butalbital

Combinations include:

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

Side effects for any psychoactive drug are difficult to predict, though butalbital is usually well tolerated. Commonly reported side effects for butalbital, some of which tend to subside with continued use, include:

• Dizziness
• Respiratory depression (impaired breathing)
• Drowsiness
• Intoxicated feeling
• Light-headedness
• 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 (or butalbital-containing medications) are combined with other sedatives (ex. ethanol, opiates, benzodiazepines, antihistamines). In particular, butalbital, especially when combined with other sedatives (e.g. opioids), 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. Taking butalbital-based medications with some other drugs may also increase the side effects of the other medication.

Butalbital can cause dependence or addiction. Mixing with alcohol, benzodiazepines, and other CNS-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 CNS-depressants can contribute to coma, and in extreme cases, fatality.

{{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

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Category:Barbiturates

Category:Allyl compounds

Category:CYP3A4 inducers

Category:Isobutyl compounds