About Fiorinal
Fiorinal is a barbiturate sedative (butalbital) mixed with aspirin
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 Fiorinal twice
a week or more on a regular basis, speak with your doctor
about headache reduction therapy. Frequent use of Fiorinal
may cause rebound headaches, particularly for migraine sufferers.
While Fiorinal 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 Fiorinal in greater doses, or for a
longer period of time, than recommended by your doctor.
Fiorinal is only available by prescription.
Fiorinal Side Effects
Common Fiorinal 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: Fiorinal 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, aspirin, NSAID,
or caffeine: Do not take Fiorinal.
- Asthma: Increased risk of serious side effects. Individuals
with aspirin sensitive asthma or who have had an asthma attack
after taking an NSAID medication should not use Fiorinal.
- 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.
- Ulcer or Gastrointestinal Bleeding: Aspirin may increase
the risk of bleeding in the upper GI tract and should probably
be either avoided or used very rarely by individuals who are at
risk.
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 Fiorinal, or combining this medication
with alcohol or other central nervous system depressant, may lead
to unconciousness or perhaps death. 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.
Fiorinal Interactions
Fiorinal contains the central nervous system depressant butalbital,
and may react strongly with other medication that has a similar
effect. Be cautious about taking Fiorinal with any medication that
warns it 'may cause drowsiness' or cautions you against driving
or operating heavy machinery. The aspirin in Fiorinal should not
be mixed with certain ingredients in other pain medication. Check
the labels on over the counter medication, as these will not all
mix safely with Fiorinal.
- Alcohol - Butalbital and alcohol can accelerate central nervous
system depression. Avoid mixing Fiorinal with alcohol, as this
could result in a fatal overdose. Excessive drinking during Fiorinal
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
- Acetaminophen can cause kidney or liver damage when taken in
high doses, and over long periods of time, in combination with
aspirin. 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 Fiorinal.
- 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 Fiorinal 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) - Fiorinal may make these medications
less effective.
- Corticotropin (ACTH) - Fiorinal may make this medication less
effective.
- Desyrel (trazodone) - Risk of additive
CNS depression.
- MAO inhibitors - Fiorinal 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 Fiorinal.
- Norflex (orphenadrine)
- Risk of oversedation.
- Oral contraceptives - Butalbital may make these medications
less effective.
- Pain medication - Do not mix Fiorinal with any over the counter
pain medication, as this will increase the risk of side effects.
If your doctor has prescribed a rotating schedule of different
types of pain medication to treat your headaches, wait the recommended
amount of time between doses. Overuse of any pain medication,
or combination of them, may cause rebound headaches.
- Sedatives like Fioricet
(butalbital, acetaminophen, and caffeine), 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 Fiorinal.
- Street drugs, such as barbiturates or opiates, must never be
mixed with Fiorinal 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 Fiorinal.
- 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 Fiorinal, consult your doctor or pharmacist.
Fiorinal Dosages
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, up to
a maximum of six capsules per day.
Higher doses of aspirin could increase the risk of stomach bleeding.
Do not exceed these guidelines without the express recommendation
of your doctor.
Fiorinal Directions
Take Fiorinal 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. Fiorinal
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 Fiorinal daily may increase the occurrence of headaches,
and reduce the effectiveness of the medication as a pain reliever.
Using Fiorinal 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 Fiorinal. If Fiorinal becomes less effective, it
may be an indication that a physical dependence is beginning.
Do not increase your dose of Fiorinal 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 Fiorinal and resume your regular schedule. Do not take double
doses of this pain medication.
Do not mix with over the counter pain medication; aspirin can cause
liver damage or an increased risk of gastrointestinal bleeding 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.
Inform your doctor, dentist, or anesthesiologist that you are taking
Fiorinal 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 Fiorinal for a day or so before any procedure.
Store Fiorinal 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 Fiorinal away from children; both when storing it, and when
discarding any unused medication.
Fiorinal 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.
Fiorinal and Pregnancy
Fiorinal is not recommended for pregnant or nursing women, as its components
can affect a developing infant. Barbiturates have been shown to increase the risk of birth defects and brain tumors in the fetus. Caffeine in large doses may interfere with the baby's heart rhythm and growth.
If you become pregnant while taking this medication, inform your
doctor immediately. If you are breastfeeding, your doctor will advise
you to stop breastfeeding if you must take Fiorinal.
Fiorinal and Children
Fiorinal has not been tested for safety in children under 12 years old. Older children might be prescribed a reduced dose.
Fiorinal and Seniors
Fiorinal may cause confusion, depression, or excitement in older adults. Your doctor will prescribe an individualized dose of Fiorinal to minimize side effects.
Fiorinal and Fiorinal with Codeine are trademarks of Novartis
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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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