Butalbital-APAP-Caffeine Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include: acetazolamide, darunavir, dichlorphenamide, ketorolac, lithium, 6-mercaptopurine, methotrexate, methoxyflurane, mifepristone, phenytoin, sodium oxybate, certain antibiotics (including penicillin, sulfonamides such as sulfamethoxazole), certain drugs used to treat gout (including uricosuric drugs such as probenecid, sulfinpyrazone).

This medication may increase the risk of bleeding when taken with other drugs that also may cause bleeding. Examples include anti-platelet drugs such as clopidogrel, “blood thinners” such as dabigatran/enoxaparin/warfarin, among others.

This drug can speed up the removal of other drugs from your body by affecting certain liver enzymes. These affected drugs include doxycycline, estrogen, felodipine, lonafarnib, quinidine, rilpivirine, tamoxifen, theophylline, voriconazole, certain beta blockers (such as metoprolol), corticosteroids (such as prednisone), among others.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), other drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).

Check the labels on all your medicines (allergy or cough-and-cold products, other headache medications) because they may contain aspirin, caffeine, or ingredients that cause drowsiness. Also keep in mind that certain beverages (such as coffee, colas, tea) contain caffeine. Ask your pharmacist about using those products safely.

Also, check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (NSAIDs such as ibuprofen, naproxen, aspirin) that may increase your risk for side effects if taken together with this medication. However, if your doctor has directed you to take low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams a day), you should continue taking the aspirin unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use additional reliable birth control methods while using this medication. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.

This medication may interfere with certain medical/laboratory tests (including fasting blood glucose, cholesterol levels, prothrombin time, urine 5-HIAA levels, urine VMA levels, certain urine glucose tests, dipyridamole-thallium imaging tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

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Acetaminophen/butalbital/caffeine: 7 things you should know

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Medically reviewed by Carmen Fookes, BPharm. Last updated on Aug 25, 2022.

1. How it works

• Acetaminophen/butalbital/caffeine is a combination pain-reliever (analgesic) containing acetaminophen, butalbital, and caffeine.
• Experts aren’t sure exactly how acetaminophen works, but suspect it may activate descending serotonergic inhibitory pathways in the CNS and other nociceptive pathways (nociceptive pain describes pain from physical or potential damage to the body such as that from a sports injury or dental procedure). Inhibition of the hypothalamic heat-regulating center gives acetaminophen its fever-lowering effect.
• Butalbital belongs to the class of medicines called barbiturates. When used for pain due to tension headaches, experts believe it works by relaxing muscle contractions and causing sedation via an enhancement of the inhibitory effects of GABA (a neurotransmitter that regulates communication between brain cells).
• Caffeine is thought to enhance the pain-relieving effects of acetaminophen by up to 40%. In addition, it has vasoconstrictive properties, narrowing blood vessels in the brain thereby decreasing blood flow and oxygen tension (before a headache or a migraine, blood vessels tend to enlarge). This also helps to relieve pain.
• Acetaminophen/butalbital/caffeine belongs to the class of medicines known as barbiturates because it contains butalbital. It may also be called a combination analgesic.

