Phenibut, sold under the brand names Anvifen, Fenibut, and Noofen among others, is a central nervous system depressant with anxiolytic effects, and is used to treat anxiety, insomnia, and for a variety of other indications. It is usually taken by mouth as a tablet, but may be given intravenously. Side effects of phenibut include sedation, sleepiness, nausea, irritability, agitation, dizziness, and 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 also 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. 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