Butalbital / Acetaminophen / Caffeine
Pronouncation: (BYOO-TAL-bih-tuhl/uh-seet-uh-MIN-oh-fen/kaff-EEN)Class: Nonnarcotic analgesic
Trade Names:
Esgic
- Capsules 325 mg acetaminophen/40 mg caffeine/50 mg butalbital
- Tablets 325 mg acetaminophen/40 mg caffeine/50 mg butalbital
Trade Names:
Esgic-Plus
- Tablets 500 mg acetaminophen/40 mg caffeine/50 mg butalbital
- Capsules 500 mg acetaminophen/40 mg caffeine/50 mg butalbital
Trade Names:
Fioricet
- Tablets 325 mg actaminophen/40 mg caffeine/50 mg butalbital
Trade Names:
Margesic
- Capsules 325 mg acetaminophen/40 mg caffeine/50 mg butalbital
Trade Names:
Medigesic
- Capsules 325 mg acetaminophen/40 mg caffeine/50 mg butalbital
Trade Names:
Repan
- Tablets 325 mg acetaminophen/40 mg caffeine/50 mg butalbital
Trade Names:
Triad
- Capsules 325 mg acetaminophen/40 mg caffeine/50 mg butalbital
Pharmacology
Butalbital has generalized depressant effect on CNS and, in very high doses, has peripheral effects. Acetaminophen has analgesic and antipyretic effects; its analgesic effects may be mediated through inhibition of prostaglandin synthetase enzyme complex. Caffeine is thought to produce constriction of cerebral blood vessels.
Indications and Usage
Relief of symptom complex of tension (or muscle contraction) headache.
Contraindications
Hypersensitivity to acetaminophen, caffeine, or barbiturates; porphyria.
Dosage and Administration
AdultsPO 1 to 2 tablets or capsules every 4 h; max, 6 tablets or capsules/day.
Storage/Stability
Store in airtight, light-resistant container at room temperature.
Drug Interactions
Beta-blockers (eg, propranolol), corticosteroids, doxycycline, estrogens (including oral contraceptives), felodipine, griseofulvin, nifedipine, phenylbutazone, quinidine, theophylline, warfarinEffects of these drugs may be decreased.
Carbamazepine, sulfinpyrazoneMay increase risk of hepatotoxicity.
MAOIsMay increase CNS effects.
Other CNS depressants (eg, ethanol, narcotics, general anesthetics, tranquilizers, sedative-hypnotics)Increased drowsiness, dizziness, and other CNS depressive effects may occur.
Tricyclic antidepressantsAntidepressant effect may decrease.
Laboratory Test Interactions
With Chemstrip bG and Dextrostix home blood glucose systems, may cause false decrease in mean glucose values; may give false-positive urinary 5-hydroxyindoleacetic acid test result.
Adverse Reactions
CNS
Drowsiness; dizziness; lightheadedness; confusion.
Dermatologic
Rash.
GI
Nausea; vomiting; flatulence.
Precautions
Pregnancy
Category C .
Lactation
Undetermined.
Children
Safety and efficacy in children younger than 12 yr of age not established.
Drug dependency
Prolonged use may produce drug tolerance and dependency (psychologic and physical).
Overdosage
Symptoms
Blood dyscrasias, respiratory depression, hepatic damage, drowsiness, confusion, coma, hypotension, tachycardia, hypovolemic shock, nausea, vomiting, insomnia, restlessness, tremor.
Patient Information
- Caution patient that dependency/tolerance may result from regular long-term use.
- Tell patient to take drug with full glass of water.
- Instruct patient not to discontinue drug abruptly after long-term regular use.
- Caution patient to avoid intake of alcoholic beverages and other CNS depressants without health care provider approval.
- Advise patient to avoid any hazardous activity (driving or smoking) if dizziness, drowsiness, or a decrease in mental acuity occurs.
- Warn patient that orthostatic hypotension may occur. Instruct patient to change positions slowly and to sit or lie down if symptoms occur.
- Inform patient to report the following symptoms to health care provider: persistent or recurrent pain before next scheduled dose, difficulty breathing, increased drowsiness, vomiting or yellowing of skin or gums.
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