Fioricet is the brand name for a combination medication that contains acetaminophen, butalbital, and caffeine.
Butalbital chemical structure is similar to other barbiturates and it has similar effects. Butalbital alone is a Schedule III controlled medication as classified by the Drug Enforcement Administration (DEA). Schedule III medications have the potential for abuse. Fioricet, however, is not scheduled federally and falls under exemption rules by the DEA.
People who suffer from tension-type headaches that do not respond to over-the-counter (OTC) medications may find relief with combination drugs that include butalbital.
Commonly prescribed as Fioricet (butalbital/acetaminophen/caffeine) or Fiorinal (butalbital/aspirin/caffeine), butalbital is a sedative in the barbiturate class of medicines. While the drug causes intense relaxation and eases the pain of a tension headache, it is not without risks.
The most common type of headache disorder, a tension headache occurs when neck and scalp muscles become tense, or contract, meaning they squeeze down. This causes pain, often described as a rubber-band-around-the-head feeling or a pressure sensation, on both sides of the head.
Tension headaches can be triggered by a number of factors including stress, hunger, lack of sleep, anxiety, and temperature changes. They may occur at any age but are most common in adults and older teens. Some people are more prone or vulnerable to developing tension headaches than others, although the reason behind this is not very clear.
The good news is that most tension headaches are mild in pain and can be easily alleviated with rest, fluids, removal of the trigger, and/or an over-the-counter medication like Motrin (ibuprofen) or Tylenol (acetaminophen). Behavioral therapies too can be effective like physical therapy or cognitive-behavioral therapy.
When recurring tension headaches do not respond to other treatments, your doctor may prescribe Fiorinal or Fioricet. Codeine may also be added to this combination of medicine. While this medication is very effective in the short-term, there are some things to watch out for.
Butalbital is a barbiturate, which means that it helps to slow down the central nervous system and relax the muscle tension believed to be associated with tension headaches.
Before taking medication containing butalbital, tell your doctor if you:
- are allergic to any ingredients in the medication, such as acetaminophen or aspirin.
- are currently taking blood thinners, antidepressants, antihistamines, or other sedatives such as sleeping pills or tranquilizers
- have or previously had liver disease, porphyria, or depression
- are pregnant, plan to become pregnant, or are currently breastfeeding
Fioricet contains enough acetaminophen that it is not considered to have high abuse potential. Despite this limitation, some states still classify it as a scheduled medication. Fioricet is a scheduled medication in:
- New Mexico
- Rhode Island
- West Virginia
Fioricet Street Names and Brand Names
The Fioricet generic name is acetaminophen/butalbital/caffeine. Fioricet does not have many known street names if any at all. However, butalbital goes by a few street names:
- Christmas trees
- Red Devils
- Yellow jackets
Different brand names for butalbital, acetaminophen, and caffeine include:
- Capacet (discontinued)
- Margesic (discontinued)
- Phrenilin Forte
What Is Fioricet Used For?
Fioricet is used for tension headaches. A tension headache is mild to moderate pain in the head that can be located in the front, back or the sides. People describe having a tension headache as feeling like they have a tight band around their head.
Tension headaches are the most common types of headaches, but Fioricet is not commonly prescribed for them because there are safer options to use.
Tension headaches can last for minutes, or they can last for days. Some people experience more than 15 days of headaches in a month. When that many headaches are experienced it’s identified as a chronic tension headache.
Each of the ingredients in Fioricet works to help with the managing headaches:
- Acetaminophen: Stops the production of a chemical in cells called prostaglandin. Prostaglandin tells brain cells to fire pain signals. Blocking prostaglandin stops or lowers the experience of pain.
- Butalbital: Attaches to GABA receptors in brain cell membranes. Butalbital increases levels of GABA in the brain, which slow down pain signals. The ingredient causes drowsiness and sleepiness.
- Caffeine: A stimulant for the central nervous system (CNS). When blood pressure is too low in the brain, blood vessels expand and push on adjacent brain cell tissue. Caffeine causes vessels to tighten, or constrict, which helps decrease pain from headaches.
How Addictive Is Fioricet?
