Butalbital, Acetaminophen, Caffeine, and Codeine (Oral)

The Butalbital, Acetaminophen, Caffeine, and Codeine combination is used to treat tension headaches. The combination is administered orally as a tablet.


Tension headaches are common forms of headaches that can feel like the sensation of having a tight elastic band gripping around the head. Pain levels can vary from mild, to moderate to severe and can be felt in the head, neck and behind the eyes. In the most extreme cases, tension headaches can be a chronic condition and can seriously and negatively impact on a person's quality of life. Caused by muscle contractions in the head and neck areas, they cause a dull and constant aching pain (in contrast to a migraine, in which the patient usually experiences bouts of throbbing pain either side of the head). Many people experience tension headaches periodically, typically taking place once to twice per month. They affect around 3% of the population of the United States and are twice as common in women than they are in men.

Butalbital, Acetaminophen, Caffeine, and Codeine are often used when a tension headache has reached a more severe level, and regular over the counter medications such as ibuprofen or aspirin have failed to work.

Butalbital is a part of a family of drugs called the barbiturates. These drugs act on the central nervous system (CNS) to help control its impact on the body.

Acetaminophen is a painkiller that is used to reduce painful symptoms and decrease fever in patients. Patients who take large quantities of this drug, or take it for a long period of time, may experience unwanted side effects, such as liver damage. In very rare cases, this damage has led to the need for transplantations and even death.

Caffeine is a stimulant that is often used alongside painkillers to heighten their impact and help to relieve the drowsiness that is often a symptom of such drugs. It is also often used to relieve migraines.

Codeine is part of a family of drugs called narcotic analgesics (painkillers). It also works by acting on the central nervous system to reduce pain symptoms. Codeine has addictive qualities and therefore prolonged use can lead to physical and mental dependency. Codeine dependency can also lead the patient to experience withdrawal symptoms if the drug is suddenly stopped. For example, those taking codeine to relieve migraines may experience bouts of headaches once the medication is stopped.

This combination of four drugs is only available as a prescription from a qualified health care professional and is supplied to patients in the form of a capsule to be taken orally. Tension headaches may be caused or set off by a number of factors; therefore, other forms of treatment or lifestyle changes may be recommended by a doctor in addition to the prescription of Butalbital, Acetaminophen, Caffeine, and Codeine. Triggers of the condition can include alcohol, dry or strained eyes, fatigue, smoking, flu, cold, staring at a computer screen for too long, bad posture, stress and anxiety, excessive caffeine intake or a sinus infection. Cutting out on these problematic lifestyle factors may aid the effectiveness of your Butalbital, Acetaminophen, Caffeine, and Codeine prescription.

Conditions treated

  • Tension headaches - chronic or severe

Type of medicine

  • Oral - capsule

Side effects

As with any medication, taking Butalbital, Acetaminophen, Caffeine, and Codeine can produce some unwanted side effects. Many people will be able to take the drug without feeling anything. And others may find that their side effects are better than living with the pain of tension headaches. Common side effects include, but are not limited to, the below. They are usually nothing to worry about, but should be reported to a doctor if they become too severe or persistent:

  • Dry mouth
  • Nausea or vomiting
  • Tiredness or drowsiness
  • Sleeping more than normal
  • Constipation

There are some side effects that can be a sign of a serious adverse reaction to Butalbital, Acetaminophen, Caffeine, and Codeine. You should call your health care professional for advice as soon as you notice any of the following, and should stop taking your Butalbital, Acetaminophen, Caffeine, and Codeine combination immediately:

  • Breathing problems
  • Confusion or dizziness
  • Anxiety
  • Depression
  • Change in heartbeat e.g. faster, slower or more irregular
  • Seizures
  • Allergic reactions, such as rashes on the skin, swelling of the facial areas, hives, itchiness
  • Peeling of the skin
  • Loosening of the skin
  • Blistering
  • Peeling, sores or blistering inside the mouth
  • Trouble going to the toilet
  • Passing more or less urine than usual
  • Jaundice in the eyes or skin
  • Low blood pressure - symptoms include dizziness, feeling faint, fainting, weakness, excessive tiredness


This drug combination is usually given to patients at the following dosage:

  • Acetaminophen 325 mg
  • Butalbital 50 mg
  • Caffeine 40 mg
  • Codeine 30 mg

Each dose of one to two tablets should be taken orally every four hours if needed - at the advice of your doctor and depending on the severity of your tension headaches. You should always take your medication with a glass of water to help it reach the stomach. Take it at meal times and at the same time each day. You should not exceed six tablets in any 24 hour period. This drug contains addictive qualities so should not be used as a long-term treatment.

