Along with its needed effects, Fioricet may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Fioricet is a prescription medicine given to people who suffer from tension headaches and migraines. It is a combination of three primary ingredients which are butalbital, acetaminophen, and caffeine. Butalbital is the component of the drug that can cause a Fioricet high, as it’s a barbiturate. Barbiturates act as a central nervous system depressant, much like drugs like opioids and other muscle relaxants.
The acetaminophen works to relieve pain in a different way for the butalbital, and the caffeine is included to help improve blood flow that can reduce the symptoms of migraines and headaches.
While in general Fioricet is thought of as a headache medicine, regarding FDA approval, it’s intended for three specific types of headaches. These are muscle contraction, tension, and post-dural puncture headaches. The FDA does not necessarily approve it as a treatment for migraines, but many doctors do prescribe it for this.
While there are risks and an abuse potential with Fioricet, people who suffer from headaches can find tremendous relief in the use of this drug.
The butalbital in this medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; other prescription pain medicine; narcotics; other barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Also, drinking large amounts of alcoholic beverages regularly while taking this medicine may increase the chance of liver damage, especially if you take more of this medicine than your doctor ordered or if you take it regularly for a long time. Therefore, do not drink alcoholic beverages, and check with your doctor before taking any of the medicines listed above, while you are using this medicine.
This medicine may cause some people to become drowsy, dizzy, or lightheaded. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert and clearheaded.
Before you have any medical tests, tell the person in charge that you are taking this medicine. Caffeine (present in some butalbital and acetaminophen combinations) interferes with the results of certain tests that use dipyridamole (e.g., Persantine) to help show how well blood is flowing to your heart. Caffeine should not be taken for 8 to 12 hours before the test. The results of other tests may also be affected by butalbital and acetaminophen combinations.
Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine. Serious side effects can occur if your medical doctor or dentist gives you certain medicines without knowing that you have taken butalbital.
If you have been taking large amounts of this medicine, or if you have been taking it regularly for several weeks or more, do not suddenly stop taking it without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are taking before stopping completely in order to lessen the chance of withdrawal side effects.
If you think you or anyone else may have taken an overdose of this medicine, get emergency help at once. Taking an overdose of this medicine or taking alcohol or CNS depressants with this medicine may lead to unconsciousness or possibly death. Signs of butalbital overdose include severe drowsiness, confusion, severe weakness, shortness of breath or unusually slow or troubled breathing, slurred speech, staggering, and unusually slow heartbeat. Signs of severe acetaminophen poisoning may not occur until 2 to 4 days after the overdose is taken, but treatment to prevent liver damage or death must be started within 24 hours or less after the overdose is taken.
Fioricet Side Effects
Check with your doctor immediately if any of the following side effects occur:
- Bleeding or crusting sores on lips
- chest pain
- fever with or without chills
- hive-like swellings (large) on eyelids, face, lips, and/or tongue
- muscle cramps or pain
- red, thickened, or scaly skin
- shortness of breath, troubled breathing, tightness in chest, or wheezing
- skin rash, itching, or hives
- sores, ulcers, or white spots in mouth (painful)
Symptoms of overdose
- Anxiety, confusion, excitement, irritability, nervousness, restlessness, or trouble in sleeping (severe, especially with products containing caffeine)
- convulsions (seizures) (for products containing caffeine)
- diarrhea, especially if occurring together with increased sweating, loss of appetite, and stomach cramps or pain
- dizziness, lightheadedness, drowsiness, or weakness, (severe)
- frequent urination (for products containing caffeine)
- hallucinations (seeing, hearing, or feeling things that are not there)
- increased sensitivity to touch or pain (for products containing caffeine)
- muscle trembling or twitching (for products containing caffeine)
- nausea or vomiting, sometimes with blood
- ringing or other sounds in ears (for products containing caffeine)
- seeing flashes of “zig-zag” lights (for products containing caffeine)
- shortness of breath or unusually slow or troubled breathing
- slow, fast, or irregular heartbeat
- slurred speech
- swelling, pain, or tenderness in the upper abdomen or stomach area
- unusual movements of the eyes
Check with your doctor as soon as possible if any of the following side effects occur:
- Confusion (mild)
- mental depression
- unusual excitement (mild)
- Bloody or black, tarry stools
- bloody urine
- pinpoint red spots on skin
- swollen or painful glands
- unusual bleeding or bruising
- unusual tiredness or weakness (mild
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Bloated or “gassy” feeling
- dizziness or lightheadedness (mild)
- drowsiness (mild)
- nausea, vomiting, or stomach pain (occurring without other symptoms of overdose)
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Butalbital exerts its toxicity through excessive sedation, resulting in respiratory depression and ultimately death via hypoxia.
Nonlethal overdoses may also result in coma and death. There is no specific antidote to barbiturate overdose; treatment is supportive, generally including the administration of intravenous saline, naloxone, thiamine, glucose, sodium bicarbonate to alkalize the urine and increase rate of excretion, and activated charcoal via nasogastric tube.
Acetaminophen exerts its toxicity through the production of a toxic metabolite that can cause liver damage at doses as low as four grams.
Larger doses can precipitate acute liver failure, acute kidney injury, or gastrointestinal bleeding; death has been known to occur with ingestion of ten to fifteen grams.
The specific antidote to acetaminophen overdose is N-acetylcysteine
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
Always take these medications as prescribed by your doctor. According to the manufacturer, the typical dose for Fioricet or Fiorinal is one to two tablets, every four to six hours as needed, not to exceed six tablets per day. These drugs should not be taken more than twice a week, as extended and repeated use of butalbital can lead to physical dependence.
- Fioricet contains 50 milligrams (mg) butalbital, 300 mg acetaminophen, and 40 mg caffeine.2
- Fiorinal contains 50 mg butalbital, 325 mg aspirin, and 40 mg caffeine.3