Migraine and headache:
Indications for: Butalbital/Acetaminophen/Caffeine
Tension (or muscle contraction) headache.
1–2 tabs or caps every 4hrs as needed; max 6 daily. Not recommended for extended or repeated use.
<12yrs: not established.
Increased risk of acute liver failure esp. in those with underlying liver disease and concomitant alcohol. Discontinue at the 1st sign of skin rash or any other hypersensitivity. Drug abusers. Severe hepatic or renal impairment (monitor). Acute abdominal conditions. Elderly. Debilitated. Pregnancy (Cat.C). Nursing mothers: not recommended.
Barbiturate + analgesic + methylxanthine.
May potentiate effects of alcohol, general anesthetics, tranquilizers, sedative-hypnotics, or other CNS depressants or narcotic analgesics; avoid. MAOIs may enhance CNS effects of butalbital. May cause false (+) urine test for 5-hydroxyindoleacetic acid.
Drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, abdominal pain, intoxicated feeling; hepatotoxicity (APAP doses >4g/day); rare: serious skin reactions (eg, acute generalized exanthematous pustulosis [AGEP], Stevens-Johnson Syndrome [SJS], toxic epidermal necrolysis [TEN]), hypersensitivity.
Formerly known under the brand name Esgic or Fioricet.
Acetaminophen: The plasma half-life is 1.25 to 3 hours, but may be increased by liver damage and following overdosage. Elimination of acetaminophen is principally by liver metabolism (conjugation) and subsequent renal excretion of metabolites. Approximately 85% of an oral dose appears in the urine within 24 hours of administration, most as the glucuronide conjugate, with small amounts of other conjugates and unchanged drug.
Butalbital: Elimination of butalbital is primarily via the kidney (59% to 88% of the dose) as unchanged drug or metabolites. The plasma half-life is about 35 hours. Urinary excretion products included parent drug (about 3.6% of the dose), 5-isobutyl-5-(2, 3- dihydroxypropyl) barbituric acid (about 24% of the dose), 5-allyl-5(3-hydroxy-2-methyl1-propyl) barbituric acid (about 4.8% of the dose), products with the barbituric acid ring hydrolyzed with excretion of urea (about 14% of the dose), as well as unidentified materials. Of the material excreted in the urine, 32% was conjugated.
Caffeine: Caffeine is cleared rapidly through metabolism and excretion in the urine. The plasma half-life is about 3 hours. Of the 70% of the dose that has been recovered in the urine, only 3% was unchanged drug.