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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.

Fioricet and Fiorinal are both used to treat tension headaches. Both medications contain butalbital and caffeine, but Fioricet also has acetaminophen whereas Fiorinal contains aspirin. Unlike acetaminophen, aspirin also treats inflammation and swelling. Neither medication is considered a first-choice option for treating tension headaches. Discuss both options with your healthcare provider to see which one is best for you.

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 can cause excessive sleepiness, dizziness, and lightheadedness. Don’t drive or use any heavy machinery until you know how the medication affects you.

    • Since Fioricet contains some caffeine, be sure to limit how much caffeine you use per day. Too much caffeine can lead to nervousness, shakiness, restlessness, trouble sleeping, and a fast heart rate.
    • Avoid drinking alcohol while taking Fioricet, since it can cause you to be more drowsy and less alert, and raise your risk of accidental injuries and liver damage.
    • Many over-the-counter and prescription medications contain acetaminophen. Don’t take more than 3 to 4 grams of acetaminophen per day to avoid liver damage. Ask your provider what your maximum daily amount of acetaminophen is, since this depends on your provider’s instructions.
    • Use caution if you currently take medications called monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil), tranylcypromine (Parnate), or selegiline (Eldepryl). Taking a MAOI with Fioricet can lead to sleepiness, dizziness, and slowed breathing.
    • If you’re using the oral syrup form of Fioricet, use the dosing cup or syringe provided by your pharmacist to measure out your dose. Don’t use kitchen spoons or cups since they might not give you the most accurate dose.
    • Store Fioricet at room temperature in a place out of reach from children due to the life-threatening risk of accidental overdose, misuse, and abuse. If you or someone you know accidentally overdoses on Fioricet, get emergency medical help or call your local poison control center at 1-800-222-1222 right away.

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:

      • Esgic®
      • 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.

More information about Fioricet, please check here.

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.

Fioricet Precaution

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.

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.

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.

Fioricet Overdose

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.

Fioricet

Generic name: acetaminophen, butalbital, and caffeine [ a-SEET-a-MIN-oh-fen, bue-TAL-bi-tal, and-KAF-een ]
Drug class: Analgesic combinations

Medically reviewed by Sanjai Sinha, MD. Last updated on Mar 16, 2022.

What is Fioricet?

Fioricet capsules contain a combination of acetaminophen, butalbital, and caffeine. Acetaminophen is a pain reliever and fever reducer. Butalbital is in a group of drugs called barbiturates. It relaxes muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

Fioricet is used to treat tension headaches that are caused by muscle contractions.

Extended and repeated use of Fioricet is not recommended because of the potential for physical dependence.

Warnings

You should not use Fioricet if you have porphyria, or if you have recently used alcohol, sedatives, tranquilizers, or other narcotic medications.

Do not use Fioricet if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine.

Do not take more Fioricet than is recommended. An overdose of acetaminophen can damage your liver or cause death. Call your doctor at once if you have nausea, pain in your upper stomach, itching, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of your skin or eyes).

In rare cases, acetaminophen may cause a severe skin reaction. Stop taking Fioricet and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling.

Before taking this medicine

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 it, if you have porphyria, or if you have recently used alcohol, sedatives, tranquilizers, or other opioids.

To make sure Fioricet is safe for you, tell your doctor if you have ever had:

  • liver disease, cirrhosis, a history of alcoholism or drug addiction, or if you drink more than 3 alcoholic beverages per day;
  • kidney disease;
  • stomach ulcer or bleeding;
  • a history of skin rash caused by any medication; or
  • a history of mental illness or suicidal thoughts.

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.

Acetaminophen, butalbital, and caffeine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breastfeeding a baby.

Fioricet is not approved for use by anyone younger than 12 years old.

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 this medicine 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 this medicine is against the law.

Store 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.

