Prescription-Strength Tylenol: What You Need to Know
Learn which forms of Tylenol (acetaminophen) need a prescription. We’ll also discuss maximum dosage recommendations and how much acetaminophen is in prescription and OTC products.
butalbital / acetaminophen
Used for Tension Headache
Used for Tension Headache
Bupap (butalbital / acetaminophen) is a combination medication containing butalbital and acetaminophen that can help treat and relieve pain from tension headaches. The medication is not a first-choice option for headaches, since it can lead to worsening headaches if it's used too often.
What is Bupap (butalbital / acetaminophen)?
What is Bupap (butalbital / acetaminophen) used for?
- Tension headaches
How Bupap (butalbital / acetaminophen) works
Bupap (butalbital / acetaminophen) is a combination of two medications that help relieve different aspects of tension headaches. Tension headaches are commonly related to stress or anxiety, and they can cause pain.
- Butalbital is a barbiturate, which is a type of medication that lowers anxiety and helps you relax.
- Acetaminophen is a pain reliever. It's unclear how exactly acetaminophen works, but it's thought to work on many chemical pathways in the body to change how we respond to pain.
Drug facts
| Common Brands | Bupap, Allzital, Tencon |
|---|---|
| Drug Class | Barbiturate / Analgesic |
| Controlled Substance Classification | Controlled in some states. See FAQs below. |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
Side effects of Bupap (butalbital / acetaminophen)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Sleepiness
- Lightheadedness
- Dizziness
- Shortness of breath
- Nausea
- Vomiting
- Stomach pain
- Lack of coordination and alertness
Bupap (butalbital / acetaminophen) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Overdose: Not responding to sound or touch, extreme sleepiness, slowed breathing, confusion, stomach pain, dark urine, yellowing of your skin or eyes, sweating
- Withdrawal: Seizures, delusions, restlessness, trouble sleeping, shakiness
- Serious skin reactions: Reddening or peeling of the skin, painful rash, fluid-filled blisters
- Serious allergic reactions: Trouble breathing, itchiness, swelling of the face, mouth, or throat
The following Bupap (butalbital / acetaminophen) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Bleeding or crusting sores on lips
fever with or without chills
hive-like swellings (large) on eyelids, face, lips, and/or tongue
muscle cramps or pain
red, thickened, or scaly skin
shortness of breath, troubled breathing, tightness in chest, or wheezing
sores, ulcers, or white spots in mouth (painful)
Symptoms of overdose
Anxiety, confusion, excitement, irritability, nervousness, restlessness, or trouble in sleeping (severe, especially with products containing caffeine)
convulsions (seizures) (for products containing caffeine)
diarrhea, especially if occurring together with increased sweating, loss of appetite, and stomach cramps or pain
dizziness, lightheadedness, drowsiness, or weakness, (severe)
frequent urination (for products containing caffeine)
hallucinations (seeing, hearing, or feeling things that are not there)
increased sensitivity to touch or pain (for products containing caffeine)
muscle trembling or twitching (for products containing caffeine)
nausea or vomiting, sometimes with blood
ringing or other sounds in ears (for products containing caffeine)
seeing flashes of "zig-zag" lights (for products containing caffeine)
shortness of breath or unusually slow or troubled breathing
slow, fast, or irregular heartbeat
slurred speech
staggering
swelling, pain, or tenderness in the upper abdomen or stomach area
unusual movements of the eyes
Check with your doctor as soon as possible if any of the following side effects occur:
Rare
Bloody or black, tarry stools
bloody urine
pinpoint red spots on skin
swollen or painful glands
unusual bleeding or bruising
unusual tiredness or weakness (mild
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Get your GoodRx coupon
$35.66
GoodRx discount
$23.39
Pros and cons of Bupap (butalbital / acetaminophen)
Pros
Cons
- Taking Bupap (butalbital / acetaminophen) for a long period of time can become habit-forming.
- Not recommended as a first-choice option for headaches because of risk of worsening headaches with overuse or frequent medication use
- Can cause bothersome symptoms if stopped suddenly after taking for a long period of time
- Is a controlled medication in some states, so it might have special requirements to getting your prescription filled
Pharmacist tips for Bupap (butalbital / acetaminophen)
- Bupap (butalbital / acetaminophen) can make you feel sleepy. Make sure you know how the medication affects you before driving a car or doing activities that require you to concentrate.
- It's not recommended to drink alcohol or take other medications that make you feel sleepy or less alert while taking Bupap (butalbital / acetaminophen). This can raise your risk of extreme sleepiness and accidental injuries. Drinking alcohol with Bupap (butalbital / acetaminophen) can also raise your risk of liver damage.
- Don't take other medications that contain acetaminophen (Tylenol) while taking Bupap (butalbital / acetaminophen). Taking high amounts of acetaminophen (Tylenol) can raise your risk of liver damage. Don't take more than 3 to 4 grams of acetaminophen per day. Ask your provider what your maximum daily amount of acetaminophen is, since this depends on your provider's instructions.
- Bupap (butalbital / acetaminophen) can be habit-forming. Don't take the medication more often than prescribed, for longer than prescribed, or at higher doses than prescribed. If you're taking the medication for a long period of time, you might start to feel the need to take higher doses to get the same relief. You can also experience bothersome side effects, such as seizures, delusions, restlessness, trouble sleeping, and shakiness, if you stop taking the medication suddenly.
