Fioricet Disease Interactions
There are 25 disease interactions with Fioricet (acetaminophen / butalbital / caffeine).
- Alcoholism
- Liver disease
- Acute alcohol intoxication
- Drug dependence
- Liver disease
- Porphyria
- Rash
- Respiratory depression
- Cardiac disease
- Hypertension
- Liver disease
- Psychiatric disorders
- PUD
- PKU
- Adrenal insufficiency
- Depression
- Hematologic toxicity
- Osteomalacia
- Paradoxical reactions
- Cardiotoxicity
- Bipolar disorders
- Psychotic disorders
- Renal dysfunction
- Seizure disorders
- GERD
Acetaminophen (applies to Fioricet) alcoholism
Major Potential Hazard, High plausibility.
Chronic alcohol abusers may be at increased risk of hepatotoxicity during treatment with acetaminophen (APAP). Severe liver injury, including cases of acute liver failure resulting in liver transplant and death, has been reported in patients using acetaminophen. Therapy with acetaminophen should be administered cautiously, if at all, in patients who consume three or more alcoholic drinks a day. In general, patients should avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure. They should also be advised to seek medical attention if they experience signs and symptoms of liver injury such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.
References
- Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med 145 (1985): 2019-23
- O'Dell JR, Zetterman RK, Burnett DA "Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic." JAMA 255 (1986): 2636-7
- Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB "Acetaminophen hepatotoxicity in alcoholics." Ann Intern Med 104 (1986): 399-404
- McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL "Potentiation of acetaminophen hepatotoxicity by alcohol." JAMA 244 (1980): 251-3
- Kartsonis A, Reddy KR, Schiff ER "Alcohol, acetaminophen, and hepatic necrosis." Ann Intern Med 105 (1986): 138-9
- Prescott LF, Critchley JA "Drug interactions affecting analgesic toxicity." Am J Med 75 (1983): 113-6
- "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical (2002):
- Whitcomb DC, Block GD "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA 272 (1994): 1845-50
- Bonkovsky HL "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
- Nelson EB, Temple AR "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
- Zimmerman HJ, Maddrey WC "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology 22 (1995): 767-73
Acetaminophen (applies to Fioricet) liver disease
Major Potential Hazard, High plausibility.
Acetaminophen is primarily metabolized in the liver to inactive forms. However, small quantities are converted by minor pathways to metabolites that can cause hepatotoxicity or methemoglobinemia. Patients with hepatic impairment may be at increased risk of toxicity due to increased minor metabolic pathway activity. Likewise, chronic or overuse of acetaminophen can saturate the primary hepatic enzymes and lead to increased metabolism by minor pathways. Severe liver injury, including cases of acute liver failure resulting in liver transplant and death, has been reported in patients using acetaminophen. Therapy with acetaminophen should be administered cautiously in patients with hepatic insufficiency. Clinical monitoring of hepatic function is recommended. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.
References
- Gillette JR "An integrated approach to the study of chemically reactive metabolites of acetaminophen." Arch Intern Med 141 (1981): 375-9
- Arnman R, Olsson R "Elimination of paracetamol in chronic liver disease." Acta Hepatogastroenterol (Stuttg) 25 (1978): 283-6
- Clements JA, Critchley JA, Prescott LF "The role of sulphate conjugation in the metabolism and disposition of oral and intravenous paracetamol in man." Br J Clin Pharmacol 18 (1984): 481-5
- Forrest JA, Adriaenssens P, Finlayson ND, Prescott LF "Paracetamol metabolism in chronic liver disease." Eur J Clin Pharmacol 15 (1979): 427-31
- Venkataramanan R, Kalp K, Rabinovitch M, et al. "Conjugative drug metabolism in liver transplant patients." Transplant Proc 21 (1989): 2455
- "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical (2002):
Barbiturates (applies to Fioricet) acute alcohol intoxication
Major Potential Hazard, High plausibility.
The use of barbiturates is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of barbiturates may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with barbiturates should be administered cautiously in patients who might be prone to acute alcohol intake.
