Expert: Jacqui - 11/5/2009

Question
QUESTION: Dear Jacqui,

Hello!

My doctor gave me 40 tablets Bupap for headache. I have been taking them for about 3 weeks now, until a few days ago when I found out my headache was caused by a sinus infection. I am afraid to tell my physician I took almost all the medication because I do not want him to stop prescribing it. I get powerful headaches during my time of the month (I am menopausal) and really do need them. I read on the Internet that you cannot stop taking these medications abruptly because you can have seizures. Well, I was taking 2-3 a day, then I cut back to 1 a day for about 5 days, then cut back to 1/2 a day for 3 days and stopped yesterday. Unfortunately, they never do tell you what "long-term use" exactly means (is a month long-term?) or what a high dose is (2-3 pills a high dose? Usually took 2). So you can see I am very nervous about this. Would you consider my taperdown okay?

I appreciate anything you can tell me on this. If you have never heard of it, I am told Bupap is like Fioracet but without any codeine or caffeine, just Tylenol and a barbiturate (if I would have known THAT going in I would never have taken the bloody things)Oh, and I also take 2mg Xanax daily.

Thank you much,

Dawn

ANSWER: Hi Dawn,

Bupap is a combination of acetaminophen (or as it is known where I live, Paracetamol) and a drug called butalbital which is a barbituate.  I was actually a bit surprised that this drug was still being used as they have mostly given way to the use of benzodiazepines.  The acetaminophen part of the tablet is non habit forming, but the butalbital is, so care needs to be taken.  Bupap is meant to be used for tension headaches, so should only be taken occasionally/

I think that you have done really well with your taper down.  I always have to say that I think the best option is to speak to a medical practitioner, but as you have already said you won't, I guess that isn't an option.  Your reduction seems very sensible, but you do need to be careful.  You haven't taken them for ages (long term can often mean years), but the fact that you are already taking xanax daily compounds things.  If you feel okay, then that is probably fine and you just need to do some self monitoring.

I get so many messages from people using xanax, and I am concerned that doctors just keep prescribing it.  It was never meant to be used long term and is quite habit forming.  So I guess you also need to know that you need to take care with the xanax.  

The one last things I guess I wanted to say is that if you do take the xanax, and the bupap, you shouldn't drink or use any other substances because the CNS depressant effects can be cumulative.  

Thanks for your question Dawn, and if you want to ask me anything else, please feel free!

Take care and stay safe,
Jacqui

---------- FOLLOW-UP ----------

QUESTION: Dear Jacqui,

Today begins day 3 without Bupap. It is hard for me to tell how I am feeling since I have a mild case of flu and feel rotten and nervous from that anyway. I am wondering, is there a cut off point where I can stop worrying about seizure? For example, can I relax after day 5, or day 9? I am not sure how to monitor myself for a seizure, which is really the only thing I am concerned about since the other withdrawal symptoms do not seem dangerous, just unpleasant, and I can handle unpleasant.

Lastly, I hate to take up your time so if the answer is too long please don't bother, but I was hoping that taking the Xanax would help prevent the Bupap withdrawal, but from your answer it sounds like it makes it worse?
Anyway, I am mostly interested in knowing when I can stop worrying about having a seizure, since that is really consuming me.

And I agree on the Xanax, the physician has both my mother and myself on it and even her insurance company calls it a "maintenance drug". I am no stranger to benzos and know probably more than my own MD about them, and I know they are not meant to be taken long term, but especially Xanax, which is highly addictive and so short acting, almost impossible to get off of without switching to Valium first.
I ramble. Thank you very much and I promise not to ask another question.

Best Wishes,

Dawn

Answer
Hi Dawn,

Great to hear things are going well!  

The risks of seizures is from generally related to reducing large amounts over long periods, and as you are still on the xanax, it sounds like things are going fine.  Sorry if I didn't make enough sense, but if you were to stop BOTH bupap and xanax, then that could be difficult if done suddenly, but yes, staying on the xanax probably keeps things 'even' at the moment.

I have just done a literature review on barbituate withdrawal syndrome cases, and it can be quite severe.  I would highly encourage you to get medical attention if you begin to feel unwell, although I don't want you to panic, you will probably be fine as you weren't on a massive dose (the case studies I found were up to 500mg daily for years).  The side effects to look out for are increased anxiety, tremors, muscular tension, restlessness.  As I said, I don't want to worry you, but I also just want to make sure that you will seek medical help if you need it.  

Below is a link to one of the articles I reviewed.  I thought you might be interested given that it seems you have done lots of your own research on the medications you are taking (which is great).

http://www.medscape.com/viewarticle/441288_8

So, I guess the main thing is to keep taking the xanax as prescribed by your doctor and do some really good self monitoring of yourself.  Let me know how it all goes.

Take care and whatever you do, do it safely!!

Jacqui