Study Results:
The number of butalbital medication tablets being taken by the patients before admission ranged from eight to 20, averaging 13.4. All patients were successfully withdrawn from butalbital medications with no adverse reactions to the phenobarbital protocol.
Study Comments:
Loder and Biondi comment:
- "Use of a phenobarbital-loading protocol appears to be an effective and well-tolerated method of withdrawing patients from large amounts of short-acting barbiturate medications...
- The most important consideration is safety. In the case of butalbital withdrawal, safety is largely measured by avoidance of withdrawal seizures ...
- Humane withdrawal methods make use of well-tolerated, easily administered medications to prevent or minimize unpleasant withdrawal symptoms such as headache, tremulousness, or nausea...
- Finally, a withdrawal method the minimizes recidivism is desirable. In most cases, this means that drug withdrawal alone is insufficient, since discontinuation of drug intake without attention to the underlying headache problem that caused the drug intake does little to help the patient avoid drug overuse in the future.
Study Conclusion:
Loder and Biondi concluded that withdrawing large amounts of butalbital medications is best handled with inpatient admission and that the phenobartibal-loading protocol proved to be safe and effective because of the natural tapering that the long half-life of phenobartibal creates. They also concluded that this method met the characteristics they had outlined for an ideal withdrawal program for patients with headache who are overusing medications. Those characteristics require that the method be safe, efficient, humane, and effective.
Summary:
Rebound headache from overuse of butalbital compounds such as Fioricet, Fiorinal, Esgic, Phrenelin, and others is, unfortunately, too common among people with various forms of headache and those with Migraine disease who either don't know about rebound or are in so much pain that they take the medications despite the rebound risk. Dr. Elizabeth Loder and Dr. David Biondi show in their article that there is a safe, effective, and human method for breaking the rebound cycle cause by these medications. Hopefully, more research will follow to establish whether this protocol is effective for rebound caused by other medications or for similar protocols to address the problem. As important as the process of withdrawing the offending medications is establishing appropriate preventive, abortive, trigger management and pain management regimens for patients.
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Resources:
1
Loder, Elizabeth & Biondi, David (2003) "Oral Phenobarbital Loading: A Safe and Effective Method of Withdrawing Patients With Headache From Butalbital Compounds." Headache: The Journal of Head and Face Pain43(8), 904-909.
doi: 10.1046/j.1526-4610.2003.03171.x
