Barbiturate Addiction
Barbiturates can cause dependence and dangerous withdrawal, even when a medicine began as treatment. Care should address the reason for use, other sedating substances, and a medically supervised plan for any change.
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What Are Barbiturates?
Barbiturates are medicines that can cause relaxation and sleepiness by slowing activity in the brain. Some, such as phenobarbital, are used to control seizures. They matter because their effects can impair coordination and judgment, excessive doses can dangerously slow breathing, and many overdoses involve alcohol, opioids, or other medicines.[1][2]
If a seizure or headache medicine is leaving you sleepy, feels less effective, or has become difficult to manage, bring those concerns to your prescriber. A medication review can address the condition being treated alongside dependence and safety. Do not stop a regularly used barbiturate abruptly.[2][3][4]
Barbiturate Symptoms That Need Emergency Care
Call 911 immediately if the person has collapsed, had a seizure, cannot be awakened, or has slow or difficult breathing. Do not delay while trying to determine the exact dose.[2][5]
If you take a barbiturate regularly, seek medical guidance before reducing or stopping it. Sudden barbiturate withdrawal can be life-threatening.[2][1]
- Phenobarbital is used to control seizures and prevent withdrawal (symptoms after stopping a medicine) in people dependent on another barbiturate, while butalbital is an ingredient in some combination headache medicines.[2][3]
- Alcohol and opioids, a drug class that includes pain medicines such as oxycodone, can make barbiturate use dangerous, and many overdoses involve more than one substance.[1][6]
- Regular use can cause tolerance, meaning less effect from the same amount, and physical dependence, meaning the body adapts and stopping may cause withdrawal, including seizures.[1][2]
Barbiturate Tolerance, Dependence, and Withdrawal
Tolerance means needing more of a substance to obtain an effect previously produced by less. With barbiturates, tolerance to mood-altering effects can develop faster than tolerance to lethal effects. Increasing the amount to chase a previous feeling can therefore narrow the safety margin rather than reliably protect against overdose.[1]
Physical dependence means the body has adapted to regular exposure and may develop withdrawal symptoms when the medicine is reduced or stopped. It does not by itself establish compulsive use or a substance use disorder, a pattern of use involving problems such as craving or loss of control.[2][7]
In a 2009 interview study of 100 inpatients at an epilepsy center, about half reported withdrawal symptoms and tolerance.[7]
Fewer than 10% of those 100 inpatients reported craving or loss of control.[7] Physical dependence indicators were more frequent among patients taking barbiturates or clobazam, another medicine used for seizures, than among those taking neither. The groups did not differ significantly in craving or loss of control.[7]
That study was small, relied on self-report, and came from one inpatient epilepsy center. It helps distinguish physical adaptation from craving or loss of control, but it cannot determine an individual reader’s risk or establish that long-term treatment is harmless.[7]
Withdrawal symptoms reported for phenobarbital include anxiety, muscle twitching, shaking, weakness, dizziness, vision changes, nausea, vomiting, insomnia (difficulty falling or staying asleep), confusion, faintness, and seizures. Sudden barbiturate withdrawal can be life-threatening.[2][1]
Before changing regular barbiturate use, ask your prescriber to assess physical dependence, seizure risk, other substance use, medical conditions, and the level of support needed. Those findings help determine a medically supervised plan for reducing or stopping the medicine.[2][8]
Detoxification is care aimed at managing intoxication and withdrawal and helping a person become medically stable. Federal treatment guidance describes it as a possible first step toward recovery, not a cure or complete treatment for a substance use disorder. Ask what ongoing care will follow withdrawal management.[8]
Treatment for Barbiturate Misuse and Addiction
Treatment needs to address both safe withdrawal and the reasons nonmedical use continues. The National Institute on Drug Abuse advises medical supervision when stopping dependence-producing sedating medicines and describes inpatient or outpatient counseling as part of care. If alcohol or opioids are also involved, the treatment plan needs to address those substances too.[9]
Choosing a Setting for Barbiturate Withdrawal Care
Outpatient withdrawal services provide scheduled monitoring. Inpatient services offer care around the clock. The choice depends on medical and psychological health, past withdrawal, and the support available at home. Having an outpatient option does not mean it is safe to stop a barbiturate at home without assessment.[8][2]
When comparing barbiturate treatment programs, ask who assesses withdrawal risk, what monitoring is available, and what happens if symptoms worsen. Also ask how continuing care will fit with seizure treatment, other medicines, work, and family responsibilities.[8]
Counseling After Barbiturate Withdrawal
Counseling can take place in inpatient or outpatient care. Cognitive behavioral therapy focuses on thoughts, expectations, behaviors, and coping with stress. NIDA discusses its use when people stop benzodiazepines, another class of sedating medicines. That evidence does not establish a barbiturate-specific success rate. Research on treatment for central nervous system depressant addiction remains limited.[9]
