Butalbital/acetaminophen explained

Type:combo
Component1:Butalbital
Class1:Barbiturate
Component2:Acetaminophen
Class2:Miscellaneous analgesic
Tradename:Allzital, Butapap, Tencon, others
Dailymedid:Butalbital and acetaminophen
Routes Of Administration:By mouth
Atc Prefix:N02
Atc Suffix:BE71
Legal Us:Rx-only
Cas Number:624746-94-7
Chemspiderid:none
Kegg:D11561
Drug Name:Butalbital/acetaminophen/caffeine
Type:combo
Component1:Butalbital
Class1:Barbiturate
Component2:Acetaminophen
Class2:Miscellaneous analgesic
Component3:Caffeine
Class3:Xanthine
Tradename:Anoquan, Fioricet, Triad, others
Dailymedid:Butalbital, acetaminophen, and caffeine
Routes Of Administration:By mouth
Atc Prefix:None
Legal Us:Rx-only
Cas Number:122018-95-5
Chemspiderid:none
Kegg:D11850

Butalbital/acetaminophen, sold under the brand name Butapap among others, is a combination medication used to treat tension headaches and migraine headaches.[1] It contains butalbital, a barbiturate and paracetamol (acetaminophen), an analgesic. Versions also containing caffeine are sold under the brand name Fioricet among others. It is taken by mouth.[2] [3] The combination is also sold with codeine.[4]

The most common side effects include sleepiness, dizziness, trouble breathing, and abdominal pain.[2] Other severe side effects may include liver problems, confusion, addiction, and allergic reactions.[2] Frequent use may result in medication overuse headache.[5] Barbiturate withdrawal may occur if rapidly stopped following long term use.[6] Use is not generally recommended during pregnancy or breastfeeding.[7]

The combination was approved for medical use in the United States in 1984.[2] It is available as a generic medication.[8] In the United States it is a schedule III controlled substance[9] in some states but not federally.[10] [11] [12] It is banned in a number of European countries.[6]

In 2022, the combination butalbital/acetaminophen/caffeine was the 248th most commonly prescribed medication in the United States, with more than 1million prescriptions.[13] [14]

Medical uses

Butalbital/acetaminophen is indicated for the treatment of tension headaches.[15]

Butalbital/acetaminophen/caffeine is indicated for the treatment of tension headaches.

Side effects

Prolonged use can cause rebound headaches.[16]

Rarely, use of barbiturates can lead to Stevens–Johnson syndrome.[17]

Mechanism of action

Butalbital has a half-life of about 35 hours. Acetaminophen has a half-life of about 1.25 to 3 hours, but may be increased by liver damage and after an overdose. Caffeine has a half-life of about 2.5 to 4.5 hours.[18]

Notes and References

  1. Web site: Butapap- butalbital and acetaminophen tablet . DailyMed . U.S. National Library of Medicine . 17 January 2020 . 10 April 2020.
  2. Web site: Butalbital and Acetaminophen - FDA prescribing information, side effects and uses . Drugs.com . 18 April 2019 .
  3. Web site: Fioricet- butalbital, acetaminophen, and caffeine capsule . DailyMed . U.S. National Library of Medicine . 27 January 2020 . 10 April 2020.
  4. Web site: Fioricet with Codeine- butalbital, acetaminophen, caffeine, and codeine phosphate capsule . DailyMed . U.S. National Library of Medicine . 7 February 2020 . 10 April 2020.
  5. Book: Mallick-Searle T . Headaches . Woo TM, Robinson MV . Pharmacotherapeutics for Advanced Practice Nurse Prescribers . 2015 . F.A. Davis . 978-0-8036-4581-3 . 1057 . https://books.google.com/books?id=2Q5hCgAAQBAJ&pg=PA1057 .
  6. Young WB, Siow HC . Should butalbital-containing analgesics be banned? Yes . Current Pain and Headache Reports . 6 . 2 . 151–155 . April 2002 . 11872187 . 10.1007/s11916-002-0012-y . 20095800 .
  7. Web site: Acetaminophen / butalbital Use During Pregnancy . Drugs.com . 18 April 2019 .
  8. Book: Hamilton, Richard J . Pharmacopoeia . 2009 . Jones & Bartlett Learning . 978-0-7637-7419-6 . 3 .
  9. Web site: Allzital- butalbital and acetaminophen tablet . DailyMed . U.S. National Library of Medicine . 17 December 2019 . 18 April 2020.
  10. Web site: Fioricet Capsules (acetaminophen/butalbital/caffeine) . Prescribers' Digital Reference . 18 April 2019 .
  11. Web site: Substances Containing Butalbital Have Long Been Schedule III; What About Fioricet and Fiorinal? . September 2014 . West Virginia Board of Pharmacy . 8 June 2019.
  12. Web site: Butalbital . Drugs Details . 18 April 2020.
  13. Web site: The Top 300 of 2022 . ClinCalc . 30 August 2024 . 30 August 2024 . https://web.archive.org/web/20240830202410/https://clincalc.com/DrugStats/Top300Drugs.aspx . live .
  14. Web site: Acetaminophen; Butalbital; Caffeine Drug Usage Statistics, United States, 2013 - 2022 . ClinCalc . 30 August 2024 .
  15. Web site: Tencon- butalbital and acetaminophen tablet . DailyMed . U.S. National Library of Medicine . 18 February 2020 . 20 May 2022.
  16. Web site: Jaret . Peter . A Hidden Cause of Headache Pain . . 29 August 2007 . https://web.archive.org/web/20160325172359/http://www.nytimes.com/ref/health/healthguide/esn-headache-ess.html?em&ex=1193198400&en=dfc3130eb5b5dd12&ei=5087%0A . 25 March 2016 . unfit . 4 March 2024.
  17. Mamishi S, Fattahi F, Pourpak Z, Aghaee FM, Moinfar Z, Mohammadi M, Ashrafi M, Moin M . Severe cutaneous reactions caused by barbiturates in seven Iranian children . International Journal of Dermatology . 48 . 11 . 1254–1261 . November 2009 . 20064188 . 10.1111/j.1365-4632.2007.03561.x . 10117062 . free .
  18. Caffeine . Examine.com Inc . 7 October 2019 . Willis B, Lopez G, Patel K, Frank K .

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