2. Upsides

• May be used short-term to relieve occasional tension or muscle contraction headaches.
• Available as capsules, tablets, and an oral solution.
• Generic acetaminophen/butalbital/caffeine is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Dizziness, drowsiness, lightheadedness, sedation, shortness of breath, nausea, vomiting, abdominal pain, or an intoxicated feeling are the most commonly reported side effects.
• Other side effects, such as constipation, excessive sweating, itch, and mental confusion are less common.
• Taken every four hours as needed but use should not exceed 6 tablets or capsules daily.
• Butalbital is habit-forming and there is a high risk of dependence with extended and repeated use of acetaminophen/butalbital/caffeine. It can cause drowsiness, sedation, hypnosis, and dose-dependent respiratory depression and is not considered a first-choice medicine for headaches.
• May cause medication-overuse headache with repeated use (more than 3 days per month) and a withdrawal syndrome (symptoms include worsened headache, nausea/vomiting, restlessness, anxiety, disturbed sleep, and sweating) upon discontinuation. When stopping acetaminophen/butalbital/caffeine that has been taken long-term, taper the dose down and discontinue slowly over 2 to 4 weeks. If a person has developed chronic migraines, consider replacing the acetaminophen/butalbital/caffeine with phenobarbital and gradually tapering down.
• The potential for liver damage with the acetaminophen component exists, even at recommended dosages. The risk is increased with higher dosages, with chronic alcohol use, with some medications, and in patients with significant liver disease.
• May not be suitable for some people, including the elderly, people with kidney or liver disease, at risk of misusing substances, or with porphyria. Not to be given to children under the age of 12.
• Although acetaminophen/butalbital/caffeine may be prescribed for migraine headaches, it is not FDA approved for this use and evidence does not support its use for migraine.
• Should not be used during pregnancy or breastfeeding.
• May interact with many other medications including those that also cause sedation such as opioids, benzodiazepines, and sedating antihistamines. Alcohol should be avoided.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

• Acetaminophen/butalbital/caffeine may be used for the short-term treatment of tension-type headaches; however, it is not a first-choice medicine because it is potentially habit-forming and causes sedation. Simpler and safer analgesics or analgesic combinations should be tried first, but if used, acetaminophen/butalbital/caffeine should not be taken for more than 3 days per month.

5. Tips

• May be administered without regard to food; although food may decrease any reported stomach upset.
• Do not overuse acetaminophen/butalbital/caffeine because you may become addicted to it and have difficulty stopping it.
• Over-use of acetaminophen/butalbital/caffeine can also result in a medication-overuse headache (also known as a rebound headache) which occurs when analgesics are taken too frequently to relieve a headache.
• Never share your acetaminophen/butalbital/caffeine with anybody else.
• If you have been taking acetaminophen/butalbital/caffeine regularly, or if you think you have become addicted to it, talk to your doctor about slowly withdrawing it, as sudden withdrawal may precipitate a withdrawal syndrome (symptoms include anxiety, dizziness, hallucinations, muscle twitching, nausea, seizures, sleeplessness, or tremor).
• Acetaminophen/butalbital/caffeine can cause sedation and affect your ability to drive or operate machinery.
• Do not drink more than two alcoholic drinks a day if you are a man or one alcoholic drink per day if you are a woman and taking acetaminophen/butalbital/caffeine.
• Talk to your doctor or pharmacist before taking any other medications or natural products with acetaminophen/butalbital/caffeine as it can interact with a large number of drugs.
• Talk to your doctor if you have any side effects of concern. Seek urgent medical advice if you develop an allergic-type reaction (difficulty breathing or swallowing, rash, or facial swelling) soon after taking acetaminophen/butalbital/caffeine.
• Not recommended for women who are pregnant or breastfeeding.
• Acetaminophen/butalbital/caffeine contains acetaminophen which may be “hidden” in other cough/cold medicines. The total dose of acetaminophen from any source should not exceed 4000mg per day (24 hours).

6. Response and effectiveness

• The pain-relieving effects of acetaminophen are reached within 30-60 minutes of administration.
• Butalbital is well absorbed from the gastrointestinal tract and produces a muscle-relaxing effect and sedation within one to two hours. Butalbital is metabolized in the liver by the CYP450 enzyme system which means it has the potential to interact with a large number of other drugs. Butalbital has an average half-life of around 35 hours, which means it lasts for a long time in the body and repeated doses may have a cumulative effect, increasing the risk of side effects.
• Caffeine is metabolized in the liver to other active substances and has a short half-life (3 to 7 hours).