Ask a program how it will help with continuing care after medical detoxification. Becoming medically stable is a starting point. Federal guidance emphasizes connection to further substance use treatment when needed.[8]
How Barbiturates Slow the Brain and Body
The brain depends on a balance between signals that excite nerve cells and signals that quiet them. Gamma-aminobutyric acid, usually shortened to GABA, is a major calming chemical messenger. Phenobarbital strengthens signaling at GABA-A receptors, structures on nerve cells that help reduce electrical activity. It also blocks some signaling involving glutamate, a chemical messenger that excites nerve cells.[10]
This slowing can be useful when the goal is to suppress seizures or produce intensive-care sedation. It can also reduce alertness, coordination, judgment, blood pressure, and breathing. As exposure rises, the effects may progress from appearing intoxicated to coma, a state of unconsciousness in which a person cannot be awakened.[1][11][5]
Barbiturates have a narrow therapeutic window, meaning the amount that produces a desired effect may be relatively close to the amount that produces serious toxicity. This limited safety margin is one reason phenobarbital is not preferred as stand-alone treatment over benzodiazepines (another class of sedating medicines) for alcohol withdrawal.[10]
Which Medicines Contain Barbiturates?
A person may encounter barbiturates as a seizure medicine, an ingredient in a combination product, or a medicine used under close monitoring in a hospital.[2][3][11]
Phenobarbital
Phenobarbital is used to control seizures. It can also be used to prevent withdrawal symptoms when a person who is physically dependent on another barbiturate is stopping that medicine. MedlinePlus notes additional use for anxiety, although older adults generally should not receive it when safer or more effective alternatives are suitable.[2]
Phenobarbital may also be used by experienced clinicians for alcohol withdrawal. American Society of Addiction Medicine guidance says it can be effective but is not preferred as stand-alone treatment over benzodiazepines because of its narrow therapeutic window and risks of excessive sedation and respiratory depression, meaning dangerously slowed or weakened breathing.[10]
Butalbital Combination Products
Fioricet contains butalbital, acetaminophen, and caffeine. Fiorinal combines butalbital, aspirin, and caffeine. These are headache-medicine combinations. Check all active ingredients on your own package, including whether codeine is present, rather than relying only on the brand name.[3][4][6]
Some formulations differ substantially. For example, a butalbital product may also contain codeine, an opioid pain medicine. The National Institute on Alcohol Abuse and Alcoholism lists butalbital with codeine among medicines that can cause increased overdose risk and slowed or difficult breathing when combined with alcohol. Check the warning information for your specific product.[6]
Fioricet’s prescribing information warns that extended use is not recommended because butalbital can be habit-forming. It also says evidence for the combination’s safety and effectiveness in treating multiple recurrent headaches is unavailable. A medicine that helps an individual headache therefore still needs review if you need it repeatedly.[3]
Combination ingredients add their own risks. Acetaminophen can cause serious liver injury, particularly when someone unintentionally takes more than one acetaminophen-containing product. Look for both “acetaminophen” and “APAP” on labels. Ask a pharmacist to check the total across your medicines rather than assuming a second pain or cold product is different.[3]
For migraine, the American Migraine Foundation advises generally avoiding combinations containing butalbital. Discuss an alternative headache plan with the prescriber instead of repeatedly increasing the medicine. If regular use has led to physical dependence, changing that plan still requires medical supervision.[12][9]
Medication-overuse headache means that frequent use of an acute headache medicine, one taken to relieve a headache attack, contributes to new or worsening headaches. It can be hard to distinguish from changes in the underlying headache disorder. A diary of headaches and medicine use can help the clinician assess the pattern.[13]
In a 2023 American Migraine Foundation interview, headache specialist Ira Turner, MD, offered a practical starting point:[12] “I have people keep a calendar and make an entry on the days you get a headache.”[12] Record medicine names and when you take them too, so the clinician can assess both headache control and medication use.[12]
Secobarbital
Secobarbital has been used for insomnia (difficulty falling or staying asleep) and may be given before surgery to reduce anxiety. Although some barbiturates have regulatory approval for insomnia, a clinical review states that secobarbital and related drugs are not recommended for insomnia because of their potential toxicity. Approval alone does not mean a product is currently available or appropriate for a particular reader.[5][14]
Why Barbiturates Are Still Used
Phenobarbital remains an antiseizure medicine, and butalbital appears in some headache combinations. In hospitals, barbiturates may be used for seizures or pressure inside the skull that has not responded to other treatments. These uses require a different level of monitoring from routine outpatient care.[2][3][4][11][15]
Experienced clinicians may also use phenobarbital for selected alcohol-withdrawal cases. Its narrow safety margin and risk of slowed breathing require close assessment. Its use in a hospital does not make it a medicine to use for withdrawal on your own.[10]
How Long Do Barbiturates Stay in the Body?
