|Systematic (IUPAC) name|
|Pregnancy cat.||C (US)|
|Legal status||Schedule III (US)|
|Half-life||35 hours |
| (what is this?)
Butalbital is a barbiturate with an intermediate duration of action. Butalbital is often combined with other medications, such as acetaminophen (paracetamol) or aspirin, and is commonly prescribed 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,
- Butalbital and paracetamol (acetaminophen) (trade names: Axocet, Bucet, Bupap, Cephadyn, Dolgic, Phrenilin, Phrenilin Forte, Sedapap)
- Butalbital, paracetamol (acetaminophen), and caffeine (trade names: Fioricet, Esgic, Esgic-Plus)
- Butalbital and aspirin (trade name: Axotal)
- Butalbital, aspirin, and caffeine (trade names Fiorinal, Fiormor, Fiortal, Fortabs, Laniroif)
- Butalbital, paracetamol (acetaminophen), caffeine, and codeine phosphate (Fioricet#3 with Codeine)
- Butalbital, aspirin, caffeine, and codeine phosphate (trade name: Fiorinal#3 with Codeine)
- Ergotamine tartrate, caffeine, butalbital, belladonna alkaloids (trade name: Cafergot-PB)
As a treatment for migraine, butalbital should be avoided in favor of more effective, migraine-specific treatments. It is a least preferable option to be used if other available treatments fail.
Side effects for any psychoactive drug are difficult to predict, but commonly reported side effects for butalbital include:
(Rare side-effects include Stevens–Johnson syndrome, an adverse reaction to barbiturates.)
There are other potential side effects; this list should not be considered all-inclusive.
Dangers and Risks
Butalbital is a physically and psychologically addictive barbiturate. Butalbital should not be mixed with alcohol due to increased risk of intoxication, increased respiratory depression, and increased liver toxicity when it is a butalbital combination including paracetamol. Many opioid-dependent persons frequently use barbiturates as a potentiator to their normal dose of opiates in order to increase the effects, or with a less than normal dose as means of conserving their supply. Especially when used with the stronger Schedule II narcotics, suicide or accidental death occurs much more frequently than first reported with one drug alone. Use of alcohol, benzodiazepines, and other CNS-depressants often also contribute to respiratory depression, coma, and in extreme cases fatality. There are other potential risks; this list should not be considered all-inclusive.
In Hong Kong, butalbital is regulated as a psychotropic substance. There are regulations governing the retail sale, wholesale and supply on prescription at community pharmacy.
Butalbital, or any preparation containing it, is a Schedule III CD (Controlled Drug) under the Misuse of Drugs Act 1971 as amended, but is not, nor has it been, available in the UK despite there having been calls for it to be made available on the NHS (National Health Service); this has been growing in recent years as more migraine sufferers have been prescribed Fioricet, Fiorinal or other preparation whilst on holiday in the USA;
- DE Patent 526854
- American Academy of Neurology (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Academy of Neurology), retrieved August 1, 2013, which cites
- Silberstein, S. D. (2000). "Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology 55 (6): 754–762. doi:10.1212/WNL.55.6.754. PMID 10993991.
- Evers, S.; Afra, J.; Frese, A.; Goadsby, P. J.; Linde, M.; May, A.; Sándor, P. S.; European Federation of Neurological Societies (2009). "EFNS guideline on the drug treatment of migraine - revised report of an EFNS task force". European Journal of Neurology 16 (9): 968–981. doi:10.1111/j.1468-1331.2009.02748.x. PMID 19708964.
- Institute for Clinical Systems Improvement (2011), Headache, Diagnosis and Treatment of, Institute for Clinical Systems Improvement
"Butalbital". On-line Medical Dictionary. Retrieved June 26, 2005. "Butalbital and Acetaminophen (Systemic)". MedicinePlus Drug Information. Archived from the original on December 30, 2006. Retrieved December 31, 2006. "Controlled Substances in Schedule III". Drug Enforcement Administration. 2007. Retrieved 2007-01-13.