What is Butalbital?

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Butalbital is a medication within the drug classification known as barbiturates. It is taken orally to treat a variety of mild to moderate conditions.

Barbiturates act primarily on the central nervous system (CNS) and have an intermediate duration of action compared to common over-the-counter medications.

butalbital

Butalbital is most commonly combined with acetaminophen and caffeine to achieve the most desirable effects. 

If you miss a dose of Butalbital, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not double dose.

Butalbital is best stored at room temperature away from moisture and heat. For more drug information on Butalbital, check the packaging of the product.

Butalbital, Acetaminophen & Caffeine

Butalbital, acetaminophen, and caffeine is a combination drug available in tablet, capsule, and solution form.

Acetaminophen is a commonly used pain reliever and fever reducer, and caffeine is a stimulant that increases the effect of pain relievers. 

Both butalbital and caffeine use can lead to low, moderate, or high physical dependence, though caffeine withdrawal is typically a milder and less serious issue. Acetaminophen is not a habit-forming substance, but it can have serious effects, such as liver damage, when taken in high doses. 

The combination drug butalbital, acetaminophen, and caffeine are only available with a doctor’s prescription. 

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What is Butalbital Used For?

Butalbital is used primarily in treating tension headaches, also known as stress headaches. These are classified as attacks that:

  • Last between 30 minutes and seven days
  • Have bilateral location, are non-pulsating, have mild or moderate intensity, and are not aggravated by activity
  • Do not cause nausea or vomiting, sensitivity to light, or sensitivity to sound

Butalbital should not be used for the treatment of migraine headaches. It is a prescription drug that should only be used on the professional medical advice of a licensed healthcare provider. 

Though used mainly for treating headaches, butalbital can also be used as a sedative to treat anxiety, seizures, and, in some cases, insomnia. 

Side Effects of Butalbital

There are several common and infrequent side effects of butalbital, including:

  • Decreases in reaction time
  • Loss of motor coordination or balance
  • Slowing of the speed and flow of thinking processes
  • Dizziness or lightheadedness
  • Lethargy
  • Drowsiness
  • Nausea
  • Vomiting
  • Stomach pain and cramps
  • Shallow breathing or shortness of breath due to respiratory depression

Rare side effects of butalbital include:

  • Allergic reaction and rash (skin reaction)
  • Difficulty breathing
  • Difficulty swallowing
  • Dry mouth
  • Indigestions and heartburn
  • Tinnitus
  • Leg pain or leg cramps

Butalbital in breastmilk can also cause poor feeding and vomiting in infants. If you are breast-feeding, it is best to avoid using Butalbital.

Is Butalbital Addictive?

Butalbital has a high potential for addiction and physical dependence on the drug. Tolerance to this medication, as well as other barbiturates, can occur in a relatively short time span, often leading to higher dosage and more potential for misuse. 

Some signs of butalbital addiction include:

  • Obtaining butalbital without a prescription
  • Overuse or taking higher doses than specified in the prescription
  • Using butalbital in ways not typically prescribed, such as grinding it up into powder and snorting it, or mixing it with other drugs
  • Appearing tired, lethargic, or in a state of intoxication
  • Slurred speech, issues with coordination, and decreased mental and physical reaction times 
  • Spending significant periods of time alone
  • Defensive or angry behavior when someone attempts to discuss medication usage or drug abuse
  • Problems with attention and with memory
  • Irritability, restlessness, sensitivity
  • Continuing to use butalbital despite experiencing obvious negative issues with work, school, or in their relationships with others
  • Porphyria, a buildup of natural chemicals that produce porphyrin (a compound essential for the function of hemoglobin) in the body
  • Withdrawal symptoms

Dangers Of Butalbital Addiction

A person with Butalbital addiction is likely to develop a tolerance to the drug. They may be more likely to take more Butalbital or mix it with other depressants to maintain the initial high. Combining Butalbital with alcohol, for example, can heighten the risk of respiratory depression and liver failure.

Some people experiencing opioid addiction will use Butalbital to enhance the effects of whatever drug they are taking while also conserving their supply. This is dangerous because taking Butalbital with narcotics can lead to overdose or accidental death.

Symptoms of a barbiturate overdose, such as Butalbital, include:

  • Drowsiness
  • Confusion
  • Coma
  • Respiratory depression
  • Trouble breathing
  • Persistent nausea and vomiting
  • Severe dizziness
  • Slow or slurred speech
  • Staggering
  • Ringing in the ears

If you suspect someone is overdosing, call 911 immediately. An untreated Butalbital addiction can be life-changing or fatal.

