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.<ref name="Butapap FDA label">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name=Pro2019/><ref name=PDR2019/> It contains butalbital, a barbiturate and paracetamol (acetaminophen), an analgesic.<ref name=Pro2019/> Versions also containing caffeine are sold under the brand name Fioricet among others.<ref name=Pha2009/> It is taken by mouth.<ref name=Pro2019>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="Fioricet FDA label">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The combination is also sold with codeine.<ref name="Fioricet with Codeine FDA label">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

The most common side effects include sleepiness, dizziness, trouble breathing, and abdominal pain.<ref name=Pro2019/> Other severe side effects may include liver problems, confusion, addiction, and allergic reactions.<ref name=Pro2019/> Frequent use may result in medication overuse headache.<ref>Template:Cite book</ref> Barbiturate withdrawal may occur if rapidly stopped following long term use.<ref name=Young2002>Template:Cite journal</ref> Use is not generally recommended during pregnancy or breastfeeding.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

The combination was approved for medical use in the United States in 1984.<ref name=Pro2019/> It is available as a generic medication.<ref name=Pha2009>Template:Cite book</ref> In the United States it is a schedule III controlled substance<ref name="Allzital FDA label">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> in some states but not federally.<ref name=PDR2019>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It is banned in a number of European countries.<ref name=Young2002/>

In 2023, the combination butalbital/acetaminophen/caffeine was the 262nd most commonly prescribed medication in the United States, with more than 1Template:Nbspmillion prescriptions.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Medical uses

Butalbital/acetaminophen is indicated for the treatment of tension headaches.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Butalbital/acetaminophen/caffeine is indicated for the treatment of tension headaches.<ref name="Fioricet FDA label" />

Side effects

Prolonged use can cause rebound headaches.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Rarely, use of barbiturates can lead to Stevens–Johnson syndrome.<ref>Template:Cite journal</ref>

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.<ref>Template:Cite journal</ref>

References

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