7. Interactions

Medicines that interact with acetaminophen/butalbital/caffeine may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with acetaminophen/butalbital/caffeine. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with acetaminophen/butalbital/caffeine include:

• acetaminophen
• antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
• anticonvulsants, such as carbamazepine, divalproex, lamotrigine, phenytoin, phenobarbital, or primidone
• antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
• any medication that may cause drowsiness, such as amphetamines, benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, fentanyl, or morphine)
• atomoxetine
• azelastine
• barbiturates
• beta-blockers such as atenolol or sotalol
• buprenorphine
• cannabis
• cyclosporine
• dextromethorphan
• duloxetine
• heart medications such as diltiazem or verapamil
• HIV medications such as ritonavir
• migraine medications, such as ergotamine or dihydroergotamine
• muscle relaxants, such as cyclobenzaprine
• naltrexone
• other medications that contain acetaminophen or an opioid either in combination or as the sole ingredient
• pentazocine
• prilocaine
• rifampin
• sodium oxybate
• tamsulosin
• tramadol
• warfarin.

Avoid drinking alcohol or taking illegal or recreational drugs while taking acetaminophen/butalbital/caffeine because it may enhance the hepatotoxic effect of acetaminophen.

Note that this list is not all-inclusive and includes only common medications that may interact with acetaminophen/butalbital/caffeine. You should refer to the prescribing information for acetaminophen/butalbital/caffeine for a complete list of interactions.

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• Butalbital, acetaminophen, and caffeine (Advanced Reading)
• Butalbital, Acetaminophen, and Caffeine Capsules and Tablets
• Butalbital, Acetaminophen, and Caffeine Solution

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• Headache

References

• Butalbital, Acetaminophen, and Caffeine. Revised 01/2022. Cerner Multum https://www.drugs.com/mtm/acetaminophen-butalbital-and-caffeine.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use acetaminophen/butalbital/caffeine only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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The story of one thing: baseball cap –

baseball cap
history

11/26/2015, 11:49

The holistic perception of the image and its charm always consists of many small details, the selection and combination of which is determined by a sense of style and individual taste.

Every modern person, leading an active lifestyle and occupying a certain social niche, strives to have his own image that will reflect his views, help him express himself and promote success. After all, each person is special in his own way, therefore, his style is unique.

Such uniqueness and personal originality is achieved by combining certain things. But the final completeness of the image and additional “zest”, of course, give accessories.

A stylish and practical accessory that almost everyone wears today is the baseball cap. It not only protects from the sun or light cold, but also piquantly complements the image. Recently, a variety of types of baseball caps have appeared: from warm “winter” caps to the most unusual designer models. And once it was an element of only sports ammunition! How did it happen that the bey cap became such a popular headdress and who first put it on their heads?

The history of this headdress can be guessed from its name. In the middle of the 20th century, it was an important element of sportswear for baseball players. The first standard baseball cap was called “59Fifty” and was released by the American company “New Era”. The classic baseball cap was inspired by jockey helmets (they took shape) and work beanie caps (one sewing technique, “petals connected at the top with a button).

It was very comfortable to wear a baseball cap under the scorching sun: it protected the head from overheating, and the visor prevented the sun from blinding the eyes. Plus, each team had their own branded baseball caps, which supported their overall team style. The first lucky ones to have their heads covered with baseball caps were members of the Brooklyn Excelsiors team in Brooklyn, in connection with which, wearing this hat with a long visor has acquired the name “Brooklyn-style”.

Soon, which is quite logical, baseball players were followed by their fans: in the 1970s and 1980s, sports fans began to actively wear baseball caps to emphasize their respect and passion for one or another baseball team. Now this headgear has also become the equipment of fan clubs.

A little later, the baseball cap found its niche as a part of corporate style, becoming part of the branded clothing of employees of many companies (for example, fast food cafes). In this case, the baseball cap also acted as an advertising medium. And soon the baseball cap became very popular among all the inhabitants of Europe.