References
- Plaa GL "Acute toxicity of antiepileptic drugs." Epilepsia 16 (1975): 183-91
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
- "Multum Information Services, Inc. Expert Review Panel"
- "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical (2001):
- "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals (2001):
- "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories (2001):
Barbiturates (applies to Fioricet) drug dependence
Major Potential Hazard, High plausibility. Applicable conditions: Drug Abuse/Dependence, Alcoholism
Barbiturates have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use of excessive dosages. Abrupt cessation and/or a reduction in dosage may precipitate withdrawal symptoms. In patients who have developed tolerance to a barbiturate, overdosage can still produce respiratory depression and death, and cross-tolerance usually will occur with other agents in the class. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance or medical supervision when treated with barbiturates. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of barbiturates should be undertaken gradually using a dosage-tapering schedule.
References
- Boisse NR, Okamoto M "Physical dependence to barbital compared to pentobarbital. II. Tolerance characteristics." J Pharmacol Exp Ther 204 (1978): 507-13
- Gersema LM, Alexander B, Kunze KE "Major withdrawal symptoms after abrupt discontinuation of phenobarbital." Clin Pharm 6 (1987): 420-2
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
- American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
- "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical (2001):
- "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals (2001):
- "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories (2001):
Barbiturates (applies to Fioricet) liver disease
Major Potential Hazard, High plausibility.
Barbiturates are extensively metabolized by the liver. The plasma clearance of barbiturates may be decreased and the half-lives prolonged in patients with impaired hepatic function. Therapy with barbiturates should be administered cautiously and initiated at reduced dosages in patients with liver disease. Barbiturates are not recommended for use in patients with cirrhosis, hepatic failure, hepatic coma, or other severe hepatic impairment.
References
- Alvin J, McHorse T, Hoyumpa A, et al. "The effect of liver disease in man on the disposition of phenobarbital." J Pharmacol Exp Ther 192 (1975): 224-35
- Kallberg N, Agurell S, Ericsson O, et al. "Quantitation of phenobarbital and its main metabolites in human urine." Eur J Clin Pharmacol 9 (1975): 161-8
- Whyte MP, Dekaban "Metabolic fate of phenobarbital: a quantitative study of p-hydroxyphenobarbital elimination in man." Drug Metab Dispos 5 (1977): 63-9
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical (2001):
- "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals (2001):
- "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories (2001):
Barbiturates (applies to Fioricet) porphyria
Major Potential Hazard, High plausibility.
The use of barbiturates is contraindicated in patients with a history of porphyria. Barbiturates may exacerbate acute intermittent porphyria or porphyria variegata by inducing the enzymes responsible for porphyrin synthesis.
References
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
- American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
- Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
- "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical (2001):
- "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals (2001):
- "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories (2001):
Barbiturates (applies to Fioricet) rash
Major Potential Hazard, High plausibility. Applicable conditions: Dermatitis - Drug-Induced
Skin eruptions may precede rare but potentially fatal barbiturate-induced reactions such as systemic lupus erythematosus and exfoliative dermatitis, the latter of which may be accompanied by hepatitis and jaundice. Therapy with barbiturates should be administered cautiously in patients with preexisting drug-induced dermatitis, since it may delay the recognition of a potential reaction to barbiturates. Barbiturate therapy should be withdrawn promptly at the first sign of a dermatologic adverse effect. However, cutaneous reactions may proceed to an irreversible stage even after cessation of medication due to the slow rate of metabolism and excretion of barbiturates. Patients should be advised to promptly report signs that may indicate impending development of barbiturate-related cutaneous lesions, including high fever, severe headache, stomatitis, conjunctivitis, rhinitis, urethritis, and balanitis. Rashes may be more likely to occur with phenobarbital and mephobarbital.
References
- Pelekanos J, Camfield P, Camfield C, Gordon K "Allergic rash due to antiepileptic drugs: clinical features and management." Epilepsia 32 (1991): 554-9
- Pagliaro L, Campesi G, Aguglia F "Barbiturate jaundice. Report of a case due to a barbital-containing drug, with positive rechallenge to phenobarbital." Gastroenterology 56 (1969): 938-43
- Shear NH, Spielberg SP "Anticonvulsant hypersensitivity syndrome. In vitro assessment of risk." J Clin Invest 82 (1988): 1826-32
- Stuttgen G "Toxic epidermal necrolysis provoked by barbiturates." Br J Dermatol 88 (1973): 291-3
- Fernandez de Corres L, Leanizbarrutia I, Munoz D "Eczematous drug reaction from phenobarbitone." Contact Dermatitis 11 (1984): 319
- Dourmishev AL, Rahman MA "Phenobarbital-induced pemphigus vulgaris." Dermatologica 173 (1986): 256-8
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical (2001):
- "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals (2001):
- "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories (2001):
Barbiturates (applies to Fioricet) respiratory depression
Major Potential Hazard, High plausibility. Applicable conditions: Asphyxia, Pulmonary Impairment, Respiratory Arrest
Barbiturates may produce severe respiratory depression, apnea, laryngospasm, bronchospasm and cough, particularly during rapid intravenous administration. In usual hypnotic dosages, the degree of respiratory depression produced is similar to that which occurs during physiologic sleep, while at higher dosages, the rate, depth and volume of respiration may be markedly decreased. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with barbiturates should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Barbiturates, especially injectable formulations, should generally be avoided in patients with sleep apnea, hypoxia, or severe pulmonary diseases in which dyspnea or obstruction is evident.
