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Is Butalbital Addictive? A Guide to the Drug (& Possible Dangers)

Butalbital is a barbiturate that is known for its intermediate duration of action. It is often used in combination with other drugs, such as aspirin or acetaminophen, as a way to relieve pain and headaches. It can also be used to treat anxiety and seizures.

Butalbital is not recommended as a first-line treatment for headaches. This is in part because it has a high risk of abuse and dependence.

As a barbiturate, it can be strongly habit-forming. Butalbital can cause both physiological and psychological dependence.

What Is Butalbital?

Butalbital works by affecting the central nervous system. It belongs to the barbiturate drug class and is used to relieve pain and treat anxiety and seizures.

Butalbital should also not be taken by individuals age 12 or under, as adequate studies have not been performed to test the efficacy and safety of pediatric administration. It should not be taken while pregnant or breastfeeding, and it should be avoided by the elderly population as well. The elderly have increased risk of kidney problems, which can cause complications when processing the drug.

Butalbital is known for its ability to be used in combination with other drugs. However, there are still several medications that should never be used in combination with butalbital. The following medications should not be used:

  • Alfentanil
  • Ulipristal
  • Triazolam
  • Thiopental
  • Carisoprodol
  • Sodium oxybate
  • Quazepam
  • Secobarbital
  • Phenobarbital
  • Primidone
  • Piperaquine
  • Pixantrone
  • Nitrazepam
  • Nifedipine

These are not all the medications that should be avoided while on butalbital, so always consult your doctor.

Also, tell your doctor if you have any medical issues, such as:

  • Alcohol abuse
  • A history of drug dependence
  • Kidney disease
  • Liver disease
  • Porphyria (an enzyme issue)
  • Stomach problems

Tobacco, ethanol, and even cabbage can cause some adverse reactions with butalbital.

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Proper Use 

It is important to take butalbital as directed by your doctor, as there is a lot of potential for abuse and misuse.

Butalbital can be highly habit-forming, both psychologically and physiologically. Individual dosing needs also vary, so it is important to follow the doctor’s recommendations closely.

The number of doses you take each day, the time between those doses, and the length of time you take the medicine will depend entirely on what you are trying to treat with the medicine.

To treat tension headaches for adults and children age 12 years or older, one or two tablets should be taken every four hours as needed. It is recommended not to take more than six tablets a day.

Side Effects

Butalbital, like many medications, comes with the risk of certain side effects. It is not likely these side effects will occur, but if they do, seek medical attention as soon as possible.

The following are some of the most common side effects associated with butalbital:

  • Lightheadedness
  • Shortness of breath
  • Blistering and peeling of skin
  • Weakness
  • Extreme fatigue
  • Unusual bleeding
  • Abdominal pain
  • Bleeding gums
  • Blood in urine or stool
  • Blurred vision
  • Unexplained weight loss
  • Trembling in hands and feet
  • Tightness in the chest
  • Swelling of feet or lower legs
  • Dry mouth
  • Fainting
  • Fast, pounding, or irregular heartbeat
  • Sweating
  • Sores
  • Ulcers
  • Sore throat
  • Seizures
  • Red, irritated eyes
  • Puffiness or swelling of the eyelids or around the face
  • Loss of appetite
  • Joint or muscle pain

These are all serious symptoms. If you are experiencing them, contact your doctor immediately.

Overuse Headaches

Butalbital has some downsides that should be considered.

Because it is a barbiturate, it slows down the central nervous system. This helps to relax muscles that are usually the underlying cause of tension headaches.

When the drug is taken inappropriately or too often, it can actually cause headaches. This happens because butalbital can cause dependence, which leads to withdrawal headaches when overused.

These overuse headaches can occur when a person takes the medicine three or more times a week, or 10 or more days a month.

Withdrawal headaches, which may occur with butalbital use, typically do not respond to preventative headache medications. In fact, lack of response to headache medication is usually how doctors diagnose an overuse headache.

Potential for Dependence and Abuse

Because butalbital is a barbiturate, it has a high risk of abuse and dependency.

When the body becomes accustomed to butalbital, sudden cessation of use will cause a withdrawal reaction. Common withdrawal symptoms for butalbital include the following:

  • Nausea
  • Lack of appetite
  • Seizures
  • Shakiness or tremors
  • Severe agitation
  • Anxiety and panic attacks
  • Diarrhea
  • Increased blood pressure and heart rate
  • Fever
  • Irritability
  • Hallucinations
  • Depression
  • Restlessness
  • Insomnia

Various factors affect the severity of withdrawal, such as the average dose, how often it was used, how long it was used, and if there are other mental health issues at play.

Abuse Rates

According to a publication in Headache: The Journal of Head and Face Pain, about 2 percent of the American population suffers from chronic migraines, and about a third of these people overuse medications like butalbital to treat their symptoms.