“Short-acting” and “long-acting” describe whether a medicine’s effects last a shorter or longer time. This is different from its half-life, the time required for the amount in the body to fall by about half.[16][2] Neither term alone tells you when it is safe to drive. Phenobarbital guidance advises waiting until you know how the medicine affects you.[16][2]
Secobarbital and phenobarbital illustrate the contrast. The Seconal prescribing information describes secobarbital as faster to begin acting and shorter-lasting, with phenobarbital at the slower-onset, longer-lasting end of the range.[16]
| Medicine | Duration Contrast | How Slowly It Leaves the Body |
|---|---|---|
| Secobarbital | A short-acting example, with a faster onset than phenobarbital. | Its half-life in adults ranges from 15 to 40 hours, averaging 28 hours. “Short-acting” does not mean it leaves the body within a few hours.[16] |
| Phenobarbital | A long-acting example, with a slower onset than secobarbital. | Its reported half-life is up to seven days. This describes slow removal from the body, not a fixed duration of sleepiness after each dose.[16][10] |
For sleep treatment, these duration labels do not establish which barbiturate works better: the Seconal label says controlled studies failed to demonstrate that short-acting drugs were better for falling asleep or intermediate-acting drugs were better for staying asleep.[16]
Ask your pharmacist how soon your particular medicine (including a butalbital combination product) starts working, how long it may affect alertness, and how repeated use changes that assessment. Do not use another barbiturate’s timing as your guide to driving.[2][3]
Duration is only one part of a medication review. These factors also matter:
| Factor | Why It Matters |
|---|---|
| Dose | Larger exposure can deepen sedation and suppress breathing. Barbiturates have a narrow therapeutic window.[10] |
| Duration of use | Repeated use can lead to tolerance and physical dependence.[1] |
| Age | For adults 65 or older, MedlinePlus advises discussing alternatives because phenobarbital is generally not as safe or effective as other medicines for the same condition.[2] |
| Breathing or liver disease | Phenobarbital precautions include conditions causing breathing difficulty and liver disease.[2] |
| Kidney or mental health conditions | Kidney disease, depression, and a history of self-harm thoughts are among the issues a prescriber should know about.[2] |
| Other substances | Alcohol and opioids can make barbiturate use dangerous. Ask a pharmacist to review other sedating medicines rather than assuming they are safe to combine.[1][6][2] |
Use your own response and professional guidance (not another person’s experience) to make decisions about driving or treatment. Phenobarbital guidance advises avoiding alcohol and discussing dose changes or stopping with the prescriber.[2]
Barbiturate Side Effects and Everyday Safety
Drowsiness, dizziness, headache, nausea, and vomiting are reported with phenobarbital. Confusion, rash, fever, and blistering or peeling skin require prompt medical attention.[2] Call 911 for slowed or difficult breathing.[2][17]
At intoxicating levels, barbiturates may cause:
- Slowed or slurred speech
- Faulty judgment
- Poor coordination or staggering
- An altered level of consciousness
Falls can lead to head, neck, or spinal injuries when balance and alertness are impaired. Memory loss is also reported with excessive, long-term use.[1]
Driving and Working While Taking Barbiturates
Do not drive or operate machinery while taking phenobarbital until you know how it affects you. Sleepiness, delayed thinking, dizziness, and poor coordination may make driving, climbing, caregiving, or safety-sensitive work hazardous. Alcohol can intensify these effects and further increase driving and fall risks.[2][1][6]
Barbiturate Effects on Memory and Balance
Excessive, long-term use may be associated with reduced functioning, changes in alertness, irritability, and memory loss. Intoxication may also cause poor judgment and difficulty walking.[1] Do not dismiss worsening concentration or falls if barbiturate exposure is possible. A practical question for your prescriber is, “Could my medicine be contributing to these changes?”
Barbiturates During Pregnancy, Breastfeeding, and Contraceptive Use
Phenobarbital may harm a fetus, and it can pass into breast milk. MedlinePlus advises monitoring a breastfed baby for drowsiness or poor weight gain. Someone who is pregnant, planning pregnancy, or breastfeeding should discuss benefits and risks with the prescriber rather than stopping phenobarbital abruptly.[2]
If you take phenobarbital, ask whether it affects your birth control. It can reduce the effectiveness of some hormonal methods. Your prescriber or pharmacist can review your exact method and discuss alternatives when needed.[2][18]
Which Barbiturate Combinations Are Especially Dangerous?