References
- Plaa GL "Acute toxicity of antiepileptic drugs." Epilepsia 16 (1975): 183-91
- Lund A, Gormsen H "The role of antiepileptics in sudden death in epilepsy." Acta Neurol Scand 72 (1985): 444-6
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
- American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
- "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical (2001):
- "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals (2001):
- "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories (2001):
CNS stimulants (applies to Fioricet) cardiac disease
Major Potential Hazard, Moderate plausibility. Applicable conditions: Hypertension, Hyperthyroidism, Heart Disease, Pheochromocytoma, Peripheral Arterial Disease
The use of CNS stimulants is contraindicated in patients with significant cardiovascular impairment such as uncompensated heart failure, severe coronary disease, severe hypertension (including that associated with hyperthyroidism or pheochromocytoma), cardiac structural abnormalities, serious arrhythmias, etc. Sudden death has been reported in adults and children taking CNS stimulant treatment. Additionally, stroke, myocardial infarction, chest pain, syncope, arrhythmias and other symptoms have been reported in adults under treatment. A careful assessment of the cardiovascular status should be done in patients being considered for treatment. This includes family history, physical exam and further cardiac evaluation (EKG and echocardiogram). Patients who develop symptoms should have a detailed cardiac evaluation and if needed, treatment should be suspended.
References
- "Product Information. Fastin (phentermine)." SmithKline Beecham (2001):
- "Product Information. Provigil (modafinil)." Cephalon, Inc (2001):
- "Product Information. Dopram (doxapram)." West Ward Pharmaceutical Corporation (2001):
- "Product Information. Desoxyn (methamphetamine)." Abbott Pharmaceutical (2001):
- "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham (2001):
- "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn (2001):
- "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals (2001):
- "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
- "Product Information. Concerta (methylphenidate)." Alza (2002):
- "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
- "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
- "Product Information. Nuvigil (armodafinil)." Cephalon Inc (2007):
- "Product Information. Phendimetrazine Tartrate SR (phendimetrazine)." Sandoz Inc (2012):
CNS stimulants (applies to Fioricet) hypertension
Major Potential Hazard, Moderate plausibility.
CNS stimulant medications have shown to increase blood pressure, and their use might be contraindicated in patients with severe hypertension. Caution should be used when administering to patients with preexisting high blood pressure and other cardiovascular conditions. All patients under treatment should be regularly monitored for changes in blood pressure and heart rate.
References
- "Product Information. Fastin (phentermine)." SmithKline Beecham (2001):
- "Product Information. Provigil (modafinil)." Cephalon, Inc (2001):
- "Product Information. Dopram (doxapram)." West Ward Pharmaceutical Corporation (2001):
- "Product Information. Desoxyn (methamphetamine)." Abbott Pharmaceutical (2001):
- "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham (2001):
- "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn (2001):
- "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals (2001):
- "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
- "Product Information. Concerta (methylphenidate)." Alza (2002):
- "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
- "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
- "Product Information. Nuvigil (armodafinil)." Cephalon Inc (2007):
- "Product Information. Phendimetrazine Tartrate SR (phendimetrazine)." Sandoz Inc (2012):
CNS stimulants (applies to Fioricet) liver disease
Major Potential Hazard, Moderate plausibility.
In general, CNS stimulants are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with CNS stimulants should be administered cautiously in patients with moderate to severe liver disease, and the dosage should be adjusted accordingly. Additionally, postmarketing reports have shown that atomoxetine can cause severe liver injury. Laboratory testing should be done at the first sign or symptom of liver dysfunction (jaundice, dark urine, upper quadrant tenderness) and treatment should be discontinued in patients with evidence of liver injury.
