Butalbital Acetaminophen Caffeine, Bac, Zebutal

Written by Helen Marshall BPharm MRPharmS
Medically reviewed by Dana Kim, PharmD
Updated on June 28, 2023

This article describes butalbital/acetaminophen/caffeine’s uses, side effects, and more. You’ll also find some coupon options to help save on the cost of butalbital/acetaminophen/caffeine.

Boxed warning: Risk of serious liver problems

Butalbital/acetaminophen/caffeine has a boxed warning about the risk of serious liver problems. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

For details, see the “Interactions and warnings for butalbital/acetaminophen/caffeine” section.

Below you’ll find answers to a few commonly asked questions about butalbital/acetaminophen/caffeine.

What brand names are available for butalbital/acetaminophen/caffeine?

At this time, butalbital/acetaminophen/caffeine is only available as a generic drug. In the past, some brand-name versions of this medication included Esgic, Triad, and Femcet. But all brand-name versions have been discontinued.

Talk with your doctor or pharmacist if you have questions about the drug’s availability.

Can butalbital/acetaminophen/caffeine cause withdrawal, misuse, and dependence?

Yes, it can. The medication contains butalbital, which is a barbiturate drug that has risks of misuse, dependence, and withdrawal.

Misuse means taking a drug in a way other than how a doctor prescribes it. Misuse of butalbital/acetaminophen/caffeine can cause a potentially fatal overdose. It can also lead to dependence, which means your body needs the drug to function like usual.

Taking the medication long term can also lead to dependence. If you become dependent on it, you may have withdrawal symptoms if you suddenly stop taking it. Withdrawal symptoms are side effects that can occur when you stop taking a drug your body is used to.

Due to these risks, doctors usually only prescribe butalbital/acetaminophen/caffeine for a short time. You should only take it as your doctor recommends. Do not take higher or more frequent doses. And do not take the drug for longer than your doctor prescribes.

If you have more questions about withdrawal, misuse, or dependence, talk with your doctor.

Is butalbital/acetaminophen/caffeine similar to ibuprofen?

No, it’s not. Doctors may prescribe both butalbital/acetaminophen/caffeine and ibuprofen (Advil, Motrin) for tension headaches. Both drugs are pain relievers, but they work in different ways and can cause different side effects.

Butalbital/acetaminophen/caffeine contains a barbiturate drug that has risks of misuse, dependence, and withdrawal. For this reason, the medication is only available with a prescription. Ibuprofen is an anti-inflammatory pain reliever that you can get over the counter.

It’s usually safe to take these drugs together. To learn more about the differences between them, talk with your doctor or pharmacist.

How does butalbital/acetaminophen/caffeine work? And how long does it take to start working?

Butalbital/acetaminophen/caffeine contains three active drugs that work in different ways to relieve tension headaches. An active drug is an ingredient that makes a drug work.

Butalbital has a calming effect on your brain and nervous system. It reduces anxiety and relaxes muscles, which can help ease tension that can cause headaches. Acetaminophen works by reducing pain messages that your brain receives. And caffeine is a stimulant that increases the pain-relieving effect of acetaminophen.

The drug usually starts working within 1 hour after taking a dose. Its pain-relieving effects usually last for about 4 hours, but each active drug has a different half-life. (A drug’s half-life describes the length of time it takes your body to remove half a dose of the drug.) Butalbital is cleared from your body slower than acetaminophen and caffeine.

For more information about how the drug works, talk with your doctor or pharmacist.

Can butalbital/acetaminophen/caffeine be used for a caffeine headache?

No, it should not be taken for a caffeine headache (also called a caffeine withdrawal headache). This type of headache can occur if your body is used to having caffeine and suddenly stops having it. Caffeine narrows blood vessels in your brain, and they widen without it.

You can treat a caffeine headache with an over-the-counter pain reliever. Examples of these include acetaminophen, ibuprofen, and aspirin. Or you could take a pain reliever that has caffeine as an ingredient. But medications containing butalbital aren’t usually prescribed for this type of headache.

To find out more about treating caffeine headaches, talk with your doctor.

Butalbital/acetaminophen/caffeine may cause mild or serious side effects. More common mild side effects of butalbital/acetaminophen/caffeine and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about butalbital/acetaminophen/caffeine’s side effects, ask your doctor or pharmacist. You can also read the prescribing information for butalbital/acetaminophen/caffeine in the “Article resources” section.

Mild side effects

More common mild side effects reported with some forms of butalbital/acetaminophen/caffeine are listed below.

This article doesn’t include all possible mild side effects of the drug. To learn more about butalbital/acetaminophen/caffeine’s side effects, see the prescribing information for butalbital/acetaminophen/caffeine in the “Article resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Mild side effects of butalbital/acetaminophen/caffeine oral tablet and oral capsule include:

• drowsiness
• feeling dizzy or lightheaded
• nausea and vomiting
• shortness of breath
• mild allergic reaction*

* For details about this side effect, see the “Interactions and warnings for butalbital/acetaminophen/caffeine” section.