Because chronic migraines are so common and most consider headache medication to be fairly safe and innocuous, drugs that combat headache symptoms are at a high risk for abuse. They are readily available, habit-forming, and there is a lot of misinformation about their abuse potential.

Dangers of Use

While many people view butalbital as a fairly harmless drug, it has several short-term and long-term dangers associated with its use.

The short-term effects of butalbital include the following:

  • Memory and judgment impairment
  • Changes in consciousness
  • Dizziness
  • Nausea
  • Slowed reflexes and thinking
  • Slurred speech
  • Sluggishness
  • Coordination problems
  • Irritability
  • Paranoia
  • Suicidal thoughts
  • Lack of inhibition
  • Extreme drowsiness

Long-term risks include the following:

  • Changes in alertness
  • Memory loss
  • Increased risk of overdose due to the need for larger doses
  • Physical dependence that can lead to potentially fatal withdrawal symptoms
  • Addiction
  • Tolerance, which in the case of butalbital develops quickly

Overdose Potential

As tolerance increases, an overdose is more likely. The following are overdose symptoms:

  • Confusion
  • Dark urine
  • Difficult or painful urination
  • Yellow eyes or skin
  • Vomiting blood
  • Unusual excitement, nervousness, or restlessness
  • Unpleasant breath odor
  • Trouble sleeping
  • A sudden decrease in the amount of urine
  • Dizziness
  • Fever
  • General feeling of discomfort or illness
  • Hallucinations
  • Headaches
  • Holding false beliefs that can’t be changed by facts
  • Increased sweating
  • Pale or bluish lips, fingernails, or skin
  • Loss of appetite
  • Light-colored stools

If someone you know has taken butalbital and is exhibiting these symptoms, seek medical help immediately.

Signs of a Problem

Butalbital is a potent drug that should be taken seriously.

A study published by the Addictive Disorders & Their Treatments journal found that butalbital withdrawal can cause protracted delirium.

One of the first signs of a problem is when a regular dose of the medication does nothing to help with a headache. The person may begin to take larger doses until they experience the same level of relief they had in the past. 

It is best to talk to a doctor immediately if butalbital loses its efficacy, as this can be an indicator of a problem. 

At higher doses, butalbital can produce euphoria. Once a person begins abusing the drug, they may continue to seek out this euphoria, and dependence can quickly form.

Addiction Treatment

While butalbital abuse can cause immense damage, it is not insurmountable.

Because there are a lot of dangers associated with the withdrawal phase, the most severe being coma and death, seek help from an experienced professional for this process. Professionals can monitor and treat symptoms of withdrawal, intervening quickly if something goes wrong.

Often, a tapering approach is used during medical detox. The individual might be switched to a long-acting benzodiazepine and then gradually weaned off that medication over time. This can help to mitigate withdrawal symptoms and cravings, making it more likely that the person will safely and successfully get through withdrawal.

Detox is only the first phase of recovery. Therapy is where the bulk of the work takes place.
In therapy, clients will identify issues that led them to abuse butalbital. They’ll learn coping skills to successfully deal with life’s stresses without turning to substances of abuse. They’ll form an aftercare plan that can sustain them in ongoing recovery.

Conclusions

Butalbital is a highly addictive barbiturate that is not recommended for regular treatment of headaches. While it can sometimes be prescribed as an alternative when conventional headache medications do not work, the many dangers and risks associated with dependence and overdose on the drug make it less than ideal for this purpose.

If people abuse butalbital recreationally, treatment is needed. Overdose is very likely with this potent drug.

Sources

(March 2019) Butalbital, Acetaminophen, and Caffeine (Oral Route). Mayo Clinic. from https://www.mayoclinic.org/drugs-supplements/butalbital-acetaminophen-and-caffeine-oral-route/description/drg-20075393

(2014) Butalbital – an overview. ScienceDirect. from https://www.sciencedirect.com/topics/medicine-and-dentistry/butalbital

(June 2017) Downsides of Taking Fiorinal or Fioricet for Headaches. Verywell Health. from https://www.verywellhealth.com/downsides-fiorinal-fioricet-headaches-1718097

(July 2010) Why Do Migraineurs Abuse Butalbital-Containing Combined Analgesics. ResearchGate. from https://www.researchgate.net/publication/45280726_Why_Do_Migraineurs_Abuse_Butalbital-Containing_Combination_Analgesics

(March 2009) Protracted Delirium Induced by Fioricet Withdrawal. Addictive Disorders & Their Treatment. from https://journals.lww.com/addictiondisorders/Citation/2009/03000/Protracted_Delirium_Induced_by_Fioricet_Withdrawal.7.aspx

(2014) Butalbital. National Center for Biotechnology Information. from https://pubchem.ncbi.nlm.nih.gov/compound/butalbital

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