References
- "Product Information. Fastin (phentermine)." SmithKline Beecham (2001):
- "Product Information. Provigil (modafinil)." Cephalon, Inc (2001):
- "Product Information. Dopram (doxapram)." West Ward Pharmaceutical Corporation (2001):
- "Product Information. Desoxyn (methamphetamine)." Abbott Pharmaceutical (2001):
- "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham (2001):
- "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn (2001):
- "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals (2001):
- "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
- "Product Information. Concerta (methylphenidate)." Alza (2002):
- "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
- "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
- "Product Information. Nuvigil (armodafinil)." Cephalon Inc (2007):
- "Product Information. Phendimetrazine Tartrate SR (phendimetrazine)." Sandoz Inc (2012):
CNS stimulants (applies to Fioricet) psychiatric disorders
Major Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis, Depression
The use of CNS stimulants can cause psychotic or maniac symptoms, suicidal ideation, aggression and can exacerbate symptoms of behavior disturbance and thought disorder. Psychiatric symptoms have been reported in patients with and without history of psychiatric disorders, and all patients should be monitored closely, specially during treatment initiation and at times of dose changes. Extreme caution should be exercised when CNS stimulants are given to patients with a history of psychosis, depression, mania, or bipolar disorder. All patients receiving treatment should be screened for bipolar disease prior to initiation. If any psychiatric symptoms emerge or are exacerbated, treatment suspension should be considered. CNS stimulants are contraindicated in patients with marked agitation or anxiety.
References
- "Product Information. Fastin (phentermine)." SmithKline Beecham (2001):
- "Product Information. Provigil (modafinil)." Cephalon, Inc (2001):
- "Product Information. Dopram (doxapram)." West Ward Pharmaceutical Corporation (2001):
- "Product Information. Desoxyn (methamphetamine)." Abbott Pharmaceutical (2001):
- "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham (2001):
- "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn (2001):
- "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals (2001):
- "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
- "Product Information. Concerta (methylphenidate)." Alza (2002):
- "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
- "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
- "Product Information. Nuvigil (armodafinil)." Cephalon Inc (2007):
- "Product Information. Phendimetrazine Tartrate SR (phendimetrazine)." Sandoz Inc (2012):
Methylxanthines (applies to Fioricet) PUD
Major Potential Hazard, High plausibility. Applicable conditions: Peptic Ulcer
Methylxanthines are known to stimulate peptic acid secretion. Therapy with products containing methylxanthines should be administered with extreme caution in patients with active peptic ulcer disease. Some manufacturers consider their use to be contraindicated under such circumstance.
References
- Stoller JL "Oesophageal ulceration and theophylline." Lancet 2 (1985): 328-9
- "Product Information. Theo-Dur (theophylline)." Schering Corporation (2001):
- Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity." Am Fam Physician 54 (1996): 1473
- "Product Information. Lufyllin (dyphylline)." Wallace Laboratories (2001):
Acetaminophen (applies to Fioricet) PKU
Moderate Potential Hazard, High plausibility. Applicable conditions: Phenylketonuria
Several oral acetaminophen and acetaminophen-combination products, particularly flavored chewable tablets, contain the artificial sweetener, aspartame (NutraSweet). Aspartame is converted to phenylalanine in the gastrointestinal tract following ingestion. Chewable and effervescent formulations of acetaminophen products may also contain phenylalanine. The aspartame/phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).
References
- "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical (2002):
Barbiturates (applies to Fioricet) adrenal insufficiency
Moderate Potential Hazard, High plausibility. Applicable conditions: Panhypopituitarism
Barbiturates, especially phenobarbital, secobarbital and butabarbital, may diminish the systemic effects of exogenous and endogenous corticosteroids via induction of hepatic microsomal enzymes, thereby accelerating the metabolism of corticosteroids. In addition, barbiturates may interfere with pituitary corticotropin production. Therapy with barbiturates should be administered cautiously in patients with adrenal insufficiency. Patients with borderline hypoadrenalism should be monitored closely, and patients receiving steroid supplementation may require an adjustment in dosage when barbiturates are added to or withdrawn from their medication regimen.
References
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical (2001):
- "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals (2001):
- "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories (2001):
Barbiturates (applies to Fioricet) depression
Moderate Potential Hazard, High plausibility.
Barbiturates depress the central nervous system and may cause or exacerbate mental depression. Therapy with barbiturates should be administered cautiously in patients with a history of depression or suicidal tendencies. It may be prudent to refrain from dispensing large quantities of medication to these patients.
