Butalbital


Butalbital is a barbiturate with an intermediate duration of action. Butalbital is often combined with other medications, such as paracetamol 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—namely, 5-allyl-5-isobutylbarbituric acid.

Available forms

Combinations include:

Contraindications

There are specific treatments which are appropriate for targeting migraines and headaches. 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. When other treatments are unavailable or ineffective, butalbital may be appropriate if the patient can be monitored to prevent the development of chronic headache.

Side effects

Side effects for butalbital are usually well tolerated. Commonly reported side effects for butalbital, some of which tend to subside with continued use, include:
Rare side effects include Stevens–Johnson syndrome, an adverse reaction to barbiturates, and anaphylaxis.
The risk and severity of all side effects is greatly increased when butalbital are combined with other sedatives. Butalbital when taken with sedatives 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.
Butalbital can cause dependence or addiction.

Interactions

Mixing with alcohol, benzodiazepines, and other depressants increases the risk of intoxication, increases respiratory depression, and increases liver toxicity when in combination with paracetamol. Use of butalbital and alcohol, benzodiazepines, and other depressants can contribute to coma, and in extreme cases, fatality.