Butalbital

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Combinations include:{{Citation needed|date=April 2025}}

• Butalbital/acetaminophen, Butalbital and acetaminophen (paracetamol), (trade names: Axocet, Bucet, Bupap, Cephadyn, Dolgic, Phrenilin, Forte, Sedapap)
• Butalbital/paracetamol/caffeine (trade names: Fioricet, Esgic, Esgic-Plus, Orbivan, Fiormor, Fiortal, Fortabs, Laniroif)
• Butalbital/caffeine/codeine (trade name: Fioricet#3 with Codeine)
• Butalbital/aspirin (trade name: Axotal)
• Butalbital/aspirin/caffeine (trade name: Fiorinal)
• Butalbital/aspirin/caffeine/codeine (trade name: Fiorinal#3 with Codeine)
• Ergotamine/caffeine/butalbital/belladonna alkaloids (trade name: Cafergot-PB)

There are specific treatments which are appropriate for targeting migraines and headaches.{{Citation |author1 = American Academy of Neurology |author1-link = American Academy of Neurology |date = February 2013 |title = Five Things Physicians and Patients Should Question |publisher = American Academy of Neurology |work = Choosing Wisely: an initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-neurology/ |access-date = August 1, 2013 |url-status = live |archive-url = https://web.archive.org/web/20130901115555/http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-neurology/ |archive-date = September 1, 2013 }}, which cites

• {{cite journal | vauthors = Silberstein SD | title = Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 55 | issue = 6 | pages = 754–62 | date = September 2000 | pmid = 10993991 | doi = 10.1212/WNL.55.6.754 | doi-access = free }}
• {{cite journal | vauthors = Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, Sándor PS | title = EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force | journal = European Journal of Neurology | volume = 16 | issue = 9 | pages = 968–81 | date = September 2009 | pmid = 19708964 | doi = 10.1111/j.1468-1331.2009.02748.x | author8 = European Federation of Neurological Societies | s2cid = 9204782 | doi-access = free }}
• {{Citation |author=Institute for Clinical Systems Improvement |year=2011 |title=Headache, Diagnosis and Treatment of |publisher=Institute for Clinical Systems Improvement |url=https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_neurological_guidelines/headache/ |url-status=dead |archive-url=https://web.archive.org/web/20131029201313/https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_neurological_guidelines/headache/ |archive-date=2013-10-29 |access-date=2013-10-24 }} Butalbital is not recommended as a first-line treatment because it impairs alertness, brings risk of dependence and addiction, and increases the risk that episodic headaches will become chronic.{{Citation |author1 = American Headache Society |author1-link = American Academy of Dermatology |date = September 2013 |title = Five Things Physicians and Patients Should Question |publisher = American Headache Society |work = Choosing Wisely: an initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/american-headache-society/ |access-date = 10 December 2013 |url-status = dead |archive-url = https://web.archive.org/web/20131203001051/http://www.choosingwisely.org/doctor-patient-lists/american-headache-society/ |archive-date = 3 December 2013 }}, which cites
• {{cite journal | vauthors = Bigal ME, Lipton RB | title = Excessive opioid use and the development of chronic migraine | journal = Pain | volume = 142 | issue = 3 | pages = 179–82 | date = April 2009 | pmid = 19232469 | doi = 10.1016/j.pain.2009.01.013 | s2cid = 27949021 }}
• {{cite journal | vauthors = Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB | title = Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study | journal = Headache | volume = 48 | issue = 8 | pages = 1157–68 | date = September 2008 | pmid = 18808500 | doi = 10.1111/j.1526-4610.2008.01217.x | s2cid = 17358333 | doi-access = free }}
• {{cite journal | vauthors = Scher AI, Stewart WF, Ricci JA, Lipton RB | title = Factors associated with the onset and remission of chronic daily headache in a population-based study | journal = Pain | volume = 106 | issue = 1–2 | pages = 81–9 | date = November 2003 | pmid = 14581114 | doi = 10.1016/S0304-3959(03)00293-8 | s2cid = 29000302 | url = https://zenodo.org/record/1260009 }}
• {{cite journal | vauthors = Katsarava Z, Schneeweiss S, Kurth T, Kroener U, Fritsche G, Eikermann A, Diener HC, Limmroth V | display-authors = 6 | title = Incidence and predictors for chronicity of headache in patients with episodic migraine | journal = Neurology | volume = 62 | issue = 5 | pages = 788–90 | date = March 2004 | pmid = 15007133 | doi = 10.1212/01.WNL.0000113747.18760.D2 | s2cid = 20759425 }} When other treatments are unavailable or ineffective, butalbital may be appropriate if the patient can be monitored to prevent the development of chronic headache.

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Side effects for butalbital is usually well tolerated. Commonly reported side effects for butalbital, some of which tend to subside with continued use, include:{{Citation needed|date=April 2025}}

• Dizziness
• Respiratory depression
• Drowsiness
• Intoxicated feeling
• Lightheadedness
• Nausea
• Sedation
• Euphoria
• Severe impairment of judgment
• Diarrhea
• Memory Loss
• Constipation

Rare side effects include Stevens–Johnson syndrome, an adverse reaction to barbiturates, and anaphylaxis.

The risk and severity of all side effects is greatly increased when butalbital are combined with other sedatives (e.g., alcohol, opioids, benzodiazepines, antihistamines). Butalbital when taken with sedatives can cause life-threatening respiratory depression and death. Inhibitors of the hepatic enzyme CYP3A4 may also increase the risk, severity, and duration of side effects, many drugs inhibit this enzyme as do some foods such as grapefruit and the blood orange.{{Citation needed|date=April 2025}}

Butalbital can cause dependence or addiction.{{Citation needed|date=April 2025}}

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Mixing with alcohol, benzodiazepines, and other depressants increases the risk of intoxication, increases respiratory depression, and increases liver toxicity when in combination with paracetamol (acetaminophen). Use of butalbital and alcohol, benzodiazepines, and other depressants can contribute to coma, and in extreme cases, fatality.{{Citation needed|date=April 2025}}

{{reflist}}

• [https://cancerweb.ncl.ac.uk/cgi-bin/omd?query=butalbital&action=Search+OMD Butalbital] {{Webarchive|url=https://web.archive.org/web/20081014233125/http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=butalbital&action=Search+OMD |date=2008-10-14 }}, Online Medical Dictionary
• [https://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202102.html Butalbital and Acetaminophen (Systemic)] ([https://web.archive.org/web/20061230122834/http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202102.html archive]), MedicinePlus Drug Information
• [https://www.deadiversion.usdoj.gov/schedules/listby_sched/sched3.htm Controlled Substances in Schedule III], ([https://web.archive.org/web/20070202220447/http://www.deadiversion.usdoj.gov/schedules/listby_sched/sched3.htm archive]), U.S. Drug Enforcement Administration

{{GABAAR PAMs}}

Category:Barbiturates

Category:Allyl compounds

Category:CYP3A4 inducers

Category:Isobutyl compounds