Butalbital is a barbiturate that has an action of intermediate duration. Chemically called 5-allyl-5-isobutylbarbituric acid, butalbital is sold in a great many forms under many brand names. It is used most often for pain in general and more specifically for headache pain. It comes in a variety of formulations that combine with codeine to treat tension headaches.
Axocet, Bucet, Bupap, Dedapap, Prenilin and Phrenelin Forte are trade-name drugs that contain butalbital mixed with acetaminophen. When mixed with caffeine and acetaminophen, it is called by the trade names of Firicet, Esgic and Esgic Plus. When combined with aspirin and caffeine, its trade names are Fiorinal, Fiormor, Fiortal, Fortabs and Laniroif. Fioricet #3 with codeine is a compound made of butalbital, acetaminophen, caffeine and codeine phosphate. Fiornial #3 with codeine has aspirin, caffeine and codeine phosphate combined with butalbital.
Butalbital, used commonly for headaches and other types of pain, can provide better and faster pain relief than many other choices. Often, less medication is needed because of butalbital's efficacy. Codeine is an analgesic narcotic barbiturate that works specifically on the central nervous system to reduce pain.
Over time, the use of butalbital in any of its combined forms can cause a tolerance to develop so that more of the drug is required for the same degree of pain relief. As a narcotic, butalbital also has addictive properties so care must be used in taking this drug over time. Caffeine as a butalbital additive is also a substance that causes dependency. When stopped suddenly, persons with that dependency will often suffer from rebound or withdrawal headaches that can be more severe than the headaches being treated were in the first place. The aspirin, when used in the formula, causes no dependency but can cause harm to the body, especially the digestive tract, with pain, disruption and even bleeding. Butalbital can cause excitability in children and confusion, depression or excitement in geriatric patients, who are almost always more drug sensitive than are other age groups. Less commonly, older patients can experience breathing problems from the codeine. Definitive studies have not been done on the effects of butalbital on pregnant women, and the jury is still out on studies about infant risk when the mother is breastfeeding.
Take butalbital with a full glass of water, only as directed by a doctor. Don't take it other than as directed or it could lead to dependency, stomach problems and rebound headaches upon stopping or between dosages. In order to be effective, butalbital should be taken at the onset of the headache when the pain is still easily managed. Waiting will make the headache harder to treat. For migraines, when taken early, the headache may be averted if the patient retreats to a dark, quiet place for a while to give the medicine its greatest advantage. If headaches are habitual, it's best to take a headache preventative as butalbital is not a good choice for long-term and or frequent use. For short-term and occasional relief, it's one of the best headache drugs out there for many people.
Butalbital's normal side effects, or those that generally pose no threat beyond discomfort to the patient, include drowsiness, dizziness, lightheadedness, gas, indigestion, heartburn, nausea, vomiting or stomach pain and a false, heightened sense of well-being. Don't drive or operate machinery until you know how your body reacts to this medication. To ease side effects, rise slowly from a seated or lying position. If nausea and vomiting occur, especially after lying down or after the first few doses, see your doctor. Don't take this drug for at least five days before any surgery--including oral surgery as the aspirin in it can cause problems with bleeding. Caffeine should also be avoided before medical tests and procedures as it can skew certain test results.
Side effects that should cause concern are flushing or bluish skin color, breathing or coughing problems, swallowing difficulty, hives or other rashes on face, mouth or eye area and nasal congestion. Seek immediate help for lip bleeding or sores, tenderness and burning or peeling of the skin, chest pain, fever with chills present or not, painful mouth sores or ulcers, sore throat, and thick, reddened or scaliness on skin. Less rare but potentially dangerous side effects include bloody stool or urine, black tarry stool, swollen or painful glands, unusual bleeding or bruising. Seek immediate medical care for any of these also.
Signs of an overdose of butalbital include seizures, loss of hearing, ear ringing or buzzing, restlessness, excitability, confusion, trouble and or slow breathing patterns, and severe drowsiness and dizziness. Cold clammy skin, slurred speech, low blood pressure, diarrhea, hallucinations, thirst, muscle twitching, flashing lights in eyes, eye twitching and unusual movement, severe stomach pain, hand flapping, and vision problems. Get help immediately if any of these symptoms (especially two or more of them) are present as unconsciousness and death can occur. Lactating (breastfeeding) moms should seek immediate help if they experience breathing problems, drowsiness, limp feelings in their limbs and sudden nursing difficulties. For more information see the RxList website listed int he URL below.