68 Butalbital
levels of imipramine, so persons taking tricyclic antidepressants such as imip-
ramine may need to have blood levels monitored.
Cancer.Not enough scientific information to report.
Pregnancy.Animal experiments apparently do not indicate butalbital’s po-
tential for causing birth defects, but a large study of human pregnancy out-
comes found no link between the drug and birth defects. In one case when a
pregnant woman using butalbital gave birth, the child experienced seizures
identified as butalbital withdrawal symptoms. Those symptoms disappeared
when the infant received another barbiturate on a gradually decreasing dose
that weaned the child off the drug.
Combination products.Fiorinal is a headache remedy that has had several
formulations but is typically butalbital, aspirin, andcaffeine. The product has
been found useful for pain relief among women who have recently given birth,
apparently more effective thanpropoxyphene. Also oral surgery patients have
received good pain relief from Fiorinal andcodeine. Fiorinal is known to
produce a false positive forphenobarbitalin body fluid testing. Abuse of the
butalbital, aspirin, and caffeine (BAC) combination headache remedy can in
itself cause rebound headaches. Although most persons feel no particular at-
traction to that combination when they take it, a minority of users experience
elevation of physical energy and psychic mood, which makes the tablets at-
tractive. Persons have been known to take from 150 to 420 BAC tablets a
month for years, habits requiring hospitalization and psychological help to
overcome. Substituting acetaminophen for aspirin in this combination has
been found to be just as good for treating headache and less likely to cause
unwanted effects. This latter combination, under the brand name Fioricet, has
been found to have the additional effect of relieving tension.
Sedapap and Phrenilin (both with butalbital and acetaminophen) are rem-
edies for headaches produced by tension or muscle contraction. The combi-
nation is not recommended for preadolescents or for persons suffering from
porphyria, a condition involving disturbances in body chemistry and abnor-
mal sensitivity to light. Potential for causing cancer or birth defects is un-
known, and the combination is assigned to Pregnancy Category C. The
combination passes into the milk supply of nursing mothers with unknown
effect.
Additional scientific information may be found in:Forbes, J.A. “Analgesic Effect of an Aspirin-Codeine-Butalbital-Caffeine Combination
and an Acetaminophen-Codeine Combination in Postoperative Oral Surgery
Pain.”Pharmacotherapy6 (1986): 240–47.
Friedman, A.P., and F.J. DiSerio. “Symptomatic Treatment of Chronically Recurring
Tension Headache: Placebo-Controlled, Multicenter Investigation of Fioricet and
Acetaminophen with Codeine.”Clinical Therapeutics10 (1987): 69–81.
Good, M.I. “Organic Dissociative Syndrome Associated with Antimigraine Pharma-
cotherapy.”Canadian Journal of Psychiatry36 (1991): 597–99.
Preskorn, S.H., R.L. Schwin, and W.V. McKnelly. “Analgesic Abuse and the Barbiturate
Abstinence Syndrome.”Journal of the American Medical Association244 (1980):
369–70.
Raja, M. “Severe Barbiturate Withdrawal Syndrome in Migrainous Patients.”Headache
36 (1996): 119–21.