So, as is always the case with the rise in popularity, the baseball cap began to change. Initially, baseball caps were produced in different sizes, but in the 80s a special clasp was developed, thanks to which buyers could independently adjust the size to fit their head. This made it possible to produce exactly the same baseball caps, which, of course, significantly simplified the process of their manufacture and increased productivity. The baseball cap is no longer a scarce commodity.

In Russia, this headdress appeared at the beginning of 90-s. But often, even now, baseball caps are confused with caps, believing that they are one and the same. Let’s figure out what the difference is.

The cap is a soft headgear with a soft small visor, without fastening at the back.

Baseball cap, on the other hand, has a rigid visor, which can be of different lengths and shapes, and a fastener at the back to adjust the size.

Modern baseball caps have a wide range of models. The following main types of baseball caps can be distinguished:

– “5-panel Cap”. Such a baseball cap is sewn from five parts: one in front, two on top and one part on the sides. The manufacturer’s logo usually flaunts in front, and there is a fastener for adjusting the size at the back. The visor of this model is straight and may differ in color or material from the main part of the baseball cap.

– “Needle Hat” or “needle hat”. In this case, six parts are used in the manufacture – “petals”, which gradually narrow from the base to the top and are connected with a special button. The peak has a curved shape, and it can also, together with the button, have a different color from the main part of the baseball cap. The company logo is printed on the front. This model can be both with a clasp and without it.

– “Bicycle Cap”. This model is designed for cycling and most of all resembles old baseball caps. The number of “petals” that make up a baseball cap can vary from 2 to 6. The main feature of the model is a very small visor, since a long visor can block the view and move under gusts of wind. There are no fasteners for this option and a thin fabric is used for sewing it, because an equally important headgear for a cyclist is a helmet, which should easily fit over a baseball cap.

– “Trucker Hat”, also known as a trucker’s cap. A very common summer version of a baseball cap. Its main feature is the presence of a plastic mesh, which replaces the rear “petals”. Also, this model is supplied with a clasp and has a fairly voluminous front part that covers the forehead.

– “Fitted Hat” or a straight visor. This is a favorite option for ardent fans of hip-hop culture. The main feature of the model is a straight wide visor and the absence of a fastener. Therefore, you need to select such a baseball cap based on the size ruler.

– “Field Cap / Patrol Cap”. This model is for military and hunters. Or for lovers of military style in clothes. It is sewn from four parts: two panels go in a semicircle, and the top and visor are flat. It does not have fasteners to adjust the size and is most often produced in camouflage or khaki colors.

– “Beanie” Perhaps the most unusual baseball cap model. It looks like a cap with a visor, but it is also sewn from “petals”, which are connected at the top of the cap with a button. The visor of this model is very small and there is no fastener to adjust the size.

In the manufacture of many models of baseball caps, special small holes, called eyelets, are used to ventilate the top of the head. The canvas of the eyelets can be metal, plastic or sheathed with threads. Also, fasteners can be made from different materials. All the seams of baseball caps are always hidden, the “petals” are sewn inside and often they are printed with the brand name.

Now the baseball cap is not just a headdress, but also an important part of the style of every fashionista. She became the true leader of headwear among people of all ages and gender.

Now there are both summer caps and insulated caps for winter. They are sewn from different materials, both natural and synthetic: leather, spandex, elastane, velor, cotton, etc. Baseball caps are decorated with various elements: rhinestones, stripes, chains, sequins; experimenting with colors.

Men, as a rule, rarely choose a hat as an accessory, but a baseball cap is always in their wardrobe! She is a symbol of a sports lifestyle, this headdress gives masculinity and some charm.

And women, thanks to a wide range of models and designer finds, can choose their version of a baseball cap to any Casual look, which makes this accessory extremely versatile.

Incredible but true: even the presidents of the great powers do not hesitate to wear baseball caps.

And Pope Benedict XVI, a famous hat lover, once tried on a cap at the 13th FINA Aquatics Championships in 2009.