References
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
- "Multum Information Services, Inc. Expert Review Panel"
- "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical (2001):
- "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals (2001):
- "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories (2001):
Barbiturates (applies to Fioricet) hematologic toxicity
Moderate Potential Hazard, Low plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts
Hematologic toxicity, including agranulocytosis, thrombocytopenic purpura and megaloblastic anemia, has been reported rarely during use of barbiturates. Therapy with barbiturates should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow suppression. Blood counts are recommended prior to and periodically during long-term therapy, and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, easy bruising, petechiae, bleeding, pallor, dizziness, or jaundice. Barbiturate therapy should be discontinued if blood dyscrasias occur.
References
- Van Hoof A, Chamone DA, Vermylen J "Platelet aggregation and anaesthesia." Lancet 2 (1980): 373
- Kiorboe E, Plum CM "Megaloblastic anaemia developing during treatment of epilepsy." Acta Med Scand Suppl 445 (1966): 349-57
- Iivanainen M, Savolainen H "Side effects of phenobarbital and phenytoin during long-term treatment of epilepsy." Acta Neurol Scand Suppl 97 (1983): 49-67
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical (2001):
- "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals (2001):
- "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories (2001):
Barbiturates (applies to Fioricet) osteomalacia
Moderate Potential Hazard, Low plausibility. Applicable conditions: Vitamin D Deficiency
Rickets and osteomalacia have rarely been reported following prolonged use of barbiturates, possibly due to increased metabolism of vitamin D as a result of enzyme induction by barbiturates. Long-term therapy with barbiturates should be administered cautiously in patients with vitamin D deficiency.
References
- Sotaniemi EA, Hakkarainen HK, Puranen JA, Lahti RO "Radiologic bone changes and hypocalcemia with anticonvulsant therapy in epilepsy." Ann Intern Med 77 (1972): 389-94
- Zerwekh JE, Homan R, Tindall R, Pak CY "Decreased serum 24,25-dihydroxyvitamin D concentration during long- term anticonvulsant therapy in adult epileptics." Ann Neurol 12 (1982): 184-6
- Marsden CD, Reynolds EH, Parsons V, Harris R, Duchen L "Myopathy associated with anticonvulsant osteomalacia." Br Med J 4 (1973): 526-7
- Iivanainen M, Savolainen H "Side effects of phenobarbital and phenytoin during long-term treatment of epilepsy." Acta Neurol Scand Suppl 97 (1983): 49-67
- Doriguzzi C, Mongini T, Jeantet A, Monga G "Tubular aggregates in a case of osteomalacic myopathy due to anticonvulsant drugs." Clin Neuropathol 3 (1984): 42-5
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
Barbiturates (applies to Fioricet) paradoxical reactions
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Hyperkinetic Syndrome of Childhood
Paradoxical reactions characterized by excitability and restlessness may occur in pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with barbiturates.
References
- Mayhew LA, Hanzel TE, Ferron FR, Kalachnik JE, Harder SR "Phenobarbital exacerbation of self-injurious behavior." J Nerv Ment Dis 180 (1992): 732-3
- "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company (2001):
- Sylvester CE, Marchlewski A, Manaligod JM "Primidone or phenobarbital use complicating disruptive behavior disorders." Clin Pediatr (Phila) 33 (1994): 252-3
- American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
- "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical (2001):
- "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company (2001):
- "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals (2001):
- "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories (2001):
Caffeine (applies to Fioricet) cardiotoxicity
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Tachyarrhythmia, Myocardial Infarction, Post MI Syndrome, Hypertension, Hyperthyroidism, Angina Pectoris
Like other methylxanthines, caffeine at high dosages may be associated with positive inotropic and chronotropic effects on the heart. Caffeine may also produce an increase in systemic vascular resistance, resulting in elevation of blood pressure. Therapy with products containing caffeine should be administered cautiously in patients with severe cardiac disease, hypertension, hyperthyroidism, or acute myocardial injury. Some clinicians recommend avoiding caffeine in patients with symptomatic cardiac arrhythmias and/or palpitations and during the first several days to weeks after an acute myocardial infarction.
References
- "Multum Information Services, Inc. Expert Review Panel"
CNS stimulants (applies to Fioricet) bipolar disorders
Moderate Potential Hazard, Moderate plausibility.
