Butalbital/acetaminophen

Butalbital/acetaminophen, sold under the brand name Butapap among others, is a combination medication used to treat tension headaches and migraine headaches. It contains butalbital, a barbiturate and paracetamol (acetaminophen), an analgesic. Versions also containing caffeine are sold under the brand name Fioricet among others. It is taken by mouth. The combination is also sold with codeine.

The most common side effects include sleepiness, dizziness, trouble breathing, and abdominal pain. Other severe side effects may include liver problems, confusion, addiction, and allergic reactions. Frequent use may result in medication overuse headache. Barbiturate withdrawal may occur if rapidly stopped following long term use. Use is not generally recommended during pregnancy or breastfeeding.

The combination was approved for medical use in the United States in 1984. It is available as a generic medication. In 2021, the combination butalbital/acetaminophen/caffeine was the 232nd most commonly prescribed medication in the United States, with more than 1million prescriptions. In the United States it is a schedule III controlled substance in some states but not federally. It is banned in a number of European countries.

Medical uses
Butalbital/acetaminophen is indicated for the treatment of tension headaches.

Butalbital/acetaminophen/caffeine is indicated for the treatment of tension headaches.

Side effects
Commonly reported side effects include euphoria, dizziness or lightheadedness, drowsiness or sedation, intoxication, nausea, vomiting, dependence, shortness of breath, and abdominal pain.

Prolonged use can cause rebound headaches.

Rarely, use of barbiturates can lead to Stevens–Johnson syndrome.

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.