Fioricet is a combination medication used to treat migraines or severe headaches. Learn the uses, effects and how to use Fioricet safely.
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Fioricet is a combination medication that is used to treat complex tension headaches when other medications have not been effective.
What is Fioricet ?
People who suffer from tension headaches may receive a prescription of Fioricet. Fioricet includes three different drug ingredients that can help manage different symptoms of tension headaches. These include:
- Butalbital: A type of barbiturate that can help muscle relaxation.
- Acetaminophen: Also called paracetamol (sold as Tylenol) and helps to relieve pain.
- Caffeine: Enhances the effects of acetaminophen.
The ingredients of Fioricet help to address pain specifically or can help to enhance the effects of the painkillers. Some types of Fioricet include codeine, which is an opiate used to treat pain. This can increase the effect of Fioricet, but also increase some of the risks for misuse or addiction.
Fioricet is a not controlled substance, but a prescription drug, which means that it requires a prescription and cannot be purchased over the counter. Fioricet can only be prescribed a certain number of times following a Fioricet prescription schedule. This is to avoid abuse or dependence and to reduce the risk of addiction.
Fioricet is a combination medication composed of acetaminophen (Tylenol’s main ingredient), caffeine, and butalbital. It is used to relieve tension headaches and can also be prescribed to treat mild to moderate migraine.
Butalbital belongs to the barbiturate class of medication, which means it is a sedative, or relaxant.1 This makes Fioricet a barbiturate. Because it contains acetaminophen and caffeine, it is also a pain reliever and a stimulant.
Medications containing this combination of ingredients come in capsule and tablet forms, which can be taken by mouth. This combination of medications is also available in generics. Other brand names and formulations include:
- Fioricet® with Codeine (containing Acetaminophen, Butalbital, Caffeine, Codeine)
- Phrenilin® with Codeine (containing Acetaminophen, Butalbital, Caffeine, Codeine)
Alternative Names for Fioricet
The combination of butalbital, acetaminophen and caffeine has been formulated by different pharmaceutical brands and can be known by different names in different places.
The combination of butalbital, acetaminophen and caffeine has been formulated by different pharmaceutical brands and can be known by different names in different places.
- Brand Names: The combination of butalbital, acetaminophen and caffeine is sold under other brand names, as well as Fioricet. These include Americet, Ezol and Alagesic among others.
- Generic Names: Fioricet may be referred to as the generic names of the drugs combination (butalbital, acetaminophen and caffeine)
- Street Names: There are few known street names for Fioricet that does not contain codeine, as it is lower risk for abuse and addiction. Barbiturates, a drug component of Fioricet, may be referred to simply as Barbs.
Fioricet with Codeine
Fioricet with Codeine may be used in cases where stronger pain management of tension headaches is required. Fioricet with Codeine can be beneficial for people struggling to manage their pain, but comes with a higher risk of abuse and the potential for dangerous side effects. Fioricet with Codeine is also a controlled substance, and is prescribed carefully to avoid dependence or misuse.
Fiorinal vs. Fioricet
Fiorinal and Fioricet are similar medications. However, the pain-killing medication included differs between the two. While Fioricet contains acetaminophen, Fiorinal contains aspirin. Both of these drugs are useful for managing pain and fever, but some people may respond better to one than the other.
How to use Fioricet ?
Take this medication by mouth with or without food as directed by your doctor, usually every 4 hours as needed. If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
The dosage is based on your medical condition, age, and response to treatment. This medication works best if it is used as the first signs of a headache occur. If you wait until the headache has worsened, the medication may not work as well. If you suddenly stop using this medication, you may have withdrawal symptoms (such as nausea/vomiting, mental/mood changes, seizures).
To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used this medication for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal. Though it helps many people, this medication may sometimes cause addiction.
This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.
Tell your doctor if you notice increased use of this medication, a worsening of headaches, an increase in the number of headaches, the medication not working as well, or use of this medication for more than 2 headache episodes a week. Do not take more than recommended. Your doctor may need to change your medication and/or add a separate medication to prevent the headaches.
Before taking this medication, tell your doctor or pharmacist if you are allergic to acetaminophen, caffeine, or butalbital; or to other barbiturates (such as phenobarbital) or xanthine derivatives (such as theophylline); or if you have any other allergies.
This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your medical history, especially of: severe breathing problems (such as bronchopneumonia), a certain enzyme disorder (porphyria), liver disease, kidney disease, personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), mental/mood disorders, abdominal/stomach problems (such as stomach ulcer).
This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis). Liquid products may contain alcohol, sugar and/or aspartame.
Caution is advised if you have diabetes, alcohol dependence, liver disease, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.
Before having surgery or certain medical procedures (such as a heart stress test or a procedure to restore a normal heart rhythm if you have an unusually fast heartbeat), tell your doctor or dentist that you use this medication and about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Older adults may be more sensitive to the side effects of this drug, especially drowsiness and trouble falling asleep. These side effects can increase the risk of falling.
During pregnancy, this medication should be used only when clearly needed. Using it for long periods or in high doses near the expected delivery date is not recommended because of possible harm to the unborn baby. Discuss the risks and benefits with your doctor. Infants born to mothers who have used this medication for an extended time may have withdrawal symptoms such as irritability, abnormal/persistent crying, vomiting, seizures, or diarrhea. Tell your doctor right away if you notice any of these symptoms in your newborn. This drug passes into breast milk and could have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
Why is Fioricet used to treat migraine?
Fioricet is an older medication that used to frequently be prescribed to treat migraine symptoms. However, there is not enough evidence that shows it’s effective for migraine attacks, especially when compared to safer products.
Although Fioricet has been used for many years for migraine, it’s not approved for this use, and there are greater risks than benefits with this medication.
Fioricet may be an option if other migraine treatment options have not worked. Your doctor will just want to monitor you closely to avoid side effects.
It’s prescribed to help relieve immediate headache symptoms, but not to prevent migraine attacks.
How does Fioricet work to treat migraine?
Fioricet contains three different active ingredients which work together on tension headaches. The exact way Fioricet works to help relieve tension headache is not clear.
Butalbital is a barbiturate that helps with relaxation and anxiety, acetaminophen works as an analgesic for pain relief, and caffeine also helps with pain relief.
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.
How should I take Fioricet?
Take Fioricet exactly as prescribed. Follow all directions on your prescription label. Do not take more of this medication than recommended. An overdose can damage your liver or cause death. Tell your doctor if the medicine seems to stop working as well in relieving your pain.
Butalbital may be habit-forming. Never share Fioricet with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. Selling or giving away Fioricet is against the law.
Take Fioricet with food or milk if it upsets your stomach.
Store Fioricet at room temperature away from moisture and heat.
Keep track of the amount of medicine used from each new bottle. Butalbital is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.
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.
Are there risks from taking Fioricet for migraine?
Fioricet has several risks and may not be suitable for everyone.
The active ingredient butalbital in Fioricet may be habit-forming. Using higher doses for a long time may lead to dependence on Fioricet. Suddenly stopping the medication after regular use may also cause withdrawal symptoms.
Drinking alcohol or taking other sedative medications with Fioricet may be harmful and cause dangerous side effects. Butalbital takes a long time to clear from your body.
Do not take Fioricet with other products that have the same active ingredients. Taking too much of these ingredients together can increase the risk of overdose, cause liver or kidney damage, and may be life-threatening.
Talk with your doctor about any medications and over-the-counter products you’re taking, including vitamins, herbs, and natural supplements.
Some examples include:
- acetaminophen (Tylenol, multi-symptom cough/cold products)
- caffeine (energy drinks, Excedrin migraine, caffeine pills)
- butalbital (barbiturates)
Taking Fioricet regularly can increase your risk for rebound headaches or medication overuse headaches. The American Migraine Prevalence and Prevention Study found use of butalbital for 5 days per month would increase the risk of acute migraine becoming chronic migraine.
Fioricet can raise blood pressure and heart rate, if you have a history of high blood pressure or heart related conditions, ask your doctor about the risks of Fioricet.
How does Fioricet compare to other migraine treatments?
Prescription migraine medications fall into two categories, those that help prevent a migraine attack and those that treat acute symptoms.
There are also over-the-counter medications that can help relieve headache pain.
Since there are many migraine medications, ask your doctor about possible options for you.
Cost of medications depends if they are brand or generic, if you have insurance, what pharmacy you use, and other factors.
Comparison of other medications available
|Generic name||Butalbital 50mg/acetaminophen 300mg/caffeine 40mg||ubrogepant||sumatriptan||lasmiditan||erenumab|
|*Cost (depends on brand or generic and if you have insurance coverage)||generic around $10-12 for 30 capsules||expensive without insurance||generic around $10-20 for 9 tablets||expensive without insurance||expensive without insurance|
|Approved Uses||tension headache||migraine attack||migraine attack||migraine attack||migraine prevention|
|Side effects||dizziness, drowsiness, nausea, abdominal pain, shortness of breath, fast heartbeat, fainting, seizures||dry mouth, nausea, sleepiness, tiredness||chest, neck, or jaw pain, fast heart rate, warm or cold feeling, dizziness, tiredness, skin tingling||serotonin syndrome, dizziness, numbness, tiredness, tingling, drowsiness, rebound migraine||constipation, high blood pressure, injection site reactions|
|How taken?||oral||oral||nasal spray, injectable solution, nasal powder||oral||Self injection pens|
|Is there withdrawal risk with the medication?||yes||no||no||no||no|
Fioricet Drug interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Some products that may interact with this drug include: darunavir, sodium oxybate, drugs affecting liver enzymes that remove this medication from your body (such as macrolide antibiotics including erythromycin, cimetidine, disulfiram, valproic acid, fluvoxamine, MAO inhibitors including isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine), isoniazid, lithium, phenothiazines (such as chlorpromazine).
This drug can speed up the removal of other drugs from your body by affecting certain liver enzymes. These affected drugs include “blood thinners” (such as warfarin), doxycycline, estrogen, felodipine, quinidine, theophylline, certain beta blockers such as metoprolol, corticosteroids such as prednisone.
Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), other drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).
Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain caffeine or ingredients that cause drowsiness. Also keep in mind that certain beverages (such as coffee, colas, tea, energy drinks) contain caffeine. Ask your pharmacist about using those products safely.
This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use additional reliable birth control methods while using this medication. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.
This medication may interfere with certain medical/laboratory tests, possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, slow/shallow breathing, severe dizziness, nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, dark urine.
Fioricet Side Effects
Get emergency medical help if you have signs of an allergic reaction to Fioricet: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
In rare cases, acetaminophen may cause a severe skin reaction that can be fatal. This could occur even if you have taken acetaminophen in the past and had no reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. If you have this type of reaction, you should never again take any medicine that contains acetaminophen.
Stop using this medicine and call your doctor at once if you have:
- confusion, seizure (convulsions);
- shortness of breath;
- a light-headed feeling, like you might pass out; or
- nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Common Fioricet side effects may include:
- drowsiness, dizziness;
- feeling anxious or restless;
- drunk feeling; or
- sleep problems (insomnia).
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
The Fioricet ‘High’ and Abuse
The butalbital in Fioricet belongs to a class of drugs called barbiturates, a central nervous system depressant. Like other barbiturates, it has the potential to cause physical and psychological dependence, which can lead to abuse.
Those who use too much Fioricet may report feeling so relaxed and stress-free that they seek out the drug as a way to get high. Some describe it as feeling intoxicated. However, users can feel depressed and “crash” once the effects wear off.