Comment: Monitor for barbiturate withdrawal in neonates
Animal reproduction studies have not been conducted on this combination product. Epidemiologic data for acetaminophen, including a population based case-control study from the National Birth Defects Prevention Study (n= 11,610) and data from 26,424 live singleton births have shown no increased risk of major birth defects in children with first trimester prenatal exposure. In 2015, the US Food and Drug Administration released results of their evaluation on published research studies looking at mothers who took acetaminophen (either over the counter or as a prescription product) at any time during their pregnancy and the risk of attention deficit hyperactivity (ADHD) in their babies. They found all studies reviewed had potential limitations in their designs that prevented drawing reliable conclusions. Barbiturates have been reported to readily cross the placental barrier. A 2-day old infant whose mother had taken a butalbital-containing product during the last two months of pregnancy experienced withdrawal seizures; butalbital was found in the infant’s serum. There are no controlled data in human pregnancy.
US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Acetaminophen, butalbital, and caffeine are excreted into human milk in small concentrations. The significance of the effects on nursing infants has not been reported, but due to the potential for serious adverse reactions in nursing infants, other agents may be preferred.
A decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother.
Excreted into human milk: Yes (acetaminophen); Yes (barbiturates); Yes (caffeine)
Fioricet is a combination medication containingbutalbital, acetaminophen, and caffeine. It’s taken by mouth as needed, typically every 4 hours, to treat tension headaches.
But it’s not a first-choice option because it can become habit-forming and can worsen headaches if taken too frequently. In addition, Fioricet can cause side effects, such as sleepiness and dizziness. It’s available as pills and an oral syrup.
Fioricet can make you sleepy, dizzy, and lightheaded. Don’t drive or use any heavy machinery until you know how the medication affects you.
Avoid alcohol while taking Fioricet because it can make you more drowsy and dizzy, raise your risk of accidental injuries and liver damage, and worsen headaches
Take Fioricet exactly as your provider instructed you to. Don’t change your dose or stop taking Fioricet without talking to your provider first. To stop the medication, they might need to lower your dose slowly before stopping it completely. This lowers your risk of getting withdrawal symptoms, such as seizures, hallucinations, and worsening of headaches.
Make sure to tell your provider about all of the medications you’re taking before starting Fioricet. Don’t start any new medications while taking Fioricet without talking to your provider first to make sure the combination is safe to take.
Many over-the-counter and prescription medications contain acetaminophen. Don’t use other medications containing acetaminophen unless your provider specifically said it was okay for you to do so. Ask your provider or pharmacist if you aren’t sure if a certain medication contains acetaminophen.
Store Fioricet at room temperature in a place out of reach from children due to the life-threatening risk of accidental overdose and misuse. If you don’t need to take Fioricet anymore, choose a medication take-back option to get rid of it safely.
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.
For the liquid form: Make sure to only use a medication dose cup or oral syringe from the pharmacy to measure out your dose. Don’t use household spoons because they aren’t accurate and might cause you to take the wrong dose.
Fioricet is a controlled substance in some states. Because it contains butalbital, a medication that can be misused and cause dependence, some state governments place strict regulations on Fioricet. But it’s not classified as a controlled substance in all states because it contains acetaminophen. Initially, regulators believed that the acetaminophen in Fioricet discourages people from misusing Fioricet. This is because taking too much acetaminophen can cause harm, such as liver damage.
Fioricet on its own is not a federally controlled substance. Although it contains butalbital, it’s on the Drug Enforcement Agency (DEA)’s list of exempted prescription products. But some states do classify BAC as a controlled substance.
Other combinations that contain Fioricet or are similar to Fioricet may be controlled substances. The DEA classifies Fiorinal, which contains butalbital, aspirin, and caffeine, as a Schedule III drug. That means that there’s a low to moderate risk of dependence or overuse.
In April 2022, the DEA proposed removing the exemption for Fioricet. The proposed rule change would add all products that contain butalbital to its list of Schedule III controlled substances.
