dependence
- Hyponatraemia (high sodium load)
- Mood changes
Interactions
- CNS depressants
- Alcohol (avoid)
- Opioids
- Topiramate
Monitoring
- Mood
- Symptoms
- Sodium intake
Reference: BNF; NICE; SmPC; https://bnf.nice.org.uk/drugs/sodium-oxybate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Pathways
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS