Butal-APAP is the brand name of an oral prescription drug that contains butalbital and acetaminophen. Butalbital is a sedative in the barbiturate drug group. Acetaminophen is an over-the-counter pain reliever. Butal-APAP is used for the treatment of severe tension headaches and other pain conditions.
Drowsiness and Sedation
Like all barbiturates, butalbital causes central nervous system depression, which may be more pronounced in some people than in others. In typical doses, Butal-APAP is intended to produce a calming effect. However, people may experience drowsiness and sedation. For this reason, people taking this medication are advised not to operate heavy machinery, perform any potentially dangerous tasks or drive while under the influence of the medication.
Light-Headedness and Dizziness
Light-headedness and dizziness are frequent side effects of Butal-APAP. These may be due to the depressive effects of butalbital on the central nervous system or a slight drop in blood pressure.
Shortness of Breath
Shortness of breath is a frequent side effect of Butal-APAP. Note that taking this medication in larger doses than prescribed or more frequently than prescribed can cause severe, potentially life-threatening respiratory depression. Butalbital-related respiratory depression is exaggerated by alcohol.
Nausea, Vomiting and Gastrointestinal Disturbances
Nausea, vomiting and abdominal pain are reported side effects of Butal-APAP. Other possible gastrointestinal side effects include dry mouth, heartburn, constipation and increased intestinal gas.
Intoxication and Euphoria
Butal-APAP can cause a sense of intoxication; this may be accompanied by euphoria (an inexplicable sense of intense happiness). Butalbital is prone to abuse and can be habit-forming. These side effects, if experienced, may contribute to the potential abuse of Butal-APAP.
Muscle Pain and Fatigue
Muscle pain, especially in the legs, is a reported side effect of Butal-APAP. Muscle fatigue also has been reported.
Tachycardia
The butalbital in Butal-APAP may cause tachycardia (a high heart rate) in response to a slight drop in blood pressure that can occur with this medication.
Mild to Severe Skin Reactions
Butal-APAP may cause generalized itching. More severe skin reactions with extensive rashes (erythema multiforme) and possibly blistering and peeling of the outermost layer of the skin uncommonly occur.
Blistering and peeling of the skin occurs with Stevens-Johnson syndrome and toxic epidermal necrolysis. The difference between these two conditions is the total body surface area involved. Stevens-Johnson syndrome is the less severe of the two conditions; less than 10 percent of the skin surface is involved. Both conditions are potentially life-threatening due to susceptibility to severe infection related to the large skin wounds.
Severe Allergic Reactions
Either of the drugs in Butal-APAP can cause severe allergic reactions. Hives, chest tightness, swelling of the face, lips, mouth, tongue or throat, and breathing difficulty may occur within minutes to hours of taking the medication. Breathing difficulty is a medical emergency; seek help immediately.
References
- "Goodman & Gilman's The Pharmacological Basis of Therapeutics"; Laurence L. Brunton, et al, Editors; 2005
- Drugs.com: Butalbital and Acetaminophen
- Drugs.com: Acetaminophen
- Drug Bank: Butalbital
- MedlinePlus: Acetaminophen, Butalbital, and Caffeine



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