So regulators left it up to the states to decide on how to classify Fioricet. But recent data shows that the acetaminophen in Fioricet might not be enough to stop people from misusing this medication. There’s a possibility that the classification of Fioricet might change in the future. Fioricet is a controlled substance in some states. Because it contains butalbital, a medication that can be misused and cause dependence, some state governments place strict regulations on Fioricet.
But it’s not classified as a controlled substance in all states because it contains acetaminophen. Initially, regulators believed that the acetaminophen in Fioricet discourages people from misusing Fioricet. This is because taking too much acetaminophen can cause harm, such as liver damage. So regulators left it up to the states to decide on how to classify Fioricet. But recent data shows that the acetaminophen in Fioricet might not be enough to stop people from misusing this medication.
There’s a possibility that the classification of Fioricet might change in the future.
The treatment of Fioricet overdose is complicated by the presence of two substances which are highly toxic when taken in excessive amounts. Fioricet overdoses generally result in toxic amounts of both acetaminophen and butalbital being consumed at once, requiring both overdoses to be treated at once.
Fioricet overdose by anyone and/or any consumption by persons to whom it is not prescribed (particularly children) is always a medical emergency and medical attention must be sought immediately if an overdose or consumption by other persons is suspected.
Fioricet overdose is often fatal and symptoms may not present for hours following consumption, once initial overdose symptoms present they can progress rapidly and there may not be time to reach appropriate medical care after this point.
Acetaminophen over-exerts its toxicity through the production of a toxic metabolite which produces liver damage in doses of 3,000mg or more per day and acute liver failure in doses above that. The specific antidote to acetaminophen overdose is N-acetyl-cysteine. Kidney failure and stomach bleeding may also occur.
Butalbital overdoses 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 butalbital overdose and treatment is supportive, common treatment regimens generally include the administration of intravenous administration of saline, naloxone, thiamine, glucose, NaHCO3 to alkalize the urine to increase rate of excretion, and activated charcoal via nasogastric tube. It is not uncommon for doctor to recommend observation of the patient in the Emergency Department for a number of hours or admission to the hospital for several days of observation if symptoms are severe and to counsel the patient on drug abuse and/or refer them for psychiatric evaluation.
Recommended dosages for this drug are based on someone’s age and weight and also the scheduled frequency of taking it.
Acetaminophen overdoses happen when someone:
Takes too much of the pain medication at one time
Re-doses too soon
Takes multiple medications at the same time that also contain acetaminophen
For a healthy adult weighing at least 150 pounds, the maximum daily dose of acetaminophen is 4,000 milligrams (mg). However, you can experience liver damage even if you stay at or below 4,000mg if you take this maximum dose for an extended period.
As such, doctors often recommend a maximum daily dose closer to 3,000 mg. Read the drug label carefully and know exactly how much acetaminophen is in each tablet, capsule or liquid dose.
The following table further details acetaminophen dosage recommendations:
325mg
500mg
650mg (extended-release)
Take how many pills at a time?
1 or 2
1 or 2
1 or 2
Take how often?
Every 4 to 6 hours
Every 4 to 6 hours
Every 8 hours
Safest maximum daily dose for most adults
8 pills
6 pills
4 pills
Never take more than this in a 24-hour period
12 pills (3,900mg)
8 pills (4000mg)
6 pills (3,900mg)
For children, acetaminophen doses usually come in 80mg and 160mg, although many of the medications are delivered in liquids (syrups), not pills or chewable tablets.
Body weight plays more of a factor in dosing for kids than it does for adults. The smaller and younger a child is the more careful adults must be when giving the correct dosage. Get an updated weight on your child before administering acetaminophen or any medications that have acetaminophen in them.
