Butalbital is abarbiturate with an intermediate duration of action. Butalbital is often combined with other medications, such asparacetamol (acetaminophen) (asButalbital/acetaminophen) or aspirin, for the treatment ofpain andheadache. The various formulations combined withcodeine areFDA-approved for the treatment oftension headaches. Butalbital has the same chemical formula astalbutal but a different structure—one that presents as 5-allyl-5-isobutylbarbituric acid.[3]
There are specific treatments which are appropriate for targetingmigraines 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 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 asgrapefruit and theblood orange. Taking butalbital-based medications with some other drugs may also increase the side effects of the other medication.
Butalbital can causedependence oraddiction. Mixing withalcohol, 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 fromthe original on 2013-10-29, retrieved2013-10-24
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.
