Butalbital (Fioricet) Addiction: Effects, Withdrawal & Treatment

This page will discuss the barbiturate drug butalbital and its uses, effects, and withdrawal symptoms, as well as treatment options for someone with a butalbital addiction.

What is Butalbital?

Butalbital, is a drug in the class known as barbiturates. Barbiturates are central nervous system (CNS) depressants that are used for a number of different reasons, but most often in the treatment of:

• Anxiety.
• Pain.
• Seizures.

In addition, barbiturates are often used as sedatives. Barbiturates are no longer prescribed as frequently as they once were due to their potential for misuse, the development of physical dependence, and overdose. Instead, other medications, such as benzodiazepines, are considered to be frontline treatments for conditions that barbiturates were once commonly used for.

What is in Butalbital?

Butalbital is often used in combination with other medications, such as acetaminophen, caffeine, aspirin, and/or codeine for treating migraine headaches or tension headaches. The drug is no longer considered a frontline treatment for these conditions, but may still be prescribed for them.

Some brand-name drugs that include butalbital are Fioricet, Esgic, and Axocet. Butalbital is listed by the United States Drug Enforcement Agency as a Schedule III controlled substance, meaning that it has a moderate potential for misuse, the development of physical dependence, and addiction.

Butalbital Side Effects & Dangers

Butalbital, like other barbiturates, produces a feeling of euphoria that is associated with feeling relaxed, free of stress, and almost as if one is intoxicated by alcohol. This sense of relaxation and euphoria contributes to its ability to treat severe headaches but also contributes to its potential as a drug of misuse.

Other side effects associated with butalbital include the following:

• Decreases in reaction time, motor coordination, balance, and in the speed and flow of thinking processes
• Feeling dizzy or lightheaded, feelings of lethargy, drowsiness, and a relaxing warm sensation
• Nausea, stomach pain, stomach cramps, and vomiting
• Feeling short of breath due to respiratory suppression
• Rare side effects, such as rash, itching, problems with breathing, problems with swallowing, dry mouth, difficulty swallowing, gas, heartburn, severe lethargy or fatigue, ringing in the years, black tarry stools, and/or leg cramps or leg pain (Call your physician if experiencing these effects.)
• The development of physical dependence and/or a substance use disorder with chronic misuse

Due to its central nervous system depressant effects, butalbital is the most common barbiturate associated with arrests for impaired driving. Operating machinery or driving while taking butalbital is extremely dangerous and akin to driving under the influence of alcohol. Individuals who use butalbital in conjunction with other substances, such as other barbiturates, benzodiazepines, narcotic medications, stimulants, or alcohol, are at risk for serious effects that can potentially be fatal.

Butalbital Overdose

Symptoms of an overdose on butalbital include:

• Cognitive symptoms, such as confusion, displaying slurred or slowed speech, issues with judgment, and irrational behavior
• Physical symptoms, such as sluggishness, extremely depressed reflexes, lack of coordination, balance issues, staggering gate, and appearing as if intoxicated
• Physical signs, such as extremely slowed breathing rates, extremely slow heart rate, extremely low temperature, extreme lethargy and sleepiness, and limp muscles

Of course, there is potential for the individual to become unconscious or comatose. Any individual who is suspected of overdosing on butalbital should receive immediate medical attention.

Is Butalbital Addictive?

Like all barbiturates, butalbital has a high potential for misuse and for the development of physical dependence. Tolerance to barbiturates like butalbital develops very quickly in individuals who misuse the drug.  When tolerance occurs, users will attempt to take higher doses more frequently in an effort to achieve the same results they used to get at lower doses. Some signs that someone is misusing or addicted to butalbital include:

• Obtaining the drug without a prescription. Or if they have a prescription, they use the drug more often or in higher doses than specified by the prescription.
• Engaging in doctor shopping to obtain more drugs are most likely using the drug.
• Spending significant amounts of time trying to obtain the drug, using the drug, or recovering from use of the drug.
• Using butalbital in ways not typically prescribed, such as grinding it up into powder and snorting it, or mixing it with other drugs.
• Often appearing drowsy or lethargic or may even appear intoxicated and present with slurred speech, issues with coordination, and decreased mental and physical reaction times.
• Spending significant periods of time alone or with other individuals that also misuse the drug.
• Getting very defensive or even angry when someone attempts to discuss their use of drugs with them.
• Demonstrating issues with attention and with memory.
• Displaying intermittent periods of irritability, restlessness, or sensitivity.
• Complaining of feeling sick or having flu-like symptoms as a result of the initial withdrawal process associated with not using butalbital.
• Misusing butalbital despite experiencing obvious negative issues associated with their drug use, such as issues with work, school, or their relationships with others.

Withdrawal from Butalbital

As mentioned, butalbital is a drug that carries a significant risk of developing physical dependence. Individuals who have been taking or misusing butalbital for significant periods of time (4-6 weeks or longer) will almost assuredly develop some withdrawal symptoms. The longer the person used the drug, the more severe the symptoms will be. The withdrawal process from butalbital can initially be quite discomforting.

Butalbital Withdrawal Symptoms and Timeline:

• The acute phase of withdrawal typically begins hours or up to 2-3 days following discontinuation, depending on the use the person was involved in. In the acute phase, potential symptoms include one or more of a long list of symptoms that can include fever, increased blood pressure, increased heart rate, increased rates of breathing, nausea, vomiting, tremors (particularly in the hands), ringing in the ears, severe fatigue, marked disorientation (delirium), confusion, anxiety, severe headache, hallucinations, and/or seizures. Obviously, individuals will begin experiencing cravings in order to reduce the intensity of the withdrawal symptoms. Individuals who become extremely confused or disoriented, or who experience hallucinations or seizures, are in need of immediate medical treatment, as the development of seizures can lead to fatal complications.
• The acute withdrawal phase can last up to 7 days. Following that phase, the symptoms will become significantly less intense, but individuals may still have issues with anxiety, irritability, nausea, fever or chills, and other feelings of being ill. The symptoms can last for several weeks. Cravings may continue.
• Longer-term issues may persist. These issues may include depression, anxiety, sensitivity to perceived stress, issues with motivation, and an occasional desire to return to using the drug.

Because the withdrawal symptoms from butalbital can be potentially severe, it is highly recommended that anyone who has used the drug for any length of time consult a physician before discontinuing its use. Individuals engaging in medically assisted withdrawal programs, where physicians monitor the withdrawal process, administer drugs to counteract severe symptoms, and taper down the dosages of the drugs to allow the individual to slowly adjust and detox, are safer and experience higher success rates than people who simply wish to stop using drugs on their own.

In addition, individuals with substance use disorders are encouraged to seek out long-term treatment to address the issues that contributed to their substance use and to develop a plan to cope without drugs, learn positive coping skills, and avoid relapse in the future. Because relapse rates for individuals who have had substance use disorders are very high, it is important to maintain a long-term treatment strategy.

Treatment for Butalbital Addiction

Fortunately, butalbital addiction is a treatable condition. Treatment may involve one or several different types of addiction treatment, such as medical detox, inpatient care, and outpatient treatment.

Butalbital addiction treatment typically involves:

• Behavioral therapies.
• Peer support.
• Psychoeducation.
• Treatment for co-occurring disorders.

Laguna Treatment Center can help you or your loved one recover from butalbital addiction. Call to speak to an admissions navigator at any time. Admissions navigators can answer your questions about our inpatient rehab in Orange County, what to expect in treatment, using insurance to pay for addiction treatment, and other ways to pay for rehab. You can also verify your insurance coverage with the confidential .