Here are basic guidelines for children taking acetaminophen:
Child’s Weight
Syrup/Liquid (160mg)
Pills (80mg)
24 to 35 lbs
1 tsp
2 tablets
26 to 47 lbs
1.5 tsp
3 tablets
48 to 59 lbs
2 tsp
4 tablets
60 to 71 lbs
2.5 tsp
5 tablets
72 to 95 lbs
3 tsp
6 tablets
96 or more lbs
4 tsp
8 tablets
An important note: Children under the age of 6 should not take more than one medication at a time that has acetaminophen as an active ingredient.
If your child is younger than 2 years old, check with your pediatrician, an urgent-care physician or pharmacist before giving any medication that contains acetaminophen.
For adults and children, if the recommended dosages don’t relieve symptoms, consult with a doctor before making the decision to increase any dosages. Acetaminophen toxicity can lead to life-threatening acute liver failure.
How Often Can You Take Acetaminophen?
Dosing frequency is a crucial part of how much acetaminophen you can take at one time or during a one-day period. How long it takes acetaminophen to work, duration of its effects, and how long the medication stays in your body determine how often you should re-dose.
The recommended frequency is every four to six hours. After ingestion, it takes acetaminophen between 30 and 90 minutes to start working. Several factors, including formulation, other drug and alcohol intake influence the effects of acetaminophen.
If you have questions about acetaminophen and the right dose for you, speak with your doctor. Discuss other medications you may be taking and your overall health to determine the best plan for your needs.
How Long Does Acetaminophen Work For?
Acetaminophen typically lasts four hours for both pain relief and fever reduction. This is why the recommended dosing frequency is no more than every four to six hours.
The biological half-life of a drug plays an essential role in its effectiveness and safety. It is also an important factor for determining dosage recommendations.
How Long Does Acetaminophen Stay in Your System?
Scientists gauge the time it takes for your body to eliminate acetaminophen from the system by using the medication’s estimated half-life. A drug’s half-life is the time it takes for half a dose to be metabolized and eliminated from your bloodstream. Acetaminophen half-life elimination for therapeutic doses is between one and two-and-a-half (2.5) hours.
However, the expected half-life of acetaminophen can vary from person to person. Factors that affect its half-life include age, genetics, weight and overall health. Generally, a therapeutic dose of acetaminophen flushes fully from your system within 24 hours.
An acetaminophen overdose can extend the half-life of the drug to four and eight, meaning it may take up to three times longer for you to get the drug out of your body. If you re-dose too soon following even a small overdose period, it can lead to an acute case of severe acetaminophen toxicity.
Although it’s only a prescription headache medication, Fioricet has the potential to cause addiction. If a person follows their prescription guidelines and uses the medication correctly, the risks of addiction are low. However, if someone takes too much Fioricet, they may develop tolerance to its effects. A person with tolerance to a certain dose of Fioricet will require higher doses of the medication to alleviate their headaches.
When a person with tolerance starts to take more Fioricet, possibly by obtaining more prescriptions, they may eventually become dependent on it. In other words, they may feel unable to get through the day without taking Fioricet; if they stop, they will experience symptoms of withdrawal. These symptoms arise because their body has grown accustomed to Fioricet in high doses.
If a Fioricet-dependent person attempts to weather withdrawal alone, it’s likely they will take Fioricet again just to relieve the symptoms of withdrawal. This is a hallmark characteristic of addiction. Anyone who compulsively abuses Fioricet to avoid withdrawal likely has an addiction to Fioricet. Additionally, people with an addiction to Fioricet will experience cravings for the medication which further compel them to keeping using it.
Moreover, the ingredient Butalbital is an addictive substance in its own right. Butalbital can cause someone to get “high” because it’s a Central Nervous System (CNS) Depressant. Since Butalbital is part of Fioricet, it is possible for someone to abuse Fioricet as a recreational drug. At high doses, Fioricet can intoxicate a person in a manner similar to alcohol. People who abuse Fioricet for this purpose have as much of a risk of developing an addiction as they would have if they repeatedly used an illegal drug.