Is Fioricet addictive? It could be, but it’s likely not very addictive in the Fioricet combination pill form.
Butalbital — one of the ingredients in Fioricet — is combined with other medications to reduce its abuse potential. The DEA classifies butalbital as a Schedule III substance, so it has the potential to be abused when it’s on its own. Fioricet has a low potential for abuse but is not commonly prescribed.
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Before taking Fioricet
Do not use Fioricet if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.
You should not use Fioricet if you are allergic to acetaminophen, butalbital, or caffeine, if you have porphyria, or if you have recently used alcohol, sedatives, tranquilizers, or other narcotic medications.
To make sure Fioricet is safe for you, tell your doctor if you have:
- liver disease, cirrhosis, a history of alcoholism or drug addiction, or if you drink more than 3 alcoholic beverages per day;
- kidney disease;
- asthma, sleep apnea, or other breathing disorder;
- stomach ulcer or bleeding;
- a history of skin rash caused by any medication;
- a history of mental illness or suicidal thoughts; or
- if you use medicine to prevent blood clots.
It is not known whether Fioricet will harm an unborn baby. If you use butalbital while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant.
What should I avoid while taking Fioricet?
This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
Avoid drinking alcohol. It may increase your risk of liver damage while taking acetaminophen.
Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP.
While you are taking this medication, avoid taking diet pills, caffeine pills, or other stimulants (such as ADHD medications) without your doctor’s advice.
Gabapentin capsules, tablets, and oral solution are used to help control certain types of seizures in people who have epilepsy. Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles).
Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down). Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.
What side effects can Fioricet cause?
Acetaminophen, Butalbital, Caffeine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- upset stomach
- stomach pain
If you experience any of the following symptoms, call your doctor immediately:
- skin rash
- difficulty breathing
Fioricet Brand names
- Quala Cet®¶
Brand names of combination products
- Esgic® Plus (containing Acetaminophen, Butalbital, Caffeine, Codeine)
- Geone® (containing Acetaminophen, Butalbital, Caffeine)¶
- Orbivan® (containing Acetaminophen, Butalbital, Caffeine)¶
- Fioricet® with Codeine (containing Acetaminophen, Butalbital, Caffeine, Codeine)
- Phrenilin® with Caffeine and Codeine (containing Acetaminophen, Butalbital, Caffeine, Codeine)
Butalbital-containing medications can be habit-forming and may lead to addiction and other problems. Risks of taking Fioricet and Fiorinal include:
Butalbital slows the central nervous system, leading to lack of coordination, problems with thinking and memory, slowness of speech, disinhibition, and emotional disturbances. Do not drive or operate heavy machinery while taking medicines containing butalbital.
Medication Overuse Headache
Medication overuse headaches, a type of headache disorder that occurs when a person takes medication too frequently to treat their headaches, are common in patients who take butalbital medications.
With Fioricet or Fiorinal, a medication overuse headache or rebound headache can occur from taking it three times a week or 10 or more days a month.
In addition, medication overuse headaches are often not responsive to preventive headache medications. This lack of response to other medications is often a clue to doctors that a medication overuse headache has developed.
Medications containing butalbital should be limited to two days per week to avoid this rebound effect.
When taking butalbital, you may experience withdrawal symptoms 8 to 36 hours after the last dose. Withdrawal symptoms may include anxiety, muscle twitching, tremor, weakness, dizziness, nausea and vomiting, insomnia, weight loss, and even seizures when the medication is discontinued.
Due to the risk of seizures with a withdrawal from butalbital, medical treatment in a monitored setting under the care of a physician is indicated.
Tolerance and Addiction
Tolerance and addiction may also occur with butalbital. Tolerance means that a person needs more of the medication to achieve headache relief. Addiction to butalbital is characterized by persistent behaviors, like compulsions, to take a butalbital-containing medication.
These behaviors impair their life in some way, negatively impacting relationships and/or everyday functioning.
Do not take Fioricet along with other medications that contain acetaminophen as it can be toxic to the liver.
What other drugs will affect Fioricet?
Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking Fioricet with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Other drugs may interact with acetaminophen, butalbital, and caffeine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.