Butalbital is a drug in the class known as barbiturates, central nervous system depressants that are used for a number of different reasons, but most often in the treatment of anxiety, pain, and 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 abuse, the development of physical dependence, and overdose. Instead, other medications, such as the benzodiazepines, are considered to be frontline treatments for conditions that barbiturates were once commonly used for.
Butalbital is often used in combination with other medications, such as acetaminophen, caffeine, aspirin, and/or codeine for the treatment of 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 abuse, the development of physical dependence, and addiction.
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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 on 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 abuse.
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 abuse
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.
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.
Like all barbiturates, butalbital has a high potential for abuse and for the development of physical dependence. Tolerance to barbiturates like butalbital develops very quickly in individuals who abuse 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 abusing or addicted to butalbital include:
- The person obtains 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.
- Individuals with prescriptions who engage in doctor shopping to obtain more drugs are most likely abusing the drug.
- People who spend significant amounts of time trying to obtain the drug, using the drug, or recovering from use of the drug are most likely abusing 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.
- Individuals who abuse barbiturates like butalbital will often appear drowsy or lethargic or may even appear intoxicated and present with slurred speech, issues with coordination, and decreased mental and physical reaction times.
- People who abuse barbiturates often begin spending significant periods of time alone or with other individuals who are known substance abusers.
- Users may get very defensive or even angry when someone attempts to discuss their use of drugs with them.
- Individuals who abuse barbiturates will often begin to demonstrate issues with attention and with memory.
- Users may display intermittent periods of irritability, restlessness, sensitivity, and/or complaining of feeling sick or having flulike symptoms as a result of the initial withdrawal process associated with not using butalbital.
- Anyone who continues to use butalbital despite experiencing obvious negative issues associated with their drug use, such as issues with work, school, or in their relationships with others, is most likely abusing the drug.
Withdrawal from Butalbital
As mentioned, butalbital is a drug that carries a significant risk for the development of physical dependence. Individuals who have been taking or abusing butalbital for significant periods of time (typically regular use or abuse for a period of 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.
- An acute phase that can begin hours or up to 2-3 days following discontinuation, depending on the level of abuse/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 seven 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, such as 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 abuse 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.