In The News

Dangers of 1,4-butanediol

June 2001; Volume 3; 48

GHB (gamma hydroxybutyrate, an ergogenic agent and recreational central nervous system depressant drug popular in the 1980s) was linked to 71 deaths and has been banned for sale since 1990. However, 1,4-butanediol, a GHB precursor, still is available over the counter. Promoted as an ergogenic agent or for treating depression or insomnia, 1,4-butanediol is both toxic and habit-forming. Toxic effects include vomiting, urinary and fecal incontinence, agitation, combativeness, a labile level of consciousness, respiratory depression, and death. A review of nine recent cases of 1,4-butanediol intoxication found that two died (doses ranged from 1-14 g in nonfatal cases and from 5.4 -20 g in fatal cases). Gamma-butyrolactone (another GHB precursor) supplements were voluntarily recalled in 1999; in a one-year period ending April 1999, the FDA received 119 reports of toxic effects associated with gamma-butyrolactone, including two deaths.

1,4-butanediol usually is listed on labels as tetramethylene glycol, butylene glycol, or sucol-B; dietary supplements containing 1,4-butanediol include Rejuv@Nite, Ultradiol, Enliven, N-force, Liquid Gold, Zen, Soma Solutions, Blue Raine, Thunder, Serenity, NRG3, Thunder Nectar, InnerG, SomatoPro, Weight Belt Cleaner, X-12, Rest-Q, Biocopia PM, Dormir, and Amino Flex. Both 1,4-butanediol and gamma-butyrolactone (often listed as furanone, furanone dihydro, lactone, or GBL) are also found in "natural" cleaners and solvents. Gamma-hydroxybutyrate-related compounds will not show up on routine toxicology tests; targeted analysis with gas chromatography-mass spectrometry is needed. v

Source: Zvosec DL, et al. Adverse events, including death, associated with the use of 1,4-butanediol. N Engl J Med 2001;344:87-94.