Butalbital is a barbiturate, so it can cause intense relaxation. In the United States, this prescription drug is most often found in combination with acetaminophen and caffeine as a medication called Fioricet, which relieves tension headaches and is sometimes prescribed to manage migraines. Because of the presence of butalbital, however, Fioricet may be addictive, and it can be diverted for abuse.
Like other barbiturates, butalbital is a sedative that affects the gamma-aminobutyric acid (GABA) production in the brain. This sedative has an intermediate effect compared to other barbiturates. The most common effects of butalbital are dose-dependent, but it may induce mild sedation, relaxation of anxiety or panic, pain relief, hypnosis, respiratory depression, and coma. At high therapeutic doses, butalbital can cause anesthesia.
Alcohol also acts on the GABA receptors and is considered a central nervous system (CNS) depressant. Combining any barbiturate, including butalbital, with alcohol can increase both drugs’ sedative effects, which can be life-threatening.
Why Is Butalbital Dangerous?
Barbiturates are not prescribed often anymore because benzodiazepines are more effective to treat anxiety, and drugs like Ambien or Lunesta are more effective for managing insomnia. Barbiturates, from phenobarbital to butalbital, have fallen out of favor as prescription substances because they can so quickly lead to intoxication, abuse, and compulsive behaviors. However, there are some instances where a potent sedative-like butalbital is important.
- Drowsiness or sleepiness
- Poor concentration
- Slurred speech
- Loss of physical coordination
- Problems with movement
- Poor memory
- Low blood pressure
- Depressed, irregular, or shallow breathing
As with other barbiturates, effects from abusing butalbital may include:
- Frequent intoxication or appearing drunk
- Paradoxical anxiety or jitteriness
- Mood changes
- Physical numbness
- Recklessness or poor decision-making
- Excessive sleep or changes to sleep cycles
Taking butalbital for a long time can lead to dependence and tolerance. The brain gets used to the presence of butalbital, so you may feel like you need more of the drug to get the original, relaxing effects; at the same time, you may feel like you need the drug regularly to feel normal. Taking a medication like butalbital as prescribed is less likely to cause long-term harm or addiction because you will have a physician’s oversight. If you report feeling fewer effects, for example, your doctor may switch your medication or adjust the dose. Do not make changes to your prescription yourself.
Barbiturates like butalbital can lead to severe withdrawal symptoms, which may feel worse than other sedatives. Withdrawing from butalbital will likely feel similar to alcohol withdrawal, including symptoms like increased anxiety, insomnia, and a risk of seizures.
What Happens When Butalbital and Alcohol Are Mixed?
Warnings on prescription drugs like Fioricet that contain butalbital state clearly that mixing the medication with alcohol is extremely dangerous. Because alcohol acts on the same area of the brain as butalbital, it can increase the drug’s sedative effects, especially slower heart rate and shallow breathing, which increases the risk of coma and death.
People who take prescription drugs may have the occasional social drink, which may increase intoxication both from alcohol and from the medication; however, people who struggle with alcohol abuse or who drink heavily are much more likely to experience harmful interactions between alcohol and the drugs they take. Because butalbital acts on the GABA receptors just like alcohol does, people who have a history of alcohol use disorder or who have overcome problem drinking are at greater risk for abusing butalbital drugs.
If you take Fioricet specifically, the caffeine offsets some of the sedative effects of the barbiturate. Drinking alcohol on top of the medication, however, will override the mild stimulant, so you may feel more exhausted, relaxed, or high. You are also more likely to pass out, which can lead to physical harm from falling, vomiting, or oxygen deprivation.
Worries of Mixing Alcohol with Other Drugs
Butalbital Overdose and Other Risks of Mixing with Alcohol
The biggest risk of mixing two depressants like alcohol and butalbital is overdose. If you see someone overdosing on sedatives, including barbiturates, alcohol, or both, immediately call 911. The person needs emergency medical attention.
- Altered consciousness
- Trouble thinking or remembering
- Faulty judgment
- Trouble with coordination
- Shallow or irregular breathing
- Slow, slurred speech
- Extreme fatigue
- Staggering or loss of balance
- Oxygen deprivation
Mixing alcohol with barbiturates makes it harder for the liver to metabolize the drug. The presence of alcohol increases the half-life of many barbiturates, keeping the drug active in the bloodstream for longer. When mixed with alcohol, less butalbital can cause a deadly overdose.
Both barbiturate drugs like butalbital and alcohol cause harm to the liver. Cirrhosis, jaundice, and liver failure are all long-term risks of this combination.
End Alcohol or Barbiturate Dependence
If you struggle with alcohol abuse, barbiturate addiction, or both, you must get help to safely detox from these drugs. Medical oversight reduces the risk of a seizure disorder during withdrawal, which both butalbital and alcohol abuse can cause and becomes a greater risk when the two drugs are combined. Once detox has been completed, an evidence-based rehabilitation program can help you avoid intoxicating substances and reduce your risk of relapse.