Patients should never attempt to up their dosage of Butalbital, Acetaminophen, Caffeine, and Codeine themselves, as the impact may be harmful. If an unauthorized dosage increase of Butalbital, Acetaminophen, Caffeine, and Codeine is taken, you may experience the side effects of an overdose and immediate medical attention may need to be sought.

If you think that your Butalbital, Acetaminophen, Caffeine, and Codeine prescription is not working, or your symptoms are not improving, you should contact your doctor for advice; you may be prescribed something different to help with your condition.

Likewise, do not suddenly stop taking your Butalbital, Acetaminophen, Caffeine, and Codeine medication. This may cause your body to have a severe withdrawal reaction as it will have become used to the medication. If you think that your prescription of Butalbital, Acetaminophen, Caffeine, and Codeine is not working, or is causing you adverse side effects, you should seek the advice of a trained medical professional before stopping the course. It may be that you need to come off the medication gradually to prevent your body from having withdrawal symptoms.


As tablets of this medication contain four separate drugs, there is an increased risk that other medications you may be taking could cause an interaction with one of the substances. There are, as such, a large number of drugs that you should not take while taking Butalbital, Acetaminophen, Caffeine, and Codeine prescriptions. You should always tell your doctor about any other medications you take, as this may alter the prescription given to you.

There are 1,145 drugs that interact with Butalbital, Acetaminophen, Caffeine, and Codeine. These are categorized into three levels - minor, moderate and major. Minor interactions are often acceptable and, if you are taking any of these drug combinations, your doctor may still prescribe you the same medications. Interactions on a moderate level should generally be avoided except in exceptional circumstances. Major drug interactions should be avoided at all times, as the risk to a patient's health will have been deemed to be greater than any health benefits offered.

There are 316 drugs (1,297 generic and brand names) that have been found to have a major interaction with Butalbital, Acetaminophen, Caffeine, and Codeine. These are listed below:

  • Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine
  • Acetaminophen, Caffeine, Dihydrocodeine
  • Acetaminophen, Chlorpheniramine, Codeine
  • Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine
  • Acetaminophen, Dichloralphenazone, Isometheptene Mucate
  • Acetaminophen, Hydrocodone
  • Acetaminophen, Oxycodone
  • Acetaminophen, Pentazocine
  • Acetaminophen, Propoxyphene
  • Acetaminophen, Tramadol
  • Acetylcarbromal
  • Alfentanil
  • Alprazolam
  • Alvimopan
  • Aminophylline, Amobarbital, Ephedrine
  • Aminophylline, Ephedrine, Guaifenesin, Phenobarbital
  • Aminophylline, Ephedrine, Phenobarbital, Potassium Iodide
  • Amitriptyline, Chlordiazepoxide
  • Amitriptyline, Perphenazine
  • Ammonium Chloride, Chlorpheniramine, Codeine, Phenylephrine
  • Amobarbital
  • Amobarbital, Secobarbital
  • Amyl Nitrite, Sodium Nitrite, Sodium Thiosulfate
  • Anisindione
  • Aripiprazole
  • Asenapine
  • Aspirin, Butalbital
  • Aspirin, Butalbital, Caffeine
  • Aspirin, Butalbital, Caffeine, Codeine
  • Aspirin, Caffeine, Dihydrocodeine
  • Aspirin, Caffeine, Orphenadrine
  • Aspirin, Caffeine, Propoxyphene
  • Aspirin, Carisoprodol
  • Aspirin, Carisoprodol, Codeine
  • Aspirin, Codeine
  • Aspirin, Hydrocodone
  • Aspirin, Meprobamate
  • Aspirin, Methocarbamol
  • Aspirin, Oxycodone
  • Aspirin, Pentazocine
  • Atropine, Hyoscyamine, Phenobarbital, Scopolamine
  • Atropine, Phenobarbital
  • Baclofen
  • Baclofen, Flurbiprofen, Lidocaine Topical
  • Belladonna, Butabarbital
  • Belladonna, Caffeine, Ergotamine, Pentobarbital
  • Belladonna, Ergotamine, Phenobarbital
  • Benzoic acid, Hyoscyamine, Methenamine, Methylene blue, Phenyl salicylate
  • Brexpiprazole
  • Bromodiphenhydramine, Codeine
  • Brompheniramine, Codeine
  • Brompheniramine, Codeine, Phenylephrine
  • Brompheniramine, Codeine, Phenylpropanolamine
  • Brompheniramine, Codeine, Pseudoephedrine
  • Brompheniramine, Dihydrocodeine, Phenylephrine
  • Brompheniramine, Dihydrocodeine, Pseudoephedrine
  • Brompheniramine, Hydrocodone, Phenylephrine
  • Brompheniramine, Hydrocodone, Pseudoephedrine
  • Bupivacaine, Fentanyl
  • Bupivacaine, Hydromorphone
  • Bupivacaine, Sufentanil
  • Buprenorphine
  • Buprenorphine, Naloxone
  • Bupropion
  • Bupropion, Naltrexone
  • Buspirone
  • Butabarbital
  • Butabarbital, Hyoscyamine, Phenazopyridine
  • Butorphanol
  • Carbinoxamine, Hydrocodone, Phenylephrine
  • Carbinoxamine, Hydrocodone, Pseudoephedrine
  • Cariprazine
  • Carisoprodol
  • Chloral hydrate
  • Chlorcyclizine, Codeine
  • Chlorcyclizine, Codeine, Phenylephrine
  • Chlorcyclizine, Codeine, Pseudoephedrine
  • Chlordiazepoxide
  • Chlordiazepoxide, Clidinium
  • Chlordiazepoxide, Methscopolamine
  • Chlormezanone
  • Chlorphenesin
  • Chlorpheniramine, Codeine
  • Chlorpheniramine, Codeine, Phenylephrine
  • Chlorpheniramine, Codeine, Phenylephrine, Phenylpropanolamine
  • Chlorpheniramine, Codeine, Phenylephrine, Potassium iodide
  • Chlorpheniramine, Codeine, Pseudoephedrine
  • Chlorpheniramine, Dihydrocodeine, Phenylephrine
  • Chlorpheniramine, Dihydrocodeine, Phenylephrine, Phenylpropanolamine
  • Chlorpheniramine, Dihydrocodeine, Pseudoephedrine
  • Chlorpheniramine, Guaifenesin, Hydrocodone, Pseudoephedrine
  • Chlorpheniramine, Hydrocodone
  • Chlorpheniramine, Hydrocodone, Phenylephrine
  • Chlorpheniramine, Hydrocodone, Pseudoephedrine
  • Chlorpromazine
  • Chlorzoxazone
  • Clobazam
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Codeine, Dexbrompheniramine, Pseudoephedrine
  • Codeine, Dexchlorpheniramine, Phenylephrine
  • Codeine, Diphenhydramine, Phenylephrine
  • Codeine, Pheniramine, Phenylephrine, Sodium citrate