Serious side effects

Serious side effects of butalbital/acetaminophen/caffeine are listed below.

This article doesn’t include all possible serious side effects of the drug. To learn more about butalbital/acetaminophen/caffeine’s side effects, see the prescribing information for butalbital/acetaminophen/caffeine in the “Article resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, serious side effects of butalbital/acetaminophen/caffeine include:

• boxed warning: risk of serious liver problems*
• severe allergic reaction*
• risks of misuse, dependence, and withdrawal if taken for long time periods†

* For details about this side effect, see the “Interactions and warnings for butalbital/acetaminophen/caffeine” section.
† To learn more about this side effect, see the “Common questions about butalbital/acetaminophen/caffeine” section.

Below, you’ll find information about butalbital/acetaminophen/caffeine’s possible interactions and warnings.

Interactions of butalbital/acetaminophen/caffeine

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol* or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take butalbital/acetaminophen/caffeine, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for butalbital/acetaminophen/caffeine” section below.

* It’s recommended that you do not consume alcohol while taking butalbital/acetaminophen/caffeine. Talk with your doctor if you have concerns about avoiding alcohol while taking this drug.

Warnings for butalbital/acetaminophen/caffeine

Some people should not take butalbital/acetaminophen/caffeine, and others should take it cautiously.

Boxed warning: Risk of serious liver problems

Butalbital/acetaminophen/caffeine has a boxed warning about the risk of serious liver problems. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

Taking too much acetaminophen can cause serious liver problems, such as liver failure, which may lead to death. Do not take more butalbital/acetaminophen/caffeine than your doctor prescribes. And do not take it with other medications containing acetaminophen, such as Tylenol. Be sure to check the ingredients of any other medications before taking them with butalbital/acetaminophen/caffeine.

If you accidentally take more than 4,000 milligrams (mg) of acetaminophen in a day, call your doctor right away, even if you feel well. For more information about overdose, see the “Interactions and warnings for butalbital/acetaminophen/caffeine” section.

To learn more, talk with your doctor or pharmacist.

Other warnings

Butalbital/acetaminophen/caffeine could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether this drug is a safe option for you.

Ask your doctor about specific warnings for butalbital/acetaminophen/caffeine, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Butalbital/acetaminophen/caffeine can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to butalbital/acetaminophen/caffeine or any of its ingredients, your doctor will likely not prescribe butalbital/acetaminophen/caffeine. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to butalbital/acetaminophen/caffeine, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of butalbital/acetaminophen/caffeine

You should not take more butalbital/acetaminophen/caffeine than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much butalbital/acetaminophen/caffeine, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and butalbital/acetaminophen/caffeine

Information about butalbital/acetaminophen/caffeine and pregnancy and breastfeeding is described below.

Butalbital/acetaminophen/caffeine and pregnancy

It’s not known whether butalbital/acetaminophen/caffeine should be taken during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking this medication.

Butalbital/acetaminophen/caffeine and breastfeeding

Butalbital/acetaminophen/caffeine should not be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this medication. Your doctor may recommend other ways to feed your child during treatment with butalbital/acetaminophen/caffeine.

The Food and Drug Administration (FDA) approves prescription drugs such as butalbital/acetaminophen/caffeine for certain conditions. One approved use for this medication is described below.

Use for tension headaches

Doctors may prescribe butalbital/acetaminophen/caffeine for treating tension headaches. It’s prescribed for this purpose in adults and children ages 12 years and older. It’s usually prescribed as a short-term treatment.

With tension headaches, you have a feeling of pressure around your forehead and temples. It may feel like a tight band is being squeezed around your head. Tension headaches can have many causes, including stress, eye strain, and muscle tension in your neck or jaw.

Your doctor may prescribe butalbital/acetaminophen/caffeine for tension headaches if other pain relievers don’t work to relieve your symptoms. You should only take this drug as your doctor prescribes. Taking it too often can cause more headaches. It can also lead to dependence,* which means your body needs the drug to function like usual.

Talk with your doctor to learn more about taking this drug to treat tension headaches.

* For details about this side effect, see the “Common questions about butalbital/acetaminophen/caffeine” section.

This article describes butalbital/acetaminophen/caffeine’s uses and side effects, ways to save on cost, and more. Let your doctor know if you have questions about butalbital/acetaminophen/caffeine or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• Can older people take butalbital/acetaminophen/caffeine?
• How long can I take butalbital/acetaminophen/caffeine for?
• What else can I do to manage tension headaches?

• Butalbital, acetaminophen, and caffeine tablets, USP. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/4ecb7bdc-4a43-7444-e054-00144ff88e88/spl-doc
• Butalbital, acetaminophen, and caffeine capsules, USP. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/3875c01b-7cd6-4bed-8d4e-c580c5540860/spl-doc
• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.