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Butalbital, Acetaminophen, and Caffeine



(byoo TAL bi tal, a seet a MIN oh fen, & KAF een)

Brand Names: U.S.

  • Bac
  • Esgic
  • Fioricet
  • Phrenilin Forte [DSC]
  • Vanatol LQ [DSC]
  • Vanatol S [DSC]
  • Vtol LQ [DSC]
  • Zebutal


Use: Labeled Indications

Tension-type headache: Relief of tension-type headache symptoms.

Limitations of use: Because barbiturates have been associated with medication overuse headache, transformation from episodic to chronic headache, and risk of dependence and abuse, reserve use for patients without alternative treatment options (Bigal 2008; CHS [Worthington 2013]; EFNS [Bendtsen 2010]; EHF [Steiner 2019]; Loder 2013). If used, limit to ≤3 days per month to avoid medication overuse headache (Garza 2006); studies have found increased risk with use of ≥5 days per month (Da Silva 2014). Safety and efficacy for the treatment of multiple recurrent headaches have not been established.

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