Reader's Mail: Is Esgic safe for long-term use?

Q. Is Esgic safe for long-term use?

A. Esgic, which contains butalbital (a barbiturate), caffeine and acetaminophen is FDA-approved for the treatment of tension-type headaches. Butalbital has a long half-life of up to 36 hours, meaning that it can take up to 7 to 10 days to clear the medication from the body. The safety concern with this medication is that it can lead to overuse and can cause drowsiness and a tendency to lead to rebound headache. When used long-term, the medication can lead to conversion from episodic migraine to chronic migraine. Esgic is not FDA-approved for migraine headache, yet it is still commonly prescribed by many physicians in the US. The medication is not available in the United Kingdom because of the concerns over drug dependence, drug tolerance, and the long half-life of the medication. Most headache specialists prefer not to prescribe Esgic, Fiorinal, Fioricet, or similar medications derived from barbiturates due to these concerns.

George Nissan, DO
Baylor Comprehensive Headache Center
Dallas, TX