Risks and warnings for Bupap (butalbital / acetaminophen)
Bupap (butalbital / acetaminophen) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Liver damage
- Risk factors: History of liver disease | Taking other medications containing acetaminophen (Tylenol) | Taking more than 3 to 4 grams of acetaminophen (Tylenol) in a day | Alcohol use
Bupap (butalbital / acetaminophen) contains acetaminophen. Taking more than 3 to 4 grams of acetaminophen (Tylenol) in a day raises your risk of serious liver damage. Because some over-the-counter medications for fever, pain, cold, or flu symptoms contain acetaminophen (Tylenol), it's important to be aware of how much acetaminophen (Tylenol) you're taking throughout the day. To lower this risk, don't take more than one medication containing acetaminophen (Tylenol). If you realize you've taken more than 3 to 4 grams of acetaminophen (Tylenol) in a day, go to the emergency room right away even if you feel well. If you notice symptoms of liver damage, like stomach pain, dark urine, yellowing of your skin or eyes, get medical help as soon as possible.
Difficulty concentrating
- Risk factors: Taking Bupap (butalbital / acetaminophen) with alcohol | Taking other medications that make you less alert | Age 65 years or older
Bupap (butalbital / acetaminophen) can affect your ability to focus, think, and react. Taking other medications that make you feel sleepy and less alert can worsen these symptoms. Avoid activities that need you to focus, like driving a car or operating machinery, until you know how this medication affects you.
Misuse, dependence, and withdrawal
- Risk factors: Taking Bupap (butalbital / acetaminophen) longer than prescribed | Taking higher doses of Bupap (butalbital / acetaminophen) than prescribed | Taking Bupap (butalbital / acetaminophen) more often than prescribed
Bupap (butalbital / acetaminophen) contains butalbital, which can be habit-forming. It can cause physical dependence if it's taken for a long time, meaning you might need higher doses of the medication to get the same relief. It can also cause withdrawal symptoms, like seizures, restlessness, trouble sleeping, and shakiness, if you lower your dose or stop taking the medication suddenly. To lower the risk of physical dependence, don't take Bupap (butalbital / acetaminophen) longer than prescribed, at higher doses than prescribed, or more often than prescribed. If you no longer want to take Bupap (butalbital / acetaminophen), talk to your healthcare provider so they can instruct you on how to stop taking the medication safely. Talk to your healthcare provider about alternative treatments if you have concerns about taking Bupap (butalbital / acetaminophen).
Severe skin reactions
Bupap (butalbital / acetaminophen) contains acetaminophen, which can cause rare but serious, life-threatening skin reactions. These reactions can look like reddening or peeling of the skin, painful rash, and fluid-filled blisters. If you notice any of these symptoms, stop taking Bupap (butalbital / acetaminophen) and go to the emergency room right away.
Severe allergic reaction
Bupap (butalbital / acetaminophen) contains acetaminophen, which have caused severe allergic reactions in some people. Bupap (butalbital / acetaminophen) shouldn't be used if you've had a severe allergic reaction to acetaminophen in the past. If you experience trouble breathing, itchiness, or swelling of the face, mouth, or throat, go to the emergency room right away.
Bupap (butalbital / acetaminophen) dosage
The average cost for 30 tablets of 50mg/325mg of Bupap (butalbital / acetaminophen) is $23.39 with a free GoodRx coupon. This is 34.41% off the average retail price of $35.66. 
Capsule
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 50mg/300mg | 20 capsules | $71.10 | $3.56 |
Interactions between Bupap (butalbital / acetaminophen) and other drugs
Bupap (butalbital / acetaminophen) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Bupap (butalbital / acetaminophen). Please note that only the generic name of each medication is listed below.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
- Riociguat
- Viloxazine
Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Alprazolam
- Amobarbital
- Anisindione
- Aprobarbital
- Butabarbital
- Calcium Oxybate
- Capmatinib
- Carisoprodol
- Chloral Hydrate
- Chlordiazepoxide
- Chlorzoxazone
- Clarithromycin
- Clonazepam
- Clorazepate
- Dantrolene
- Darunavir
- Diazepam
- Dicumarol
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Esketamine
- Estazolam
- Ethchlorvynol
- Etonogestrel
- Flunitrazepam
- Flurazepam
- Givosiran
- Halazepam
- Imatinib
- Iobenguane I 131
- Isoniazid
- Ketazolam
- Lorazepam
- Lormetazepam
- Magnesium Oxybate
- Medazepam
- Mephenesin
- Mephobarbital
- Meprobamate
- Metaxalone
- Methocarbamol
- Methohexital
- Midazolam
- Nifedipine
- Nitrazepam
- Oxazepam
- Peginterferon Alfa-2b
- Pentobarbital
- Phenindione
- Phenobarbital
- Phenprocoumon
- Piperaquine
- Pixantrone
- Pneumococcal 13-Valent Vaccine, Diphtheria Conjugate
- Potassium Oxybate
- Prazepam
- Primidone
- Quazepam
- Secobarbital
- Sodium Oxybate
- Temazepam
- Thiopental
- Trazodone
- Triazolam
- Ulipristal
How much does Bupap (butalbital / acetaminophen) cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
Bupap (butalbital / acetaminophen) (generic)
$23.39
Bupap (butalbital / acetaminophen) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Bupap (butalbital / acetaminophen) will not be safe for you to take.
- Porphyria (a condition that affects your skin and nerves)
What are alternatives to Bupap (butalbital / acetaminophen)?
There are a number of medications that your doctor can prescribe in place of Bupap (butalbital / acetaminophen). Compare a few possible alternatives below.
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