Side effects: Most common:
drowsiness, stomach upset, lightheadedness, shortness of breath,
abdominal pain, and intoxicated feeling. Less frequent headache,
shaky feeling, numbness seizure, tachycardia, leg pain, muscle
fatigue, irritability, tremor, irregular heartbeat, nephrotoxicity, dizziness, hyperglycemia,
diuresis, fever, earache, nasal congestion, tinnitus, and
allergic reactions, and GI upset (nausea, vomiting, and
Several cases of dermatological reactions have been observed.
Side effects if contains acetaminophen:
rash, thrombocytopenia, and agranulocytosis.
Side effects if contains aspirin: occult
blood loss, anemias, peptic ulcer, prolonged bleeding time, and
acute airway obstruction.
Side effects if contains codeine:
constipation and pruritus.
Drug abuse and dependence:
Butalbital may be habit forming. Tolerance,
physiological dependence and physical dependence may occur
especially with prolonged use of high doses of barbiturates. The
average daily dose for barbiturate addiction is usually about
1500 mg. As tolerance to barbiturates develops, the amount needed
to maintain the same level of intoxication increases; tolerance
to a fatal dose does not increase more than two fold. The lethal
dose of barbiturates is far less is alcohol is also ingested.
Withdrawal symptoms (convulsions and delirium) may occur with in
16 hours and last up to 5 days after abrupt cessation of these
drugs. Intensity of withdrawal symptoms gradually declines over
approximately 15 days. Treatment of barbiturate dependence
requires gradual withdrawal of the drug.
Toxicity from barbiturate:
drowsiness, confusion, coma, respiratory depression, hypotension,
and hypovolemic shock.
Toxicity from acetaminophen:
potentially fatal hepatic necrosis, renal tubular necroses,
hypoglycemic coma and thrombocytopenia. Early symptoms; nausea,
vomiting, diaphoresis and general malaise. Clinical and
laboratory evidence of hepatic toxicity may not be apparent until
48-72 hours post ingestion. In adults hepatic toxicity has rarely
been reported with acute overdose of less than 10 grams or
fatalities with less than 15 grams.
Toxicity from caffeine: insomnia,
restlessness, tremor, delirium, tachycardia, and extrasystoles.
Toxicity from codeine: pinpoint
pupils, respiratory depression, loss of consciousness, and
Toxicity from aspirin: hyperpnea,
acid-base disturbances (metabolic acidosis, vomiting, abdominal
pain, tinnitus, hyperthermia, hypoprothrombinemia, restlessness,
delirium and convulsion.
Toxic and lethal doses:
- Butlabital: Toxic dose 1.0gm. (adult)
Lethal doses 2 to 5 gm.
- Aspirin: Toxic blood level greater
than 30 mg/100ml. Lethal dose 10-30g. (adult)
- Caffeine: Toxic dose greater than 1.0
gm. Lethal dose unknown.
- Codeine: Toxic dose 240 mg. Lethal
dose 0.5 to 1.0 gm (adult).
- Acetaminophen: Toxic dose 10.0gm