butalbital/acetaminophen/caffeine (Alagesic LQ, Capacet, Dolgic Plus, Esgic, Fioricet, and Others)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

A Guide to Migraine Headaches

What is narcotic analgesic-apap-caffeine-butalbital-oral, and how does it work (mechanism of action)?

Butalbital/acetaminophen/caffeine is a combination product used for treating headache.

Butalbital is a narcotic that depresses the central nervous system.

Acetaminophen is a pain reliever and fever reducer. It is the active compound in Tylenol. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body's temperature when the temperature is elevated.

Caffeine has pain relieving properties and may boost the action of other pain relievers by mechanisms that are not well understood. It may reduce the activity of pain sensing nerves in the brain. The FDA approved butalbital/acetaminophen/caffeine in November 1984.

Patients taking combination drugs of butalbital, acetaminophen, and caffeine should review the patient safety information such as specific side effects, drug interactions, and pregnancy safety for each of these drugs.

What brand names are available for narcotic analgesic-apap-caffeine-butalbital-oral?

Alagesic LQ, Capacet, Dolgic Plus, Esgic, Esgic-Plus, Fioricet, Dolgic LQ, Ezol, Geone, Margesic, Nonbac, Orbivan, Repan, Zebutal

Is narcotic analgesic-apap-caffeine-butalbital-oral available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for narcotic analgesic-apap-caffeine-butalbital-oral?

Yes

What are the side effects of narcotic analgesic-apap-caffeine-butalbital-oral?

Side effects of butalbital/acetaminophen/caffeine are lightheadedness, dizziness, shortness of breath, nausea, dry mouth, increase heart rate, and tremors.

Butalbital/acetaminophen/caffeine has a boxed warning of liver toxicity if used in excessive amounts for prolonged periods. Acetaminophen dosage should not exceed 4000 mg per day to avoid acute liver injury. Butalbital is habit forming and may be abused.

Tolerance, dependence, and physical dependence may occur after prolonged periods of use of barbiturates (butalbital).

This product is contraindicated in patients who have hypersensitivity to any of its compounds and in patients with porphyria.

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Migraine or Headache? Migraine Symptoms, Triggers, Treatment

What is the dosage for narcotic analgesic-apap-caffeine-butalbital-oral?

Adults and children of 12 years of age and older

  • 50/325/40 mg tablets or capsules: Take 1 to 2 tablets by mouth every 4 hours. Maximum of 6 doses per day. Not to exceed 4000 mg of acetaminophen per day to avoid liver injury.
  • Dolgic Plus (50/750/40 mg): Take 1 tablet by mouth every 4 hours. Maximum of 5 tablets per day.
  • Alagesic LQ: Take 1 to 2 tablespoons (15-30 ml) by mouth every 4 hours. Maximum daily dose of 6 tablespoons (180 ml) per day.
  • Safe and effective use of butalbital/acetaminophen/caffeine is not established in children under 12 years of age.

Which drugs or supplements interact with narcotic analgesic-apap-caffeine-butalbital-oral?

Butalbital/acetaminophen/caffeine should not be used with MAOI (monoamine oxidase inhibitors) like phenelzine (Nardil) and selegiline (Emsam) because they can significantly increase central nervous system effects of butalbital and increased blood levels of caffeine.

Butalbital can increase the effects of narcotic pain killers, alcohol, sedative or hypnotic medications, and other medications that depress the central nervous system. Loss of consciousness, troubled breathing, lowered heart rate, coma, and in severe cases death can occur.

Is narcotic analgesic-apap-caffeine-butalbital-oral safe to take if I'm pregnant or breastfeeding?

There are no adequate studies done on butalbital/acetaminophen/caffeine to determine its safe and effective use in pregnant women.

Butalbital/acetaminophen/caffeine enters breast milk in small amounts; therefore, it is best to be cautious before using it in nursing mothers.

What else should I know about narcotic analgesic-apap-caffeine-butalbital-oral?

What preparations of narcotic analgesic-apap-caffeine-butalbital-oral are available?

  • Alagesic LQ is available in tropical fruit punch flavor, oral solution form. It contains 50 mg butalbital, 325 mg acetaminophen, and 40 mg caffeine per 15 ml of solution. It contains 7.368% alcohol. It is available in 16 fluid ounce containers.
  • Capacet, Esgic, Fioricet, Margesic, Orbivan, and generic capsules contain butalbital/ acetaminophen/caffeine in 50 mg/325 mg/40 mg strengths.
  • Esgic, Fioricet, Nonbac, Repan and generic tablets are available in 50 mg/325 mg/40 mg strengths.
  • Esgic-Plus, Zebutal, and generic tablets are available in 50 mg/500 mg/40 mg strengths.
  • Dolgic Plus tablets are available in 50 mg/750 mg/40 mg strength.
  • Generic tablets are also available in reformulated strengths, which contain 300 mg acetaminophen.

How should I keep narcotic analgesic-apap-caffeine-butalbital-oral stored?

STORAGE: Alagesic LQ is stored at room temperature between 20 C to 25 C (68 F to 77 F). Butalbital / acetaminophen / caffeine containing tablets and capsules should be stored between 15 C to to30 to C (59 F to to 86 F).

REFERENCES:

MedlinePlus. Acetaminophen, Butalbital, and Caffeine.

Medscape. butalbital/acetaminophen/caffeine (Rx).

Quick GuideMigraine or Headache? Migraine Symptoms, Triggers, Treatment

Migraine or Headache? Migraine Symptoms, Triggers, Treatment

Summary

Butalbital/acetaminophen/caffeine (Alagesic LQ, Capacet, Dolgic Plus, Esgic, Esgic-Plus, Fioricet, Dolgic LQ, Ezol, Geone, Margesic, Nonbac, Orbivan, Repan, Zebutal) is a combination medication prescribed to great headache. Side effects, drug interactions, dosage, storage, and pregnancy safety information should be reviewed prior to taking this drug.

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Reviewed on 6/23/2014
References
REFERENCES:

MedlinePlus. Acetaminophen, Butalbital, and Caffeine.

Medscape. butalbital/acetaminophen/caffeine (Rx).

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