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butalbital, acetaminophen (byoo-tal-bi-tal & a-seet-a-min-oh-fen)

Bucet, Phrenilin, Phrenilin Forte, Tencon

butalbital, acetaminophen, caffeine (byoo-tal-bi-tal, a-seet-a-min-oh-fen, & kaf-een) Esgic-Plus, Fioricet

butalbital, aspirin, caffeine (byoo-tal-bi-tal, as-pir-in, & kaf-een)

Fiorinal, imageTecnal, imageTrianal


Therapeutic: nonopioid analgesics (combination with barbiturate)

Pharmacologic: barbiturates


Relief of the symptom complex of tension (or muscle contraction) headaches (use should be short term only as the butalbital component may be habit forming).


Contains a barbiturate (butalbital) for its sedative effect. Also contains an analgesic (aspirin or acetaminophen) for relief of pain. Caffeine may also be included in some formulations because it may be of benefit in tension headaches. Therapeutic Effects: Decreased severity of pain with some sedation.

Adverse Reactions/Side Effects

CNS: drowsiness, confusion, delirium, depression, dizziness, excitation, headache (with chronic use), irritability, lethargy, nervousness, numbness, tingling. EENT: earache, nasal congestion, tinnitus. Resp: respiratory depression. CV: tachycardia. GI: constipation, dry mouth, dysphagia, flatulence, heartburn. Derm: dermatitis, pruritus, rash, sweating. MS: leg pain, muscle weakness. Misc: fever, physical dependence, psychologic dependence, tolerance.


Implications refer to the butalbital (barbiturate) component. For information on the analgesic component in the formulation, see the aspirin or acetaminophen monograph.

Examination and Evaluation

  • Assess the frequency and severity of headaches, and document whether drug therapy is successful in decreasing headache attacks.

  • Monitor and report daytime drowsiness and other changes in mood or behavior, including confusion depression, lethargy, irritability, nervousness, excitation, or delirium. Repeated or excessive symptoms may require change in dose or medication.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report increased heart rate (tachycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess any leg pain or muscle weakness to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.


  • Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce headache pain and decrease the need for this drug.

  • Because of the risk of tachycardia and other arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

  • Advise patient to avoid alcohol and other CNS ...

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