Complications that may occur from a Butalbital overdose include:

  • Head and spinal injuries from falls
  • Pneumonia from depressed gag reflex
  • Muscle damage from lying on a hard surface for an extended period of time

Misusing Butalbital can lead to long-lasting effects on your health.

Long-term and consistent use of barbiturates can lead to chronic symptoms including:

  • Irritability
  • Memory loss
  • Decreased function
  • Shifts in alertness

Butalbital Addiction Withdrawal And Detox

Butalbital addiction is likely to cause uncomfortable withdrawal symptoms when use is quickly stopped. Barbiturates like Butalbital can lead to psychological and physical dependence, meaning withdrawal symptoms will occur when the individual stops taking the drug.

These withdrawal symptoms generally occur within two to four days of stopping Butalbital use.

Withdrawal symptoms of Butalbital include:

  • Seizures
  • Psychosis
  • Tremors
  • Restlessness
  • Insomnia
  • Anxiety

If severe withdrawal symptoms go untreated or are not quickly recognized, then the following may occur:

  • Hypothermia
  • Failure of blood circulation
  • Death

Detoxification, or detox, is the procedure of clearing the body of harmful substances. Medically supervised detox can involve administering other drugs, like opioids, in small quantities to aid with the uncomfortable effects of withdrawal symptoms. Common opioids used for detoxification include methadone, buprenorphine, and naltrexone.

You must never try to detox alone. Detox is safe and effective in a medical environment where doctors and nurses can assess dosage and progress. Withdrawal symptoms can be painful, uncomfortable, and potentially life-threatening, so professional aid is necessary.

Treatment Options for Butalbital Abuse

Behavioral treatments are often necessary to change the patient’s mindset and avoid relapse for butalbital. Cognitive behavioral therapies can be done as both outpatient (from home) and inpatient (from a medical facility) treatments.

Inpatient treatment is generally more effective as the patient will have access to constant medical and professional care. 

Outpatient treatment can also be problematic due to a lack of supervision and potential home factors (such as social environment) that may have contributed to butalbital abuse in the first place.

Butalbital: Common Questions and Answers

Common questions associated with Butalbital use and addiction:

What Kind of Drug is Butalbital?

Butalbital is a barbiturate drug, which is a class of CNS depressants. This class of medication acts on the central nervous system as a depressant. They are effective as anticonvulsants, but they also carry habit-forming potential. Benzodiazepines have replaced barbiturates in recent years for several types of treatment. 

Is Butalbital the Same as Fioricet?

Fioricet is not the same as butalbital, but it does contain this barbiturate compound. Fioricet is a brand-name drug containing butalbital, acetaminophen, and caffeine in one oral tablet or capsule. This medication is very similar to esgic, fiorinal, orbivan, repan, margesic, phrenilin, and phenobarbital, all of which contain butalbital and some form of pain reliever. 

Is Butalbital Used for Anxiety?

Though it is used primarily to treat tension headaches, butalbital can also be prescribed to treat anxiety. This was once used as a common medication to treat this condition, but it has become less prescribed in favor of benzodiazepines, which are more widely used today.

What are the Possible Side Effects of Acetaminophen, Butalbital, and Caffeine?

In addition to those listed above, possible adverse effects of the combination drug of acetaminophen, butalbital, and caffeine include:

  • Liver damage or liver disease
  • Kidney disease
  • Abdominal pain
  • Irritability
  • Constipation
  • Nervousness
  • Tremors
  • Increased urination
  • Dark urine
  • Fainting
  • Confusion
  • Rapid heart rate
  • Difficulty sleeping

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Resources +

U.S. Food and Drug Administration. “Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules for Oral Use.” FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020232s041lbl.pdf

National Library of Medicine. “Butalbital.” NLM. https://pubchem.ncbi.nlm.nih.gov/compound/Butalbital

National Institute of Health. “Harmful Drug Interactions.” NIH https://www.niaaa.nih.gov/sites/default/files/publications/Harmful_Interactions.pdf

National Highway Traffic Safety Administration. “2013–2014 National Roadside Study of Alcohol and Drug Use by Drivers.” NHTSA https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/13013-nrs_drug_092917_v6_tag.pdf

Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Butalbital. [Updated 2019 Jun 30]. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK501481/

Silberstein, S D, and D C McCrory. “Butalbital in the treatment of headache: history, pharmacology, and efficacy.” Headache vol. 41,10 (2001): 953-67. doi:10.1046/j.1526-4610.2001.01189.x, https://pubmed.ncbi.nlm.nih.gov/11903523/

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