Phenibut, sold under the brand name Anvifen among others, is a central nervous system (CNS) depressant with anxiolytic effects, and is used to treat anxiety, insomnia, and for a variety of other indications. It is usually taken orally (swallowed by mouth), but may be given intravenously. Side effects of phenibut can include sedation, sleepiness, nausea, irritability, agitation, dizziness, euphoria, and sometimes headache, among others. Overdose of phenibut can produce marked central nervous system depression including unconsciousness. The medication is structurally related to the neurotransmitter γ-aminobutyric acid (GABA), and hence is a GABA analogue. Phenibut is thought to act as a GABAB receptor agonist, similarly to baclofen and γ-hydroxybutyrate (GHB). However, at low concentrations, phenibut mildly increases the concentration of dopamine in the brain, providing stimulatory effects in addition to the anxiolysis. Phenibut was developed in the Soviet Union and was introduced for medical use in the 1960s. Today, it is marketed for medical use in Russia, Ukraine, Belarus, Kazakhstan, and Latvia. The medication is not approved for clinical use in the United States and most of Europe, but it is sold on the Internet as a supplement and purported nootropic. Phenibut has been used recreationally and can produce euphoria as well as addiction, dependence, and withdrawal. It is a controlled substance in Australia, and it has been suggested that its legal status should be reconsidered in Europe as well. In Germany, phenibut is not approved as a drug and, as a food supplement, is controlled under the German New Psychoactive Substances Act. In a 2023 assessment, the U.S. Food and Drug Administration (FDA) determined that phenibut does not meet the definition of a dietary ingredient, thereby making phenibut supplement products misbranded and illegal for marketing. FDA warning letters had been issued to supplement manufacturers marketing phenibut products as adulterated.
Medical uses Phenibut is used in Russia, Ukraine, Belarus and Latvia as a pharmaceutical drug to treat anxiety and to improve sleep (e.g., in the treatment of insomnia). It is also used for various other indications, including the treatment of asthenia, depression, alcoholism, alcohol withdrawal syndrome, post-traumatic stress disorder, stuttering, tics, vestibular disorders, Ménière's disease, dizziness, for the prevention of motion sickness, and for the prevention of anxiety before or after surgical procedures or painful diagnostic tests.
Available forms Phenibut is available as a medication in the form of 250 mg or 500 mg tablets for oral administration and as a solution at a concentration of 10 mg/mL for infusion. In the US, dietary supplements labeled as containing phenibut have been found to contain zero to greater than 1,100 mg of phenibut per serving.
Contraindications Contraindications of phenibut include:
Intolerance to phenibut Pregnancy and breastfeeding Children who are younger than two years of age Liver insufficiency or failure Ulcerative lesions of the gastrointestinal tract Phenibut should not be combined with alcohol.
Side effects Phenibut is generally well-tolerated. Possible side effects may include sedation, somnolence, nausea, irritability, agitation, anxiety, dizziness, headache, and allergic reactions such as skin rash and itching. At high doses, motor incoordination, loss of balance, and hangovers may occur. Due to its CNS depressant effects, people taking phenibut should refrain from potentially dangerous activities such as operating heavy machinery. With prolonged use of phenibut, particularly at high doses, the liver and blood should be monitored, due to risk of fatty liver disease and eosinophilia.
Dependence and withdrawal Tolerance to phenibut easily develops with repeated use, leading to dependence. Withdrawal symptoms may occur upon discontinuation, and, in recreational users taking high doses, have been reported to include severe rebound anxiety, insomnia, aggression, irritability, agitation, visual and auditory hallucinations, seizures and acute psychosis. Baclofen has successfully been used for treatment of phenibut dependence.
Overdose In overdose, phenibut can cause severe drowsiness, nausea, vomiting, eosinophilia, lowered blood pressure, renal impairment, and, above 7 grams, fatty liver degeneration. There are no specific antidotes for phenibut overdose. Lethargy, somnolence, agitation, delirium, tonic–clonic seizures, reduced consciousness or unconsciousness, and unresponsiveness have been reported in recreational users who have overdosed. Management of phenibut overdose includes activated charcoal, gastric lavage, induction of vomiting, and symptom-based treatment. There have been three associated deaths which found Phenibut in the users system but only one of these cases solely included Phenibut.
Interactions Phenibut may mutually potentiate and extend the duration of the effects of other CNS depressants, including anxiolytics, antipsychotics, sedatives, opioids, anticonvulsants, and alcohol.
Pharmacology
Pharmacodynamics
Phenibut acts as a full agonist of the GABAB receptor, similarly to baclofen. It has between 30- and 68-fold lower affinity for the GABAB receptor than baclofen, and, in accordance, is used at far higher doses in comparison. (R)-Phenibut has more than 100-fold higher affinity for the GABAB receptor than does (S)-phenibut; hence, (R)-phenibut is the active enantiomer at the GABAB receptor.
Phenibut also binds to and blocks α2δ subunit-containing VDCCs, similarly to gabapentin and pregabalin, and hence is a gabapentinoid. Both (R)-phenibut and (S)-phenibut display this action with similar affinity (Ki = 23 and 39 μM, respectively). It is often claimed on websites about nootropics and elsewhere on the internet that phenibut increases dopamine. Three papers published in Russian by Soviet scientists in 1979, 1986, and 1990 report that phenibut increases dopamine in the striatum of rats and in the mouse brain. The mechanism underlying this putative effect is unclear. Structurally, phenibut can also be considered a derivative of phenethylamine, and some research suggests that phenibut antagonizes the action of phenethylamine.
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