  • Codeine, Phenylephrine, Promethazine
  • Codeine, Phenylephrine, Pyrilamine
  • Codeine, Phenylephrine, Triprolidine
  • Codeine, Promethazine
  • Codeine, Pseudoephedrine, Pyrilamine
  • Codeine, Pseudoephedrine, Triprolidine
  • Codeine, Pyrilamine
  • Conjugated estrogens, Meprobamate
  • Cyclobenzaprine
  • Dantrolene
  • Dexbrompheniramine, Hydrocodone, Phenylephrine
  • Dexchlorpheniramine, Hydrocodone, Phenylephrine
  • Dezocine
  • Diazepam
  • Dicumarol
  • Dihydrocodeine, Guaifenesin
  • Dihydrocodeine, Guaifenesin, Phenylephrine
  • Dihydrocodeine, Guaifenesin, Pseudoephedrine
  • Dihydrocodeine, Phenylephrine
  • Dihydrocodeine, Phenylephrine, Pyrilamine
  • Diphenhydramine, Hydrocodone, Phenylephrine
  • Droperidol
  • Droperidol, Fentanyl
  • Dyphylline, Ephedrine, Guaifenesin, Phenobarbital
  • Ephedrine, Hydroxyzine, Theophylline
  • Ephedrine, Phenobarbital, Potassium iodide, Theophylline
  • Ephedrine, Phenobarbital, Theophylline
  • Epinephrine, Prilocaine
  • Estazolam
  • Eszopiclone
  • Ethanol
  • Ethchlorvynol
  • Fentanyl
  • Fentanyl, Ropivacaine
  • Fluoxetine, Olanzapine
  • Fluphenazine
  • Flurazepam
  • Furazolidone
  • Guaifenesin, Hydrocodone
  • Guaifenesin, Hydrocodone, Pheniramine, Phenylephrine, Phenylpropanolamine
  • Guaifenesin, Hydrocodone, Pheniramine, Phenylpropanolamine, Pyrilamine
  • Guaifenesin, Hydrocodone, Phenylephrine
  • Guaifenesin, Hydrocodone, Pseudoephedrine
  • Guaifenesin, Hydromorphone
  • Halazepam
  • Haloperidol
  • Hemin
  • Heroin
  • Homatropine, Hydrocodone
  • Hydrocodone
  • Hydrocodone, Ibuprofen
  • Hydrocodone, Pheniramine, Henylephrine, Phenylpropanolamine, Pyrilamine
  • Hydrocodone, Phenylephrine
  • Hydrocodone, Phenylephrine, Pyrilamine
  • Hydrocodone, Phenylpropanolamine
  • Hydrocodone, Potassium guaiacolsulfonate
  • Hydrocodone, Potassium guaiacolsulfonate, Pseudoephedrine
  • Hydrocodone, Pseudoephedrine
  • Hydrocodone, Pseudoephedrine, Triprolidine
  • Hydromorphone
  • Hydromorphone, Ropivacaine
  • Hydroxyzine
  • Hyoscyamine, Methenamine, Methylene blue, Phenyl salicylate
  • Hyoscyamine, Methenamine, Methylene blue, Phenyl salicylate, Sodium biphosphate
  • Hyoscyamine, Methenamine, Methylene blue, Sodium biphosphate
  • Hyoscyamine, Phenobarbital
  • Ibuprofen, Oxycodone
  • Iloperidone
  • Iohexol
  • Iopamidol
  • Isocarboxazid
  • Leflunomide
  • Levomethadyl acetate
  • Levorphanol
  • Lidocaine, prilocaine topical
  • Lomitapide
  • Lorazepam
  • Loxapine
  • Lurasidone
  • Meperidine
  • Meperidine, Promethazine
  • Mephobarbital
  • Meprobamate
  • Mesoridazine
  • Metaxalone
  • Methadone
  • Methocarbamol
  • Methylene blue
  • Metrizamide
  • Mipomersen
  • Molindone
  • Morphine
  • Morphine liposomal
  • Morphine, Naltrexone
  • Nalbuphine
  • Naloxone, Oxycodone
  • Naloxone, Pentazocine
  • Naltrexone
  • Naltrexone, Oxycodone
  • Olanzapine
  • Orphenadrine
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Paliperidone
  • Paraldehyde
  • Pentazocine
  • Pentobarbital
  • Perphenazine
  • Phenelzine
  • Phenobarbital
  • Pimavanserin
  • Pimozide
  • Prilocaine
  • Primidone
  • Procarbazine
  • Promazine
  • Propiomazine
  • Propoxyphene
  • Quazepam
  • Quetiapine
  • Ramelteon
  • Ranolazine
  • Remifentanil
  • Risperidone
  • Ropivacaine, sufentanil
  • Secobarbital
  • Sodium nitrite
  • Sodium nitrite, Sodium thiosulfate
  • Sodium oxybate
  • Sufentanil
  • Suvorexant
  • Tapentadol
  • Tasimelteon
  • Temazepam
  • Teriflunomide
  • Thioridazine
  • Thiothixene
  • Tizanidine
  • Tramadol
  • Tranylcypromine
  • Triazolam
  • Trifluoperazine
  • Triflupromazine
  • Warfarin
  • Zaleplon
  • Ziprasidone
  • Zolpidem