Dosing information

Usual Adult Dose for Headache:

Butalbital 50 mg/acetaminophen 300 mg/caffeine 40 mg: 1 or 2 capsules orally every 4 hours as needed not to exceed 6 capsules per day

Uses: For the relief of the symptom complex of tension (or muscle contraction) headache.

Usual Pediatric Dose for Headache:

12 years or older: Butalbital 50 mg/acetaminophen 300 mg/caffeine 40 mg: 1 or 2 capsules orally every 4 hours as needed not to exceed 6 capsules per day

Comments:
-Due to high rate of physical dependence, the extended use of this drug is not recommended.
-The safety and efficacy of treating multiple recurrent headaches with this product is not known.

Uses: For the relief of the symptom complex of tension (or muscle contraction) headache.

What happens if I miss a dose?

Since this medicine is used when needed, you may not be on a dosing schedule. If you are on a schedule, use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of acetaminophen, butalbital, and caffeine can be fatal.

The first signs of an acetaminophen overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in your upper stomach, dark urine, and yellowing of your skin or the whites of your eyes.

Overdose symptoms may also include insomnia, restlessness, tremor, diarrhea, increased shallow breathing, uneven heartbeats, seizure (convulsions), or fainting.

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.

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, a seizure;
  • 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 include:

  • drowsiness, dizziness;
  • feeling light-headed;
  • nausea, vomiting, stomach pain;
  • drunk feeling; or
  • shortness of breath.

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.

What other drugs will affect Fioricet?

Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking Fioricet with a sleeping pill, opioid pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with acetaminophen, butalbital, and caffeine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.

Popular FAQ

Is Fioricet a controlled substance?

According to the Drug Enforcement Administration (DEA), Fioricet is not a controlled substance. However, butalbital belongs to a class of drugs known as barbiturates. These drugs are habit-forming and can be abused. For this reason, it’s not recommended to take Fioricet long-term.

Is Fioricet the same as Excedrin?

Fioricet is not the same as Excedrin. Fioricet contains butalbital, which is available by prescription only. Excedrin products are available over the counter and contain different combinations of aspirin, acetaminophen, caffeine and diphenhydramine:

Excedrin Extra Strength Excedrin Migraine Excedrin Tension Headache Excedrin PM Headache
Acetaminophen 250 mg 250 mg 500 mg 250 mg
Aspirin 250 mg 250 mg 250 mg
Caffeine 65 mg 65 mg 65 mg
Diphenhydramine 38 mg

 

Is it OK to take Fioricet every day?

Because butalbital is habit-forming, it is not recommended to take Fioricet every day. It’s possible to build up a tolerance to butalbital. Over time, higher doses may be needed to have the same effect, leading to drug dependence. Taking higher doses of Fioricet can also increase the chance of an overdose.

Fioricet is intended for occasional use every 4 hours when symptoms occur.

Does Fioricet make you sleepy?

Butalbital affects the central nervous system and can make you sleepy. It can also cause lightheadedness, dizziness and mental confusion. Drowsiness is also one of the first signs of an overdose from barbiturates.

How long does Fioricet stay in your system?

Fioricet contains three different drugs. Each drug is estimated to stay in your body for a different amount of time.

  • Acetaminophen is eliminated after about 6 to 15 hours
  • Caffeine is eliminated after about 15 hours
  • Butalbital is eliminated after about 7 days

How much caffeine is in Fioricet?

Fioricet contains 40 mg of caffeine, similar to a cup of tea. The following shows the average amount of caffeine in some common beverages:

  • 8 oz of coffee: 80 to 100 mg of caffeine
  • 8 oz green or black tea: 30 to 50 mg of caffeine
  • 12 oz caffeinated soda: 30 to 40 mg of caffeine

Does Fioricet cause weight loss?

In clinical studies, weight loss was not a reported side effect from Fioricet. However, it can cause nausea, vomiting and stomach pain. Having those side effects may lead to a decreased appetite and lead to weight loss.