Alcohol and opioids are particular concerns: many barbiturate overdoses involve these combinations, which can lead to coma or death. Before taking a barbiturate, share a complete list of prescriptions, nonprescription medicines, vitamins, supplements, herbal products, and other substances with a pharmacist or prescriber.[1][2]
Bring these questions about other substances to the medication review:
- Alcohol: Mixing alcohol with medicines can worsen drowsiness, dizziness, loss of coordination, falls, and breathing difficulty. Phenobarbital guidance specifically advises avoiding alcohol during treatment.[6][2]
- Opioids: MedlinePlus names heroin, oxycodone, and fentanyl as examples involved in barbiturate overdoses. Combined use can lead to coma or death. Include pain and cough medicines in your ingredient review.[1][6]
- Benzodiazepines: Ask before combining a barbiturate with medicines such as alprazolam, clonazepam, diazepam, or lorazepam. Benzodiazepines themselves can cause sedation, and mixing them with alcohol or opioids can suppress breathing and cause death.[2][6][10]
- Sleep medicines: Ask about products such as zolpidem, eszopiclone, temazepam, diphenhydramine, or doxylamine. Alcohol-interaction guidance identifies sedation-related risks with these medicines. Your pharmacist should assess the specific barbiturate combination rather than treating every sleep medicine as interchangeable.[6][2]
- Other sedating medicines: Include allergy, nausea, muscle-relaxant, seizure, and mental health medicines in the review, including products bought without a prescription. Ask which ingredients need special precautions with your barbiturate.[6][2]
Ask about timing as well as ingredients, especially with long-lasting phenobarbital. Its reported half-life of up to seven days means the amount in the body can decline slowly. It is not a basis for choosing a safe interval for alcohol or another medicine yourself.[10][2]
How to Recognize Barbiturate Poisoning
Severe barbiturate poisoning can resemble extreme alcohol intoxication but may progress to life-threatening suppression of consciousness, breathing, circulation, and body temperature.[1][5]
Warning signs include:
- Extreme sleepiness or inability to wake the person
- Slow, shallow, difficult, or absent breathing
- Confusion, severely reduced alertness, or coma
- Slurred speech and severe loss of coordination
- Fainting or extremely low blood pressure
- Seizures
- Blisters or skin injury in someone who has been unconscious for a prolonged period[1][5][2]
What Should You Do for Suspected Barbiturate Poisoning?
A collapse, seizure, inability to wake, or slow or difficult breathing after possible barbiturate exposure requires an immediate 911 call. Do not wait for the amount taken to be confirmed.[2][5]
For suspected exposure without those immediately life-threatening signs, call Poison Help at 1-800-222-1222 anywhere in the United States. The service is free, confidential, and available 24 hours a day. Have the person’s age, condition, product name, ingredients, approximate amount, and exposure time available if possible, but do not delay seeking help to gather them.[1][5]
Follow the emergency dispatcher’s instructions for helping the person breathe or giving CPR (cardiopulmonary resuscitation). If they are unconscious and not breathing normally or are only gasping, begin CPR as instructed. Do not put an unresponsive person on their side instead of providing needed breathing care.[19]
If the person is breathing normally but unconscious and no head, neck or back injury is suspected, place them on their side. If such an injury is possible, tell the dispatcher and leave them in the position found unless moving them is needed for safety, CPR or bleeding control. Keep checking breathing and responsiveness.[19]
Give naloxone if an opioid overdose is possible and it is available. Naloxone reverses opioids, not barbiturates, and does not replace emergency medical care. Stay with the person until help arrives.[20][1] Do not induce vomiting after a swallowed overdose.[17]
Take the medication container to the hospital if it is readily available. There is no direct antidote that reverses a barbiturate, although naloxone may reverse an opioid component when opioids were also taken. Emergency care focuses on supporting breathing, circulation, and other body functions while treating complications.[1]
Getting Help with Barbiturate Use
If You Are Considering a Prescription
Ask what problem the barbiturate is intended to treat, what benefit is expected, and why it is being considered instead of available alternatives. Review your breathing, liver and kidney conditions, pregnancy plans, alcohol or substance use, and every sedating medicine or supplement you take.[2]
Also ask how sleepiness or impaired balance could affect driving, work, or falls, and discuss questions about memory, contraception, and breastfeeding.[2][1] Confirm the active ingredients if it is a combination product.[6]
If You Currently Take a Barbiturate
Take it only as prescribed, do not share it, and do not increase the amount because it seems less effective. Store it securely and use a medicine take-back program for medication you no longer need.[2]
