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Butalbital/Acetaminophen/Caffeine Side Effects & Dosage

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
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?


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


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.

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
    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.

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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

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
  • 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).


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