Butalbital/acetaminophen

Butalbital/acetaminophen

Combination of
Butalbital	Barbiturate
Acetaminophen	Miscellaneous analgesic
Clinical data
Trade names	Allzital, Butapap, Tencon, others
AHFS/Drugs.com	Professional Drug Facts
License data	US DailyMed: Butalbital and acetaminophen
Routes of administration	By mouth
ATC code	N02BE71 (WHO)
Legal status
Legal status	US: ℞-only[1][2]
Identifiers
CAS Number	624746-94-7
ChemSpider	none
KEGG	D11561

Butalbital/acetaminophen/caffeine

Combination of
Butalbital	Barbiturate
Acetaminophen	Miscellaneous analgesic
Caffeine	Xanthine
Clinical data
Trade names	Anoquan, Fioricet, Triad, others
AHFS/Drugs.com	Professional Drug Facts
MedlinePlus	a601009
License data	US DailyMed: Butalbital, acetaminophen, and caffeine
Routes of administration	By mouth
ATC code	None
Legal status
Legal status	US: ℞-only[3]
Identifiers
CAS Number	122018-95-5
ChemSpider	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][4][5] It contains butalbital, a barbiturate and paracetamol (acetaminophen), an analgesic.[4] Versions also containing caffeine are sold under the brand name Fioricet among others.[6] It is taken by mouth.[4][3] The combination is also sold with codeine.[7]

The most common side effects include sleepiness, dizziness, trouble breathing, and abdominal pain.[4] Other severe side effects may include liver problems, confusion, addiction, and allergic reactions.[4] Frequent use may result in medication overuse headache.[8] Barbiturate withdrawal may occur if rapidly stopped following long term use.[9] Use is not generally recommended during pregnancy or breastfeeding.[10]

The combination was approved for medical use in the United States in 1984.[4] It is available as a generic medication.[6] In the United States it is a schedule III controlled substance[2] in some states but not federally.[5][11][12] It is banned in a number of European countries.[9]

In 2022, the combination butalbital/acetaminophen/caffeine was the 248th most commonly prescribed medication in the United States, with more than 1 million 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.[3]

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]

References

1. "Butapap- butalbital and acetaminophen tablet". DailyMed. U.S. National Library of Medicine. 17 January 2020. Retrieved 10 April 2020.
2. "Allzital- butalbital and acetaminophen tablet". DailyMed. U.S. National Library of Medicine. 17 December 2019. Retrieved 18 April 2020.
3. "Fioricet- butalbital, acetaminophen, and caffeine capsule". DailyMed. U.S. National Library of Medicine. 27 January 2020. Retrieved 10 April 2020.
4. "Butalbital and Acetaminophen - FDA prescribing information, side effects and uses". Drugs.com. Retrieved 18 April 2019.
5. "Fioricet Capsules (acetaminophen/butalbital/caffeine)". Prescribers' Digital Reference. Retrieved 18 April 2019.
6. Hamilton RJ (2009). Pharmacopoeia. Jones & Bartlett Learning. p. 3. ISBN 978-0-7637-7419-6.
7. "Fioricet with Codeine- butalbital, acetaminophen, caffeine, and codeine phosphate capsule". DailyMed. U.S. National Library of Medicine. 7 February 2020. Retrieved 10 April 2020.
8. Mallick-Searle T (2015). "Headaches". In Woo TM, Robinson MV (eds.). Pharmacotherapeutics for Advanced Practice Nurse Prescribers. F.A. Davis. p. 1057. ISBN 978-0-8036-4581-3.
9. Young WB, Siow HC (April 2002). "Should butalbital-containing analgesics be banned? Yes". Current Pain and Headache Reports. 6 (2): 151–155. doi:10.1007/s11916-002-0012-y. PMID 11872187. S2CID 20095800.
10. "Acetaminophen / butalbital Use During Pregnancy". Drugs.com. Retrieved 18 April 2019.
11. "Substances Containing Butalbital Have Long Been Schedule III; What About Fioricet and Fiorinal?" (PDF). West Virginia Board of Pharmacy. September 2014. Retrieved 8 June 2019.
12. "Butalbital". Drugs Details. Retrieved 18 April 2020.
13. "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024.
14. "Acetaminophen; Butalbital; Caffeine Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.
15. "Tencon- butalbital and acetaminophen tablet". DailyMed. U.S. National Library of Medicine. 18 February 2020. Retrieved 20 May 2022.
16. Jaret P (29 August 2007). "A Hidden Cause of Headache Pain". The New York Times. Archived from the original on 25 March 2016. Retrieved 4 March 2024.
17. Mamishi S, Fattahi F, Pourpak Z, Aghaee FM, Moinfar Z, Mohammadi M, et al. (November 2009). "Severe cutaneous reactions caused by barbiturates in seven Iranian children". International Journal of Dermatology. 48 (11): 1254–1261. doi:10.1111/j.1365-4632.2007.03561.x. PMID 20064188. S2CID 10117062.
18. Willis B, Lopez G, Patel K, Frank K (7 October 2019). "Caffeine". Examine.com Inc.