About Fioricet
Fioricet is a barbiturate sedative (butalbital) mixed
with a non-aspirin pain medication (acetaminophen) and caffeine.
This non-narcotic pain medication and relaxant is often prescribed
for tension headaches caused by contractions of the muscles
in the neck and shoulder area, and migraine
headaches. If you find yourself needing to use Fioricet twice
a week or more on a regular basis, speak with your doctor
about headache reduction therapy. Frequent use of Fioricet
may cause rebound headaches, particularly for migraine sufferers.
Fioricet is only available by prescription. While Fioricet's manufacturer
has had periodic recent difficulty securing the ingredient butalbital,
this drug has not been discontinued. Under the brand names Esgic,
Margesic, or Repan, you can get the same ingredients if Fioricet
is not available.
While Fioricet is a highly effective pain reliever, it has
been associated with an increased risk of addiction when used
improperly, or for too long. Never take Fioricet in greater
doses, or for a longer period of time, than recommended by
your doctor. Do not share your prescription, or use someone
else's.
Fioricet Side Effects
Common Fioricet Side Effects: Abdominal cramps, bloating,
dizziness, drowsiness, feeling of intoxication, light-headedness,
sedation, shortness of breath, nausea or vomiting (if it occurs
without other symptoms of overdose).
Alert your doctor if you experience any of the following
symptoms: mild excitement, depression, mild confusion, bloody or
black stools, bloody urine, red pinpoints on skin, painful or swollen
glands, unusual (mild) tiredness or weakness, unusual bleeding or
bruising.
Cautions: Fioricet may not be suitable for some patients,
and some conditions require that this medication be taken in lower
doses or with other precautions. Discuss a history of any of the
following conditions with your doctor so that your treatment will
be as safe as possible.
- Alcohol or drug abuse: You may be at an increased risk for
liver damage or dependence.
- Allergic reaction to any barbiturate, acetaminophen, or caffeine: Do not take Fioricet.
- Asthma: Increased risk of serious side effects
- Depression: Butalbital may worsen this condition
- Diabetes (sugar): Butalbital may worsen this condition
- Heart disease: Caffeine may make certain heart conditions worse
- Hepatitis or other liver damage: Increased risk of serious
side effects
- Hyperactivity (children): Increased risk of serious side effects
- Kidney disease: Increased risk of serious side effects
- Overactive thyroid: Butalbital may worsen this condition
- Porphyria: Butalbital is listed as an unsafe drug for porphyria,
an enzyme deficiency that can cause fragile skin that is sensitive
to sunlight, digestive difficulties, anxiety, and reddish-brown
urine.
Contact a doctor immediately if you experience any of the
following symptoms, and especially if you experience several together:
bleeding sores on your lips, chest pain, fever, large hive-like
swellings on face or in mouth, muscle cramping or pain, thick or
reddened skin, scaly skin, rash, itching, hives, sores or ulcers
in the mouth, painful white spots in mouth, sore throat.
Overdose: An overdose of Fioricet, or combining this
medication with alcohol or other central nervous system depressant,
may lead to unconciousness or perhaps death. Combining this
medication with other pain treatments, including aspirin and
ibuprofen, could increase the risk of liver damage or failure.
Butalbital overdose is indicated by severe drowsiness, confusion,
extreme weakness, hallucination, shortness of breath, too
slow or troubled breathing, slurred speech, lack of coordination,
vomiting with blood, unusually slow heartbeat. Caffeine overdose
is characterized by convulsions, diarrhea, sweating, frequent
urination, ringing sounds in ears, muscle twitching or trembling,
or seeing 'zig-zag' lights. Acetaminophen overdose can result
in severe liver poisoning, but rarely has this effect in doses
under 10g. An overdose of acetaminophen may not show symptoms
for two to four days, but must be treated within twenty-four
hours to prevent liver damage or death. Be alert to any signs
of yellowing skin or eyes, or a sense of whole-body nausea.
Fioricet Interactions
Fioricet contains the central nervous system depressant butalbital,
and may react strongly with other medication that has a similar
effect. Be cautious about taking Fioricet with any medication
that warns it 'may cause drowsiness' or cautions you against
driving or operating heavy machinery. The acetaminophen in
Fioricet should not be mixed with other pain medication. Check
the labels on over the counter medication, as these will not
all mix safely with Fioricet.
- Alcohol - Butalbital and alcohol can accelerate central
nervous system depression. Avoid mixing Fioricet with alcohol,
as this could result in a fatal overdose. Excessive drinking
during Fioricet treatment may also increase the likelihood
of serious liver damage or stomach bleeding.
- Antidiabetic drugs or insulin - Can cause hypoglycemia
in combination, dosage adjustments may be required.
- Antihistamines like Benadryl or Tavist
- Anticoagulants or blood thinners
- Aspirin (or any salicylate, such as salicylamide, or salicylic
acid) can cause kidney or liver damage when taken in high
doses, and over long periods of time, in combination with
acetaminophen. When taken in the recommended doses, for
a short time, it has not been seen to produce this effect.
- Benzodiazepines (a class of antidepressants, anti-panic
agents, and muscle relaxants) such as Ativan
(lorazepam), Valium
(diazepam), Halcion
(triazolam), Restoril
(temazepam), Librium(chlordiazepoxide),
Xanax (alprazolam),
Tranxene-SD (clorazepate), Paxipam (halazepam), ProSom (estazolam),
Klonopin (clonazepam),
and others, should be used cautiously with Fioricet.
- Beta Blockers - Drugs like Inderal
(propranolol), Lopressor
(metoprolol), Tenormin
(atenolol), and others may become less effective treatments
when used with barbiturates such as butalbital.
