PHENIBUT
GABA(B) agonist developed in Russia as an anxiolytic and nootropic; unregulated supplement with high dependence and withdrawal risk.
Multiple systematic reviews have documented phenibut toxicity and withdrawal from case reports and case series, with no controlled clinical trials available. Across 62 identified cases, 80.7% were male with a mean age of 30.9 years, and 63.2% involved concomitant substance use. Intoxication cases required intubation in 48.7% of cases, and withdrawal cases frequently required multiple medications including benzodiazepines, baclofen, and barbiturates. Evidence is limited to case reports subject to publication bias, and no standardized treatment protocols exist. Doses reported in the literature range from 1.5 g/day to 200 g/day, reflecting unregulated use patterns rather than established therapeutic dosing.