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.[3]
There are specific treatments which are appropriate for targeting
migraines and headaches.[4] 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.[5] When other treatments are unavailable or ineffective, butalbital may be appropriate if the patient can be monitored to prevent the development of chronic headache.[5]
Side effects
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:
The risk and severity of all side effects is greatly increased when butalbital (or butalbital-containing medications) are combined with other sedatives (ex.
ethanol,
opiates,
benzodiazepines,
antihistamines). In particular, butalbital, especially when combined with other sedatives (e.g. opioids), can cause life-threatening respiratory depression and death. Inhibitors of the hepatic enzyme CYP3A4 may also increase the risk, severity, and duration of side effects, many drugs inhibit this enzyme as do some foods such as
grapefruit and the
blood orange. Taking butalbital-based medications with some other drugs may also increase the side effects of the other medication.
Dangers and risks
Butalbital can cause
dependence or
addiction. Mixing with
alcohol, benzodiazepines, and other CNS-depressants increases the risk of intoxication, increases respiratory depression, and increases liver toxicity when in combination with paracetamol (acetaminophen). Use of butalbital and alcohol, benzodiazepines, and other CNS-depressants can contribute to coma, and in extreme cases, fatality.
Institute for Clinical Systems Improvement (2011),
Headache, Diagnosis and Treatment of, Institute for Clinical Systems Improvement, archived from
the original on 2013-10-29, retrieved 2013-10-24
Katsarava Z, Schneeweiss S, Kurth T, Kroener U, Fritsche G, Eikermann A, et al. (March 2004). "Incidence and predictors for chronicity of headache in patients with episodic migraine". Neurology. 62 (5): 788–90.
doi:
10.1212/01.WNL.0000113747.18760.D2.
PMID15007133.
S2CID20759425.