Fioricet

Fioricet and Esgic are brand names of a combination of butalbital (a barbiturate), acetaminophen and caffeine which is indicated for the treatment of tension headaches, muscle contraction headaches and post-dural puncture headaches. Although not indicated, they are commonly used to treat migraines and other pain related ailments.

Fioricet is indicated for the treatment of muscle tension or muscle contraction headaches. It is also commonly prescribed for migraines although it is not FDA indicated for this use in the United States. The usual adult dose is 1-2 tablets every four hours as needed, not exceeding six tablets in a 24-hour period.

Side effects
Commonly reported side effects for Fioricet include:

Euphoria
Dizziness
Drowsiness
Intoxicated feeling
Light-headedness
Nausea
Vomiting
Sedation
Substance dependence
Shortness of breath
Abdominal pain

Fioricet is implicated as causing repeat headaches with over-use.

Fioricet contains 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.

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 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.

This medicine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

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.

What is Fioricet?

Fioricet is a combination medication. That is, it contains several different medications that work together to have a stronger effect.

The active ingredients in Fioricet are:

  • Acetaminophen (the main ingredient in Tylenol)
  • Caffeine
  • Butalbital

Acetaminophen is a pain reliever. It starts working in less than an hour to reduce headache pain. Caffeine is also useful for fighting a headache, and it increases the effectiveness of acetaminophen. Butalbital is a barbiturate, which is a sedating or relaxing type of medication. The butalbital in Fioricet helps reduce anxiety and cuts down on the restlessness caused by the caffeine.

Is it effective for migraines?

Sometimes. There is very little scientific research to show Fioricet can stop a migraine. It is intended to be used for tension-type (muscle tension) headaches, which are different from migraines.

There is good research to show acetaminophen is effective at stopping migraines. Unfortunately, the dose of acetaminophen that works best to stop a migraine is lower than the dose in Fioricet.

What are some of the dangers of taking Fioricet for migraine?

  • Fioricet can be habit-forming: Over time, your body can stop responding to a regular dose of Fioricet, which might push you to take a higher dose than you normally would. It is also possible to develop a dependency on Fioricet. In other words, you might begin to think you can’t feel normal without it. This might cause you to take Fioricet too frequently.
  • Too much Fioricet can make you dangerously sleepy: Butalbital is a relaxant, and it can be harmful when combined with other relaxants, including alcohol. In large doses this effect can be life-threatening. Additionally, because Fioricet contains acetaminophen and caffeine, you should not take it with Tylenol, cold medicines that contain acetaminophen, caffeine pills, or caffeine-containing beverages like coffee, soda, or energy drinks. Both acetaminophen and caffeine are also dangerous at high doses.
  • Stopping Fioricet quickly can cause withdrawal: If you’ve been taking Fioricet for a while, you could experience symptoms of withdrawal, including seizures, if you stop taking it suddenly. Talk to your provider about finding a way to lower your dose safely if this is a problem for you.
  • Taking Fioricet can increase your risk of headaches: Taking Fioricet frequently can cause a different sort of headache, called a medication-overuse headache. Also, when the caffeine in Fioricet wears off, some people get a rebound headache.
  • Too much Fioricet can damage your liver: The acetaminophen ingredient in Fioricet can cause damage to your liver if you take it too often. If you already have liver problems you should avoid Fioricet.
  • Fioricet is not a good choice for pregnant or nursing women: If you take Fioricet while you are pregnant, your newborn baby could experience withdrawal symptoms after they are born. Acetaminophen and caffeine carry their own risks during pregnancy. In addition, all three ingredients can be passed through the breastmilk to infants who are nursing. Fortunately, there are other medications you can take if you are pregnant or nursing and need treatment for your migraines.

When should you take Fioricet for migraine?

Fioricet is best when it is used for tension-type headaches, which are different from migraines.

Tension-type headaches, which are also known as muscle contraction headaches, usually feel like a steady tightness on both sides of the head. They don’t cause nausea or vomiting and don’t get worse with movement. Unlike migraines, tension-type headaches also don’t usually get worse with bright lights or loud sounds.

For migraines, safer and more effective medications are available (see next section). If nothing else works for you, Fioricet can be a back-up option.

Regardless of why you are taking it, Fioricet should only be used occasionally.

A number of other medications are available for treating migraines. These include over-the-counter and prescription options.

  • Over-the-counter medications
    • Acetaminophen (Tylenol)
    • Ibuprofen (Motrin or Advil)
    • Naproxen (Aleve)
    • Acetaminophen, aspirin, caffeine (Excedrin Migraine)
  • Prescription medications
    • Triptans, such as rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
    • Gepants, such as ubrogepant (Ubrelvy) or rimegepant (Nurtec)
    • Lasmiditan (Reyvow)

In addition, a variety of daily medications, such as amitriptyline (Amitril, Elavil), propranolol (Inderal LA), and topiramate (Topamax) are available to keep migraines from happening in the first place. Fioricet should never be used as a daily medication.

How long after taking Fioricet can you take Excedrin Migraine and other medications?

After taking Fioricet, wait at least 4 hours before taking anything else that contains caffeine or acetaminophen so you don’t overdose on these ingredients. This includes Excedrin Migraine, Excedrin Extra Strength, Excedrin Tension Headache, and Excedrin PM Headache.

Butalbital stays in your body for about 35 hours after a single dose of Fioricet. It causes sleepiness, and taking more doses of Fioricet in this time will make the sleepiness worse. Avoid alcohol or other relaxant medications while there is still butalbital in your body.

The bottom line

Fioricet is a combination medication for headaches that has some serious downsides. For most people with migraines, there are safer and more effective options available.