Butalbital is a barbiturate, a type of sedative that works by depressing the central nervous system.Butalbital is a barbiturate with an intermediate duration of action. Butalbital is often combined with other medications, such as paracetamol (acetaminophen) (as Butalbital/acetaminophen) or aspirin, for the treatment of pain and headache.
The various formulations combined with codeine are FDA-approved for the treatment of tension headaches. Butalbital has the same chemical formula as talbutal but a different structure—one that presents as 5-allyl-5-isobutylbarbituric acid.
It’s often used in combination medications to treat tension headaches and migraines. Butalbital helps to relax muscle contractions involved in tension headaches.
It’s commonly combined with other ingredients such as:
- Acetaminophen (Tylenol): A pain reliever and fever reducer.
- Caffeine: Used to enhance the effectiveness of pain relievers.
One example of such a combination is Fioricet, which contains butalbital, acetaminophen, and caffeine.
However, because butalbital can be habit-forming and has a risk of abuse, these medications are typically prescribed for short-term use. Long-term or excessive use can lead to dependence, withdrawal symptoms, and other health risks, such as liver damage when combined with acetaminophen in high doses.
Preparations
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)
Contraindications
There are specific treatments which are appropriate for targeting migraines and headaches. 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. 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 of Butalbital
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.
What is Butalbital Abuse and How to Treat and Prevent it ?
Butalbital Abuse
Butalbital abuse refers to the misuse of medications containing butalbital, often leading to dependency, tolerance, and addiction. Since butalbital is a barbiturate, it depresses the central nervous system, and individuals may misuse it to experience sedative or calming effects, especially if combined with other medications like acetaminophen and caffeine.
Common signs of butalbital abuse:
- Taking larger doses than prescribed or using it without a prescription.
- Developing tolerance, requiring higher doses for the same effect.
- Dependence, where the person feels they need the drug to function normally.
- Withdrawal symptoms when not taking it, such as anxiety, restlessness, insomnia, or seizures.
- Mood swings or behavioral changes, such as increased irritability or depression.
- Liver damage (due to acetaminophen in combination drugs) or other health risks from overuse.
Risks of butalbital abuse:
- Addiction: Chronic use can lead to a psychological or physical dependence.
- Withdrawal: Stopping abruptly can result in life-threatening seizures, anxiety, and hallucinations.
- Overdose: Taking too much can lead to respiratory depression, coma, or even death.
- Co-use with alcohol or other sedatives: This greatly increases the risk of overdose.
Treatment for Butalbital Abuse
- Medical Detox:
- Since sudden withdrawal from butalbital can cause severe symptoms, detoxification should be supervised by a healthcare professional.
- A gradual tapering process is usually recommended, where the dose is slowly reduced to minimize withdrawal symptoms.
- Medications:
- In some cases, medications may be prescribed to manage withdrawal symptoms, control cravings, or stabilize mood.
- Behavioral Therapies:
- Cognitive-behavioral therapy (CBT): Helps the person understand the thoughts and behaviors contributing to their addiction and teaches coping skills to avoid relapse.
- Counseling: Both individual and group counseling can provide support.
- 12-Step Programs: Programs like Narcotics Anonymous (NA) offer peer support and accountability.
- Inpatient or Outpatient Rehab:
- Inpatient rehab may be recommended for severe cases, where the individual lives at a treatment facility for more intensive therapy.
- Outpatient rehab allows the person to continue daily life while attending therapy sessions.
- Support Groups:
- Attending support groups, like NA, can provide ongoing support after treatment to help maintain sobriety.
Prevention of Butalbital Abuse
- Use Only as Prescribed:
- Only take butalbital-containing medications exactly as prescribed by a doctor.
- Avoid increasing the dosage or frequency without medical approval.
- Short-Term Use:
- These medications are usually intended for short-term use only, so prolonged use should be avoided unless a doctor specifically advises otherwise.
- Avoid Mixing Substances:
- Do not combine butalbital with alcohol, benzodiazepines, or other sedatives, as it increases the risk of abuse and overdose.
- Regular Monitoring:
- Patients who are prescribed butalbital should have regular follow-ups with their healthcare provider to monitor for any signs of dependency or abuse.
- Education:
- Both patients and healthcare providers should be aware of the risks associated with butalbital, including the potential for abuse and overdose, especially when used in combination with other sedatives.
Preventing abuse involves strict adherence to medical guidelines, educating patients on risks, and early intervention if any signs of misuse or dependency emerge.