Butalbital/acetaminophen

Butalbital/acetaminophen, sold under the brand name Butapap among others, is a combination medication used to treat tension headaches and migraine headaches.^[1][4][5] It contains butalbital, a barbiturate and paracetamol (acetaminophen), an analgesic.^[4] Versions also containing caffeine are sold under the brand name Fioricet among others.^[6] It is taken by mouth.^[4][3] The combination is also sold with codeine.^[7]

The most common side effects include sleepiness, dizziness, trouble breathing, and abdominal pain.^[4] Other severe side effects may include liver problems, confusion, addiction, and allergic reactions.^[4] Frequent use may result in medication overuse headache.^[8] Barbiturate withdrawal may occur if rapidly stopped following long term use.^[9] Use is not generally recommended during pregnancy or breastfeeding.^[10]

The combination was approved for medical use in the United States in 1984.^[4] It is available as a generic medication.^[6] In the United States it is a schedule III controlled substance^[2] in some states but not federally.^[5][11][12] It is banned in a number of European countries.^[9]

In 2023, the combination butalbital/acetaminophen/caffeine was the 262nd most commonly prescribed medication in the United States, with more than 1 million prescriptions.^[13][14]