Central nervous system (CNS) stimulants may induce a mixed/manic episode in patients with bipolar disorder. Prior to initiating treatment, screen patients for risk factors for developing a manic episode (e.g., comorbid or history of depressive symptoms or a family history of suicide, bipolar disorder, and depression). Close monitoring is recommended when using these agents in patients with bipolar disorders.
References
- "Product Information. Fastin (phentermine)." SmithKline Beecham (2001):
- "Product Information. Cylert (pemoline)." Abbott Pharmaceutical (2001):
- "Product Information. Ritalin (methylphenidate)." Novartis Pharmaceuticals (2001):
- "Product Information. Desoxyn (methamphetamine)." Abbott Pharmaceutical (2001):
- "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham (2001):
- "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc (2001):
- "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn (2001):
- "Product Information. Prelu-2 (phendimetrazine)." Boehringer-Ingelheim (2001):
- "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals (2001):
- "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals (2001):
- "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
- "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
CNS stimulants (applies to Fioricet) psychotic disorders
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis
Central nervous system (CNS) stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a preexisting psychotic disorder. Close monitoring is recommended when using these agents in patients with psychotic disorders.
References
- "Product Information. Fastin (phentermine)." SmithKline Beecham (2001):
- "Product Information. Cylert (pemoline)." Abbott Pharmaceutical (2001):
- "Product Information. Ritalin (methylphenidate)." Novartis Pharmaceuticals (2001):
- "Product Information. Desoxyn (methamphetamine)." Abbott Pharmaceutical (2001):
- "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham (2001):
- "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc (2001):
- "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn (2001):
- "Product Information. Prelu-2 (phendimetrazine)." Boehringer-Ingelheim (2001):
- "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals (2001):
- "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals (2001):
- "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
- "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
- "Product Information. Fintepla (fenfluramine)." Zogenix, Inc (2020):
CNS stimulants (applies to Fioricet) renal dysfunction
Moderate Potential Hazard, Moderate plausibility.
Overall CNS stimulants should be administered with caution in patients with significantly impaired renal function as the reduction in the rate of elimination may alter the therapeutic response. The dosage should be adjusted accordingly.
References
- "Product Information. Fastin (phentermine)." SmithKline Beecham (2001):
- "Product Information. Provigil (modafinil)." Cephalon, Inc (2001):
- "Product Information. Dopram (doxapram)." West Ward Pharmaceutical Corporation (2001):
- "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn (2001):
- "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
CNS stimulants (applies to Fioricet) seizure disorders
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Seizures
Due to general central nervous system stimulation, therapy with CNS stimulant drugs may cause seizures. These drugs may lower the convulsive threshold in patients with prior history of seizures or EEG abnormalities, and very rarely in patients with no previous history of seizures. Therapy with CNS stimulants should be used with caution in patients with or predisposed to seizures. If seizures appear, therapy should be discontinued.
References
- "Product Information. Fastin (phentermine)." SmithKline Beecham (2001):
- "Product Information. Provigil (modafinil)." Cephalon, Inc (2001):
- "Product Information. Cylert (pemoline)." Abbott Pharmaceutical (2001):
- "Product Information. Desoxyn (methamphetamine)." Abbott Pharmaceutical (2001):
- "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham (2001):
- "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn (2001):
- "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals (2001):
- "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
- "Product Information. Concerta (methylphenidate)." Alza (2002):
- "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
- "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
- "Product Information. Nuvigil (armodafinil)." Cephalon Inc (2007):
- "Product Information. Phendimetrazine Tartrate SR (phendimetrazine)." Sandoz Inc (2012):
Methylxanthines (applies to Fioricet) GERD
Moderate Potential Hazard, High plausibility. Applicable conditions: Gastroesophageal Reflux Disease
Methylxanthines increase gastric acidity and may also relax lower esophageal sphincter, which can lead to gastric reflux into the esophagus. Therapy with products containing methylxanthines should be administered cautiously in patients with significant gastroesophageal reflux.
References
- Stoller JL "Oesophageal ulceration and theophylline." Lancet 2 (1985): 328-9
- American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
- Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity." Am Fam Physician 54 (1996): 1473
- "Product Information. Lufyllin (dyphylline)." Wallace Laboratories (2001):
Fioricet drug interactions
There are 609 drug interactions with Fioricet (acetaminophen / butalbital / caffeine).
Fioricet alcohol/food interactions
There are 6 alcohol/food interactions with Fioricet (acetaminophen / butalbital / caffeine).
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Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
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