butalbital/acetaminophen

{{Short description|Combination medication}}

{{Use dmy dates|date=February 2023}}

{{cs1 config |name-list-style=vanc |display-authors=6}}

{{Infobox drug

| type = combo

| image = Fioricet.jpg

| alt =

| caption =

| component1 = Butalbital

| class1 = Barbiturate

| component2 = Acetaminophen

| class2 = Miscellaneous analgesic

| tradename = Allzital, Butapap, Tencon, others

| Drugs.com = {{Drugs.com|ppa|butalbital-and-acetaminophen}}

| MedlinePlus =

| DailyMedID = Butalbital and acetaminophen

| routes_of_administration = By mouth

| ATC_prefix = N02

| ATC_suffix = BE71

| legal_AU =

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| legal_CA_comment =

| legal_DE =

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| legal_NZ =

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| legal_UK =

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| legal_US = Rx-only

| legal_US_comment =

| legal_EU =

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| legal_status =

| CAS_number = 624746-94-7

| ChemSpiderID = none

| KEGG = D11561

}}

{{Infobox drug

| drug_name = Butalbital/acetaminophen/caffeine

| type = combo

| image =

| caption =

| component1 = Butalbital

| class1 = Barbiturate

| component2 = Acetaminophen

| class2 = Miscellaneous analgesic

| component3 = Caffeine

| class3 = Xanthine

| tradename = Anoquan, Fioricet, Triad, others

| Drugs.com = {{Drugs.com|ppa|butalbital-acetaminophen-and-caffeine}}

| MedlinePlus = a601009

| DailyMedID = Butalbital, acetaminophen, and caffeine

| routes_of_administration = By mouth

| ATC_prefix = None

| legal_AU =

| legal_AU_comment =

| legal_BR =

| legal_BR_comment =

| legal_CA =

| legal_CA_comment =

| legal_DE =

| legal_DE_comment =

| legal_NZ =

| legal_NZ_comment =

| legal_UK =

| legal_UK_comment =

| legal_US = Rx-only

| legal_US_comment =

| legal_EU =

| legal_EU_comment =

| legal_UN =

| legal_UN_comment =

| legal_status =

| 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.{{cite web | title=Butapap- butalbital and acetaminophen tablet | work = DailyMed | publisher = U.S. National Library of Medicine | date=17 January 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ca8a0862-1956-43ad-844d-77153aa09dfb | access-date=10 April 2020}} 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.{{cite web |title=Butalbital and Acetaminophen - FDA prescribing information, side effects and uses |url=https://www.drugs.com/pro/butalbital-and-acetaminophen.html |website=Drugs.com |access-date=18 April 2019 }}{{cite web | title=Fioricet- butalbital, acetaminophen, and caffeine capsule | work = DailyMed | publisher = U.S. National Library of Medicine | date=27 January 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c018be7d-f7b8-45e2-97b8-8e7a71740657 | access-date=10 April 2020}} The combination is also sold with codeine.{{cite web | title=Fioricet with Codeine- butalbital, acetaminophen, caffeine, and codeine phosphate capsule | work = DailyMed | publisher = U.S. National Library of Medicine | date=7 February 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=df9801fc-03fe-41da-a6b3-0f76788217c9 | access-date=10 April 2020}}

The most common side effects include sleepiness, dizziness, trouble breathing, and abdominal pain. Other severe side effects may include liver problems, confusion, addiction, and allergic reactions. Frequent use may result in medication overuse headache.{{cite book | vauthors = Mallick-Searle T | chapter = Headaches | veditors = Woo TM, Robinson MV |title=Pharmacotherapeutics for Advanced Practice Nurse Prescribers |date=2015 |publisher=F.A. Davis |isbn=978-0-8036-4581-3 |page=1057 | chapter-url=https://books.google.com/books?id=2Q5hCgAAQBAJ&pg=PA1057 }} Barbiturate withdrawal may occur if rapidly stopped following long term use.{{cite journal | vauthors = Young WB, Siow HC | title = Should butalbital-containing analgesics be banned? Yes | journal = Current Pain and Headache Reports | volume = 6 | issue = 2 | pages = 151–155 | date = April 2002 | pmid = 11872187 | doi = 10.1007/s11916-002-0012-y | s2cid = 20095800 }} Use is not generally recommended during pregnancy or breastfeeding.{{cite web |title=Acetaminophen / butalbital Use During Pregnancy |url=https://www.drugs.com/pregnancy/acetaminophen-butalbital.html |website=Drugs.com |access-date=18 April 2019 }}

The combination was approved for medical use in the United States in 1984. It is available as a generic medication.{{cite book | first = Richard J | last = Hamilton |title=Pharmacopoeia |date=2009 |publisher=Jones & Bartlett Learning |isbn=978-0-7637-7419-6 |page=3 |url=https://books.google.com/books?id=qkQHcIDy0QgC&pg=PA3 }} In the United States it is a schedule III controlled substance{{cite web | title=Allzital- butalbital and acetaminophen tablet | work = DailyMed | publisher = U.S. National Library of Medicine | date=17 December 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a054238f-b250-4aec-975d-b64d6685e0cd | access-date=18 April 2020}} in some states but not federally.{{cite web |title=Fioricet Capsules (acetaminophen/butalbital/caffeine) |url=https://www.pdr.net/drug-summary/Fioricet-Capsules-acetaminophen-butalbital-caffeine-3284 |website=Prescribers' Digital Reference |access-date=18 April 2019 }}{{cite web | title = Substances Containing Butalbital Have Long Been Schedule III; What About Fioricet and Fiorinal? | date = September 2014 | work = West Virginia Board of Pharmacy |url=https://nabp.pharmacy/wp-content/uploads/2016/06/WV092014.pdf |access-date=8 June 2019}}{{cite web | title=Butalbital | website=Drugs Details | url=https://drugsdetails.com/butalbital/ | access-date=18 April 2020}} It is banned in a number of European countries.

In 2022, the combination butalbital/acetaminophen/caffeine was the 248th most commonly prescribed medication in the United States, with more than 1{{nbsp}}million prescriptions.{{cite web | title=The Top 300 of 2022 | url=https://clincalc.com/DrugStats/Top300Drugs.aspx | website=ClinCalc | access-date=30 August 2024 | archive-date=30 August 2024 | archive-url=https://web.archive.org/web/20240830202410/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status=live }}{{cite web | title = Acetaminophen; Butalbital; Caffeine Drug Usage Statistics, United States, 2013 - 2022 | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/AcetaminophenButalbitalCaffeine | access-date = 30 August 2024 }}