Arrange a pharmacist or prescriber review if you have persistent sleepiness, memory problems, falls, reduced benefit, new medicines, or concerns about dependence. Do not stop regular use abruptly.[2][1]
If You Are Worried About Someone Else
If the person is hard to wake, breathing slowly, or has collapsed or seized, call 911. Otherwise, Poison Help at 1-800-222-1222 can advise you about a possible exposure, even when it is not yet an emergency.[1][2]
Approach nonmedical use without blame. Federal treatment guidance describes substance use disorders as treatable health conditions, not evidence of moral weakness, and emphasizes respectful, dignified care. Encourage the person to seek medical guidance and treatment support.[8]
Finding Treatment for Barbiturate Misuse and Addiction
Seek medical guidance before stopping regular use because barbiturate withdrawal can be dangerous. Tell the clinician what was taken, how often, for how long, and whether alcohol, opioids, benzodiazepines, sleep medicines, or other medicines are also involved. Do not wait for severe withdrawal before asking for help.[1][2]
If you need help finding treatment in the United States, call the Substance Abuse and Mental Health Services Administration’s National Helpline at 1-800-662-HELP (4357). It offers free, confidential treatment information and referrals 24 hours a day in English and Spanish. It is a referral service and does not provide counseling.[21]
For a suspected overdose, call Poison Help at 1-800-222-1222. Call 911 immediately if someone has collapsed, had a seizure, has trouble breathing, or cannot be awakened.[2]
If you lack insurance or have limited coverage, ask the helpline about state-funded programs or facilities with sliding-scale fees. A medical assessment can help determine the level of withdrawal care needed based on symptoms, past withdrawal, other health conditions, and your circumstances. Ask any referred program whether it can meet those needs and what costs apply.[21][8]
You can take the next step at your own pace. Explore AddictionHelp’s Treatment Center Directory → to compare care options for barbiturate use.
For emotional support alongside care, explore online therapy options. A prescribing or medical clinician should manage medication and withdrawal questions.
In the United States, call 988, text 988, or chat with the 988 Lifeline for thoughts of suicide or urges to hurt yourself. Call 911 in a life-threatening situation.[22]
Frequently Asked Questions
Does Taking a Barbiturate Mean I Have an Addiction?
No. Physical dependence means your body has adapted and stopping may cause withdrawal. Addiction involves a problematic pattern such as craving or loss of control. Dependence can occur during medical treatment, so it deserves a supervised medication review even without compulsive use. Do not abruptly stop a regularly used barbiturate.[2][7]
How Long Does Barbiturate Withdrawal Last?
There is no single timetable that is safe to apply to every person or medicine. Products differ in how slowly they leave the body, and withdrawal after abrupt stopping can include seizures or severe confusion. A clinician needs to review the exact medicine, use pattern, other substances and health conditions before planning reduction. Do not use another person’s schedule.[16][3][2]
Can Butalbital Headache Medicine Cause Dependence?
Yes. Butalbital can be habit-forming, and the Fioricet label warns against extended and repeated use because of physical dependence. If you need headache medicine more often or it is becoming difficult to manage, bring a headache and medication record to your prescriber. Ask about treating the headaches and planning any medication change safely, rather than stopping regular use abruptly.[3][12][9]
Are Barbiturates Opioids or Benzodiazepines?
No. Barbiturates are a separate class of medicines that slow brain activity. Benzodiazepines are another sedating medicine class, and opioids include pain medicines such as codeine and oxycodone. Some butalbital combination products also contain an opioid such as codeine. Check every active ingredient, because mixing sedating substances can dangerously suppress breathing.[1][10][4][6]
Does Naloxone Reverse a Barbiturate Overdose?
Naloxone reverses opioid effects, not barbiturate poisoning. Give it if an opioid overdose is possible and it is available, but do not delay emergency help. Call 911 if someone cannot be awakened, has trouble breathing, collapses or has a seizure. Follow the dispatcher’s instructions for breathing care. A mixed overdose still needs medical treatment even if naloxone helps.[1][20][17][19]
Where Can I Find Help for Barbiturate Use?
Start with a prescriber or medical clinician who can assess withdrawal risk and the condition the medicine was treating. If you need a treatment referral in the United States, call SAMHSA, the Substance Abuse and Mental Health Services Administration, at 1-800-662-HELP (4357). The free, confidential service operates around the clock in English and Spanish. Ask any program about medical monitoring and costs.[2][9][21]
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