Alcohol (ethanol) causes a reaction in all of the drugs present in this medication. You should therefore refrain from consuming alcohol while you are taking this medication. Not only will it react with Butalbital, Acetaminophen, Caffeine, and Codeine and cause unwanted side effects, it will also be likely to result in further bouts of tension headaches. If you consume alcohol while taking this medication, you will be more vulnerable to the effects of alcohol and the side effects will be more severe. You are likely to experience nausea, vomiting, severe headaches, dizziness and drowsiness. In some cases, you may experience fainting, low blood pressure, coma or even death.

If you need help or advice on how to stop drinking, you should contact a local support group of a health care professional. If you do not think you can quit drinking immediately, your doctor may prescribe you a different medication to treat tension headaches. However, a lifestyle change will be advised first and foremost to quit or cut down on alcohol consumption.


You should not normally need to alter your diet when taking a prescription of Butalbital, Acetaminophen, Caffeine, and Codeine. However, your doctor may have recommendations regarding diet plans. There may also be certain supplements and additives that you consume that could impact on the effectiveness of your medication and should therefore be avoided. You should always tell your doctor about any vitamins and supplements you are taking.


Nicotine has a major interaction with codeine. You should not smoke while taking codeine as this will put you at serious risk of coma, respiratory diseases, heart failure and even death.

Nicotine also has a moderate reaction with acetaminophen and a minor reaction with caffeine. You are at increased risk of developing symptoms such as excessive tiredness, weakness, bleeding in unusual places, vomiting, nausea, skin rashes, fever, chills and joint pain if you continue to smoke while taking a Butalbital, Acetaminophen, Caffeine, and Codeine prescription. If you are worried about the implications of smoking on your health, you should speak to a smoking helpline, charity or medical professional for advice on how to quit your habit.

High blood pressure (hypertension)

High blood pressure has a major interaction with central nervous system stimulants. Therefore, if you suffer from high blood pressure - or if you are vulnerable or at risk of developing it - you should not take Butalbital, Acetaminophen, Caffeine, and Codeine to treat your tension headaches. An alternative treatment should be recommended by your health care professional.

If you suffer from high blood pressure and start to take Butalbital, Acetaminophen, Caffeine, and Codeine, you are at risk of sudden death, severe hypertension, heart failure, coronary disease or serious arrhythmias. You may also be at risk from other severe health implications, such as suffering a stroke, or experiencing severe chest pain or problems breathing.

Disease and condition interactions

There are 39 disease or condition interactions with this medication. You should always tell your doctor if you have any other conditions or diseases. This might affect the suitability of Butalbital, Acetaminophen, Caffeine, and Codeine for treating your condition. You should also tell your doctor about any history of any of these conditions, as taking Butalbital, Acetaminophen, Caffeine, and Codeine may put you at increased risk of developing the conditions again. Conditions to tell your doctor about are below:

  • Alcoholism
  • Porphyria
  • Rash
  • Respiratory Depression
  • Depression
  • Hematologic Toxicity
  • Cardiac Disease
  • Prematurity
  • Renal Dysfunction
  • Cardiotoxicity
  • Hypothyroidism
  • Acute Alcohol Intoxication
  • Drug Dependence
  • Liver Disease
  • Seizure Disorders
  • Pud
  • Impaired Gi Motility
  • Paradoxical Reactions
  • Urinary Retention
  • Arrhythmias
  • Hypertension
  • Infectious Diarrhea
  • Pku
  • Psychiatric Disorders
  • Gerd
  • Biliary Spasm
  • Adrenal Insufficiency
  • Hypotension
  • Intracranial Pressure
  • Osteomalacia


It is important that you keep this medication out of the reach of children. There are more than 60,000 admissions to accident and emergency rooms each year in the United States due to consumption of prescription medications that were not stored properly out of their reach. You can help to minimise the risk of your children or pets consuming your prescription by keeping it in a locked cabinet that is safely out of reach. If consumed by children, Butalbital, Acetaminophen, Caffeine, and Codeine can be extremely harmful to health. If you are worried that a child may have consumed this medication, you should seek emergency help immediately.

