Butalbital Abuse and Addiction

Butalbital is a medication that acts on the central nervous system (CNS). It is used primarily to treat tension headaches and is often mixed with acetaminophen and caffeine for optimal effects. Butalbital can also be used to treat other conditions, such as anxiety, but it is no longer prescribed as often as in previous years.
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What is Butalbital?

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. 

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. 

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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 is only available with a doctor’s prescription. 

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

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

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

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

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Updated on: October 20, 2020
Author
Jordan Flagel
About
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Medically Reviewed
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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