Butalbital/acetaminophen
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Butalbital/acetaminophen, sold under the brand name Butapap among others, is a combination medication used to treat tension headaches and migraine headaches.[1][2][3] It contains butalbital, a barbiturate and paracetamol (acetaminophen), an analgesic.[2] Versions also containing caffeine are sold under the brand name Fioricet among others.[4] It is taken by mouth.[2][5] The combination is also sold with codeine.[6]
The most common side effects include sleepiness, dizziness, trouble breathing, and abdominal pain.[2] Other severe side effects may include liver problems, confusion, addiction, and allergic reactions.[2] Frequent use may result in medication overuse headache.[7] Barbiturate withdrawal may occur if rapidly stopped following long term use.[8] Use is not generally recommended during pregnancy or breastfeeding.[9]
The combination was approved for medical use in the United States in 1984.[2] It is available as a generic medication.[4] In the United States it is a schedule III controlled substance[10] in some states but not federally.[3][11][12] It is banned in a number of European countries.[8]
In 2023, the combination butalbital/acetaminophen/caffeine was the 262nd most commonly prescribed medication in the United States, with more than 1Script error: No such module "String".million prescriptions.[13][14]
Medical uses
Butalbital/acetaminophen is indicated for the treatment of tension headaches.[15]
Butalbital/acetaminophen/caffeine is indicated for the treatment of tension headaches.[5]
Side effects
Prolonged use can cause rebound headaches.[16]
Rarely, use of barbiturates can lead to Stevens–Johnson syndrome.[17]
Mechanism of action
Butalbital has a half-life of about 35 hours. Acetaminophen has a half-life of about 1.25 to 3 hours, but may be increased by liver damage and after an overdose. Caffeine has a half-life of about 2.5 to 4.5 hours.[18]
References
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