Always keep your prescription of Butalbital, Acetaminophen, Caffeine, and Codeine in the package it was supplied in, and with all the original labels attached. Placing your tablets into unmarked containers can cause them to become mixed up with other medications and may increase the risk of someone else consuming them.


You should always dispose of drugs in a safe and responsible way. Often, this means that you should contact a local take-back scheme if one is available in your area. Due to the harmful nature of Butalbital, Acetaminophen, Caffeine, and Codeine tablets if consumed by an unintended person, it is necessary to take extra precautions when throwing the tablets away. Take back schemes were initiated by the FDA in order to provide a safe and convenient collection service for unwanted or expired medications. These professionals can then recycle and dispose of these drugs safely, minimising the risk of them getting into the wrong hands. You should find out if there is a take-back scheme in your area when your Butalbital, Acetaminophen, Caffeine, and Codeine becomes out of date or unneeded.

If there is no such scheme available in your area, you can dispose of the drugs yourself. Do not flush the tablets down the sink or toilet, and do not try to ground them. Instead, mix them in their whole form with an undesirable substance, such as cat litter, soil, dirt or used ground coffee. Then put them into a plastic bag that can be tightly sealed shut. You can then place the bag into your regular trash cans for collection. Do not attempt to use tablets that are out of date as they may be ineffective or may cause you serious side effects. Do not give unwanted medication to other people either, as it is intended only for you.

When disposing of your Butalbital, Acetaminophen, Caffeine, and Codeine tablets, make sure you take them out of the box and also take any labels containing your personal information off the box before throwing it away. This will help to prevent identity theft.


Provided all the instructions on the usage labels are adhered to, Butalbital, Acetaminophen, Caffeine, and Codeine can be a safe and effective treatment for easing the symptoms of tension headaches. When used over a medium term, the drug combination can drastically improve the quality of life of the patient, helping him or her to cope when a bout of the condition starts. However, the Butalbital, Acetaminophen, Caffeine, and Codeine drug combination is not a cure for the condition and should not be used as a long-term solution due to its addictive qualities. As tension headaches are usually caused and aggravated by certain lifestyle habits - such as smoking, sitting for long periods at a desk, alcoholism and poor posture - a doctor will usually recommend the prescription along with a holistic treatment programme that might include recommendations on lifestyle changes, physiotherapy, massage and interventions.

In order to cure tension headaches, or prevent them from occurring, patients need to make certain lifestyle commitments and not rely solely on Butalbital, Acetaminophen, Caffeine, and Codeine - or any other drug prescription.

This medication has been found to cause harm to children, pregnant women and nursing babies; therefore it is not normally recommended for these groups of people.

Studies have found the drug to be safe if used in accordance with instructions, and when not used in conjunction with any drugs, conditions, diseases, or substances that cause a moderate or major interaction. Patients and doctors should be aware that there are a large number of interactions with this form of treatment, so extra care should be taken to learn the patient's full medical history prior to issuing the prescription. Patients should take care to list any other conditions (past or present) they suffer from, any medications they take and any lifestyle and food or alcohol choices. It is also important for patients to mention whether or not they are smokers, and also whether they are participating in any detrimental lifestyle activities that might be causing or aggravating their tension headaches.

Butalbital, Acetaminophen, Caffeine, and Codeine is usually issued as a next step when over the counter drugs such as Ibuprofen and Aspirin have not been sufficient in easing the symptoms of tension headaches. It is a strong combination of drugs and should be administered with caution during a treatment cycle. Patients should be closely monitored throughout their treatments by a health care professional, and should also report any unwanted side effects. If the treatment needs adjusting, it is possible to increase or decrease the dosage based on the individual patient's requirements.


Last Reviewed:
January 31, 2018
Last Updated:
April 05, 2018
Content Source: