Sodium Oxybate for Narcolepsy: Explaining Untoward Effects and Recommending New Approaches in Light of Prevailing Receptor Pharmacology.

Gamma-hydroxybutyrate (GHB) has been an abused and illicit substance for decades, but the antinarcoleptic medication Xyrem (sodium oxybate), the sodium salt of GHB, was approved just in 2002 for increasing wakefulness. We present a case of coma induced by co-ingestion of prescription GHB and ethanol and describe the response to naloxone treatment, by first responders, without evidence of opiate exposure. The purpose of this report is to bridge updated knowledge on GHB and ethanol pharmacology with the clinical sequence of events in a patient co-ingesting these compounds and to theorize on a potentially better pharmacological approach to narcolepsy.

A Tale of Unequal Substitution: Minocycline and Acute Autoimmune Hepatitis.

In this case report, we describe the development of an acute autoimmune hepatitis associated with a short course of minocycline prescribed for a skin infection. Due to a drug shortage, minocycline was substituted for doxycycline. It is imperative that practitioners be aware of the different risks that accompany switching between drugs in the tetracycline class, particularly the risk of autoimmune conditions including hepatitis.