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Butalbital / Aspirin / Caffeine / Codeine Phosphate
Pronunciation: BYOO-TAL-bih-tuhl/ASS-pihr-in/Kaff-EEN/KOE-deen FOSS-fate
Class: Narcotic analgesic
Fiorinal with Codeine
- Capsules 30 mg codeine phosphate/325 mg aspirin/40 mg caffeine/50 mg butalbital
Fiorinal-C ¼ (Canada)
ratio-Tecnal C ½ (Canada)
ratio-Tecnal C ¼ (Canada)
Trianal C½ (Canada)
Trianal C¼ (Canada)
Butalbital has generalized depressant effect on CNS and, in very high doses, has peripheral effects. Aspirin has analgesic, antipyretic, anti-inflammatory, and antirheumatic effects; its analgesic and anti-inflammatory effects may be mediated through inhibition of prostaglandin synthetase enzyme complex. Aspirin also irreversibly inhibits platelet aggregation. Caffeine is thought to produce constriction of cerebral blood vessels. Codeine binds to opiate receptors in CNS, causing inhibition of ascending pain pathways and altering perception of and response to pain.
Indications and Usage
Relief of symptom complex of tension (or muscle contraction) headache.
Hypersensitivity to salicylates, aspirin, caffeine, opiates, or barbiturates; porphyria; bleeding disorders; syndrome of nasal polyps, angioedema, and bronchospastic reactivity to aspirin or other NSAIDs; peptic ulcer.
Dosage and AdministrationAdults and Children 12 yr of age and older
PO 1 to 2 tablets or capsules every 4 h; max, 6 tablets or capsules/day.
Store in airtight, light-resistant container at room temperature.
Drug InteractionsBeta-blockers (eg, propranolol), doxycycline, estrogens (including oral contraceptives), felodipine, griseofulvin, nifedipine, phenylbutazone, quinidine, theophylline
Effects of these drugs may be decreased.Corticosteroids
May enhance renal Cl of aspirin; sudden discontinuation of corticosteroids may result in symptoms of salicylism; effects of corticosteroid may be decreased.Insulin, oral antidiabetic agents
Hypoglycemic effects may be increased.MAOIs
May increase CNS effects.Methotrexate, 6-mercaptopurine
Bone marrow toxicity may occur.NSAIDs
Increased GI ulceration may occur.Other CNS depressants (eg, ethanol, narcotics, general anesthetics, tranquilizers, sedative-hypnotics)
Increased drowsiness, dizziness, and other CNS depressive effects may occur.Probenecid, sulfinpyrazone
Uricosuric effects may be decreased.Tricyclic antidepressants
Antidepressant effects may decrease.Warfarin
Anticoagulant effects may be increased or decreased.
Laboratory Test InteractionsBlood tests
Serum amylase; fasting blood glucose; cholesterol; protein; serum hepatic aminotransferase (ALT); uric acid; prothrombin time.Urine tests
Glucose; 5-hydroxyindoleacetic acid; Gerhardt ketone, vanillylmandelic acid; uric acid; diacetic acid; spectrophotometric detection of barbiturates. Codeine component may increase serum amylase or lipase levels.
Drowsiness; dizziness; lightheadedness; confusion; mental depression; unusual excitement; nervousness.
Nausea; vomiting; flatulence; heartburn; abdominal pain; constipation.
Category C .
Safety and efficacy in children younger than 12 yr of age not established.
Use caution because of decreased elimination.
Use caution because of decreased elimination.
Prolonged use may produce drug tolerance and dependency (psychologic and physical).
Respiratory depressant effects may be enhanced and CSF pressure may be increased.
Peptic ulcer, coagulation abnormalities, and preoperative states
Use extreme caution because of increased bleeding time.
May occur in children because of aspirin component; do not use for chickenpox or flu symptoms.
Hyperthermia, tachycardia, respiratory depression, bleeding, drowsiness, confusion, coma, hypotension, hypovolemic shock, nausea, vomiting, tremor, fluid and electrolyte abnormalities, insomnia, restlessness.
- Caution patient that dependency/tolerance may result from long-term use.
- Tell patient to take with food or full glass of water.
- Instruct patient not to discontinue abruptly after long-term regular use.
- Caution patient to avoid intake of alcoholic beverages and other CNS depressants.
- Warn patient to avoid any hazardous activity (eg, driving, operating heavy machinery) if dizziness, drowsiness or a decrease in mental acuity occurs.
- Instruct patient to avoid sudden position changes to prevent orthostatic hypotension.
- Tell patient to notify health care provider if any surgical procedures are required. Aspirin therapy should be discontinued 5 days before surgery to reduce potential for bleeding problems.
- Advise patient to report the following symptoms to health care provider: persistent or recurring pain before next scheduled dose, difficulty breathing, blurred vision, buzzing in ears, increased drowsiness, vomiting, abdominal pain, tarry stools, unusual bruising or bleeding.
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