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Fioricet Patient Tips

Written by C. Fookes, BPharm on Mar 01, 2017

How it works

Fioricet is a combination tablet containing acetaminophen, butalbital, and caffeine.

Experts aren't sure exactly how acetaminophen works, but suspect it blocks a specific type of cyclo-oxygenase (COX) enzyme, located mainly in the brain.

Butalbital belongs to the class of medicines called barbiturates. When used for tension headaches it relaxes muscle contractions and causes sedation via an enhancement of the inhibitory effects of GABA (a neurotransmitter that regulates communication between brain cells).

Caffeine is thought to enhance the pain-relieving effects of acetaminophen by up to 40%. In addition, it has vasoconstrictive properties, narrowing blood vessels in the brain thereby decreasing blood flow and oxygen tension (before a headache or migraine, blood vessels tend to enlarge). This also helps to relieve pain.

Upsides

Effective for the short-term treatment of episodic tension-type headaches.

Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Dizziness, drowsiness, lightheadedness, sedation, shortness of breath, nausea, vomiting, abdominal pain, or an intoxicated feeling are the most commonly reported side effects.
  • Other side effects, such as constipation, excessive sweating, itch, and mental confusion and uncommon.
  • Butalbital is habit-forming and there is a high risk of dependence with extended and repeated use of Fioricet.
  • May cause medication-overuse headache with repeated use and a withdrawal syndrome on discontinuation.
  • The potential for liver damage with the acetaminophen component exists, even at recommended dosages. The risk is increased with higher dosages, with chronic alcohol use, with some medications, and in patients with significant liver disease.
  • May not be suitable for some people, including the elderly and people with kidney or liver disease.
  • Although Fioricet may be prescribed for migraine headaches, it is not FDA approved for this and evidence does not support its use for migraine.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

Bottom Line

Fioricet is an effective pain reliever for the short-term treatment of tension-type headaches. However, it is sedating and potentially habit forming and should not be used repeatedly. Simpler and safer analgesics or analgesic combinations should be tried first.

Tips

  • Do not overuse Fioricet because you may become addicted to it and have difficulty stopping it.
  • Over-use of Fioricet can also result in medication-overuse headache (also known as a rebound headache) which occurs when analgesics are taken too frequently to relieve headache.
  • Never share your Fioricet with anybody else.
  • May be administered without regards to food; although food may decrease any reported stomach upset.
  • If you have been taking Fioricet regularly, or if you think you have become addicted to it, talk to your doctor about slowly withdrawing it, as sudden withdrawal may precipitate a withdrawal syndrome (symptoms include anxiety, dizziness, hallucinations, muscle twitching, nausea, seizures, sleeplessness, or tremor).
  • Fioricet can cause sedation and affect your ability to drive or operate machinery.
  • Do not drink more than two alcoholic drinks a day if you are a man or one alcoholic drink per day if you are women and taking Fioricet.
  • Talk to your doctor or pharmacist before taking any other medications or natural products with Fioricet as it can interact with a large number of drugs.
  • Talk to your doctor if you have any side effects of concern. Seek urgent medical advice if you develop an allergic-type reaction (difficulty breathing or swallowing, rash, or facial swelling) soon after taking Fioricet.
  • Not recommended for women who are pregnant or breastfeeding.

Response and Effectiveness

  • The pain-relieving effects of acetaminophen are reached within 30-60 minutes of administration.
  • Butalbital is well absorbed from the gastrointestinal tract and produces a muscle relaxing effect and sedation within one to two hours. Butalbital is metabolized in the liver by the CYP450 enzyme system which means it has the potential to interact with a large number of other drugs. Butalbital has an average half-life of around 35 hours, which means it lasts for a long time in the body and repeated doses may have a cumulative effect, increasing the risk of side effects.
  • Caffeine is metabolized in the liver to other active substances, and has a short half-life (3 to 7 hours).

References

Fioricet [Package Insert]. Revised 04/2014. Watson Pharma, Inc. https://www.drugs.com/pro/fioricet.html

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Fioricet only for the indication prescribed.

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