Triaprinbutalbital, acetaminophen, caffeine
Triadbutalbital, aspirin, caffeine
Tecnal [Canada]Controlled Substance Schedule
III(products with aspirin only)Pregnancy CategoryCategory DTher. class.nonopioid analgesics
(combination with barbiturate) Pharm. class.
For information on acetaminophen component in formulation, see acetaminophen monographFor information on aspirin component in formulation, see salicylates monograph
Management of mild to moderate pain
Contain an analgesic (aspirin or acetaminophen) for relief of pain, a barbiturate (butalbital) for its sedative effect, and some contain caffeine, which may be of benefit in vascular headaches
Decreased severity of pain with some sedation
Absorption: Well absorbed
Distribution: Widely distributed; cross the placenta and enter breast milk
Metabolism and Excretion: Mostly metabolized by the liver
Half-life: 35 hr
|PO||1530 min||12 hr||26 hr|
Hypersensitivity to individual components
Cross-sensitivity may occur
Comatose patients or those with pre-existing CNS depression
Uncontrolled severe pain
Aspirin should be avoided in patients with bleeding disorders or thrombocytopenia
Acetaminophen should be avoided in patients with severe hepatic or renal disease
Caffeine should be avoided in patients with severe cardiovascular disease
Pregnancy or lactation
PorphyriaUse Cautiously in:
History of suicide attempt or drug addiction
Chronic alcohol use/abuse (for aspirin and acetaminophen content)
Geri: Appears on Beers list. Geriatric patients are at increased risk for side effects (dosage reduction recommended)
Use should be short-term only
Children (safety not established)
Adverse Reactions/Side Effects
CNS: caffeinedrowsiness, hangover, delirium, depression, excitation, headache (with chronic use), insomnia, irritability, lethargy, nervousness, vertigo.
Resp: respiratory depression.
CV: caffeinepalpitations, tachycardia.
GI: caffeineconstipation, diarrhea, epigastric distress, heartburn, nausea, vomiting.
Derm: dermatitis, rash.
Misc: HYPERSENSITIVITY REACTIONS INCLUDING ANGIOEDEMA AND SERUM SICKNESS , physical dependence, psychological dependence, tolerance.
*CAPITALS indicates life-threatening.
*italic indicates most frequent.
Additive CNS depression with other CNS depressants , including alcohol , antihistamines , antidepressants , opioid analgesics , and sedative/hypnotics
May increase the liver metabolism and decrease the effectiveness of other drugs including hormonal contraceptives , chloramphenicol , acebutolol , propranolol , metoprolol , timolol , doxycycline , corticosteroids , tricyclicantidepressants , phenothiazines , phenylbutazone , and quinidine
MAO inhibitors , primidone , and valproic acid may prevent metabolism and increase the effectiveness of butalbital
May enhance the hematologic toxicity of cyclophosphamideDrug-Natural Products
St. John's wort may decrease barbiturate effect
Concurrent use of kava-kava , valerian , skullcap , chamomile , or hops can increase CNS depression
PO (Adults): 12 capsules or tablets (50100 mg butalbital) every 4 hr as needed for pain (not to exceed 4 g acetaminophen or aspirin/24 hr).
Tablets and capsules: 50 mg
In combination with: aspirin, acetaminophen, caffeine, and codeine Rx. See combination drugs
Assess type, location, and intensity of pain before and 60 min following administration
Prolonged use may lead to physical and psychological dependence and tolerance. This should not prevent patient from receiving adequate analgesia. Most patients who receive butalbital compound for pain do not develop psychological dependence
Assess frequency of use. Frequent, chronic use may lead to daily headaches in headache-prone individuals because of physical dependence on caffeine and other components. Chronic headaches from overmedication are difficult to treat and may require hospitalization for treatment and prophylaxis
Potential Nursing Diagnoses
Acute pain (Indications)
Risk for injury (Side Effects)
Do not confuse Fiorinal with Fioricet
» Explain therapeutic value of medication before administration to enhance the analgesic effect
» Regularly administered doses may be more effective than prn administration. Analgesic is more effective if given before pain becomes severe
» Medication should be discontinued gradually after long-term use to prevent withdrawal symptoms
: Oral doses should be administered with food, milk, or a full glass of water to minimize GI irritation
Instruct patient to take medication exactly as directed. Do not increase dose because of the habit-forming potential of butalbital. If medication appears less effective after a few weeks, consult health care professional. Doses of acetaminophen or aspirin should not exceed the maximum recommended daily dose. Chronic excessive use of >4 g/day (2 g in chronic alcoholism) may lead to hepatotoxicity, renal or cardiac damage
Advise patients with vascular headaches to take medication at first sign of headache. Lying down in a quiet, dark room may also be helpful. Medications taken for prophylaxis should be continued
May cause drowsiness or dizziness. Advise patient to avoid driving and other activities requiring alertness until response to medication is known
Caution patient to avoid concurrent use of alcohol or other CNS depressants
Advise patient to use an additional nonhormonal method of contraception while taking butalbital compound
Decrease in severity of pain without a significant alteration in level of consciousness
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