- Caffeine - As Fioricet contains caffeine, you should limit
your intake of caffeine through coffee or over the counter
stimulants such as Vivarin or NoDoz. Too much caffeine can
cause rebound headaches and constipation as withdrawal symptoms.
- Corticosteroids (cortisone) - Fioricet may make these
medications less effective.
- Corticotropin (ACTH) - Fioricet may make this medication
less effective.
- Desyrel (trazodone) - Risk
of additive CNS depression.
- Ibuprofen - Risk of liver damage or failure.
- MAO inhibitors - Fioricet must not be mixed with MAO (monoamine
oxidase) inhibitors such as the antidepressants Nardil,
Marplan, or Parnate.
- Narcotic pain medication, like Codeine, Demerol
(meperidine), Buprenex (buprenorphine), Darvon (propoxyphene),
Dilaudid (hydromorphone), MS Contin or Kadian (morphine),
nalbuphine, OxyContin
(oxycodone), Percocet
(oxycodone, acetaminophen), Stadol (butorphanol), Talwin
compound (pentazocine), Vicodin
(hydrocodone, acetaminophen), or Vicoprofen
(hydrocodone, ibuprofen) should not be mixed with Fioricet.
- Norflex (orphenadrine)
- Risk of oversedation.
- Oral contraceptives - Butalbital may make these medications
less effective.
- Sedatives like Fiorinal,
Phenobarbitol, Seconal, or barbiturates of any other kind,
should not be mixed with butalbital.
- Sleep medication like Ambien
(zolpidem), Sonata
(zaleplon), or over the counter sleeping pills should
be used with butalbital only as, and if, advised by your
doctor.
- Skeletal muscle relaxants - such as Flexeril
(cyclobenzaprine), Skelaxin
(metaxalone), Soma
(carisoprodol), or Robaxin
(methocarbamol) should not be mixed with Fioricet.
- Street drugs, such as barbiturates or opiates, must never
be mixed with Fioricet as this could result in a fatal overdose.
- Tegretol (carbamazepine)
- Tranquilizers such as Haldol (haloperidol), Mellaril (thioridazine),
or Thorazine (chlorpromazine) may cause oversedation; they
should not be mixed with butalbital.
- Tricyclic antidepressants such as Elavil
(amitriptyline), Asendin (amoxapine), Anafranil (clomipramine),
Pertofrane or Norpramin (desipramine), Sinequan
(doxepin), Tofranil (imipramine), Aventyl or Pamelor
(nortriptyline),
Vivactil (protriptyline), and Surmontil (trimipramine),
may increase the central nervous system suppressant effects
from either the antidepressant, or the Fioricet.
- Valproic acid, also Depakote, Depakene, divalproex.
- Wellbutrin/Zyban
(bupropion) - Barbiturates such as butalbital may decrease
levels of bupropion in the body.
If you are unsure about the safety of combining any medication
with Fioricet, consult your doctor or pharmacist.
Do not mix with over the counter pain medication; acetaminophen
can cause liver damage when mixed with certain pain medications.
Check any cold or flu medication you may need to take to be sure
it does not contain additional pain medication.
Fioricet Directions
The dosages below are guidelines for the typical adult; young people
and seniors may be prescribed lower doses. Follow your doctor's
instructions, or the instructions on the label, for your personal
treatment.
- Take one to two tablets or capsules every four hours
- 325-500 mg of acetaminophen per capsule or tablet; take a maximum
of six capsules or tablets per day.
- 650 mg of acetaminophen per capsule or tablet; take a maximum
of four capsules or tablets per day.
Higher doses of acetaminophen could increase the risk of
severe liver toxicity. Do not exceed these guidelines without
the express recommendation of your doctor, and do not combine
this medication with any other pain treatment. Acetaminophen
should never be mixed with aspirin, ibuprofen, or any non-steroidal
anti-inflammatories.
Take Fioricet as soon as a headache begins; the sooner you take
it, the more likely it is to be an effective treatment. Caffeine,
in particular, is most useful in the early stages of migraine. Fioricet
has an increased risk of dependence for individuals who take it
for frequent headaches. You might ask your doctor to prescribe an
additional treatment to prevent attacks. While prevention therapy
may take several weeks to become fully effective, it should decrease
both the frequency and intensity of your migraines.
Taking Fioricet daily may increase the occurrence of headaches,
and reduce the effectiveness of the medication as a pain reliever.
Using Fioricet more than 2-3 days per week may cause rebound headaches
and decrease the effectiveness of this pain medication. Speak to
your doctor immediately if your headaches become more frequent while
you are taking Fioricet. If Fioricet becomes less effective, it
may be an indication that a physical dependence is beginning.
Do not increase your dose of Fioricet without instructions from
your doctor. If you miss a dose, take it as soon as you remember,
unless it is almost time for your next dose. Skip the missed dose
of Fioricet and resume your regular schedule. Do not take double
doses of this pain medication.
Inform your doctor, dentist, or anesthesiologist that you are taking
Fioricet before any kind of surgery or medical test. This medication
may interfere with certain test results. Butalbital should not be
combined with certain medications given during surgery. You may
need to avoid Fioricet for a day or so before any procedure.
Store Fioricet away from direct light and heat. Store in a dry
location; avoid storing it in the bathroom, near sinks, or other
areas where it may become damp. Do not use after the expiration
date.
Keep Fioricet away from children; both when storing it, and when
discarding any unused medication.
Fioricet may cause drowsiness or disorientation. Be cautious if
you plan to drive or operate heavy machinery, avoid these activities
if you find yourself feeling tired or experience slowed reactions.
Fioricet is a trademark of Novartis
Esgic Plus is a trademark of Forest Phamaceuticals
Repan is a trademark of Everett Labs
Margesic is a trademark of Marnel Pharmaceuticals
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This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.
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