How Much Acetaminophen Is Too Much?
Aside from determining how long acetaminophen works and how long it stays in your system, the drug’s half-life also determines how much is too much to take. The goal of medication is to achieve a steady state, at which point the amount of the drug you ingest and the amount that’s eliminated are equal.
Regardless of a drug’s half-life, it takes approximately four times longer for its concentration to reach a steady state in your body. Acetaminophen side effects often occur when you’re not in a steady state. A small amount of acetaminophen is metabolized into the compound NAPQI, which can cause liver toxicity in large amounts.
Taking too much acetaminophen can cause acute liver damage, which can be fatal. As such, you should not exceed the 4,000 mg maximum daily dose recommendation (you should ideally stay closer to 3,000 mg). Acetaminophen may also effect blood pressure. One 2022 clinical research study found that regular daily intake of 4 g acetaminophen increased systolic blood pressure in individuals with hypertension by about 5 mm Hg compared with a placebo.
Primary symptoms of acetaminophen overdose are:
Abdominal pain
Nausea
Vomiting
Diarrhea
Excessive sweating
Jaundice
Irritability
Seizures
Coma
In case you suspect someone took an overdose of acetaminophen or if you see someone exhibit the above symptoms, you should immediately call 911, emergency medical services, a poison control center or a doctor.
Emergency room treatment will depend on the presenting condition and other drugs that may have been taken. If you make it to the hospital just after taking an overdose, the doctor will attempt to empty your stomach.
Doctors like to prescribe a dose of activated charcoal within four hours of an overdose to bind drugs remaining in your gastro-intestinal tract. They also give N-Acetylcysteine, an antidote for acetaminophen toxicity, orally or intravenously within eight hours.
Emergency doctors recommend that anyone suspected to have taken an acetaminophen overdose get treatment as soon as possible, even before the symptoms occur. Early treatment of acetaminophen overdose can improve the outcome significantly.
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.
Paracetamol (acetaminophen) is generally considered to be a weak inhibitor of the synthesis of prostaglandins (PGs). However, the in vivo effects of paracetamol are similar to those of the selective cyclooxygenase-2 (COX-2) inhibitors. Paracetamol also decreases PG concentrations in vivo, but, unlike the selective COX-2 inhibitors, paracetamol does not suppress the inflammation of rheumatoid arthritis.
It does, however, decrease swelling after oral surgery in humans and suppresses inflammation in rats and mice. Paracetamol is a weak inhibitor of PG synthesis of COX-1 and COX-2 in broken cell systems, but, by contrast, therapeutic concentrations of paracetamol inhibit PG synthesis in intact cells in vitro when the levels of the substrate arachidonic acid are low (less than about 5 mumol/L).
When the levels of arachidonic acid are low, PGs are synthesized largely by COX-2 in cells that contain both COX-1 and COX-2. Thus, the apparent selectivity of paracetamol may be due to inhibition of COX-2-dependent pathways that are proceeding at low rates.
This hypothesis is consistent with the similar pharmacological effects of paracetamol and the selective COX-2 inhibitors. COX-3, a splice variant of COX-1, has been suggested to be the site of action of paracetamol, but genomic and kinetic analysis indicates that this selective interaction is unlikely to be clinically relevant.
There is considerable evidence that the analgesic effect of paracetamol is central and is due to activation of descending serotonergic pathways, but its primary site of action may still be inhibition of PG synthesis.
The action of paracetamol at a molecular level is unclear but could be related to the production of reactive metabolites by the peroxidase function of COX-2, which could deplete glutathione, a cofactor of enzymes such as PGE synthase.
Currently, products that contain butalbital/aspirin/caffeine are classified as schedule III controlled substances; butalbital products listed on the DEA’s list of Exempted Prescription Products, including butalbital/acetaminophen/caffeine products, are unscheduled. This rule change eliminates the disparity of scheduling for butalbital-containing products and recognizes all products containing butalbital, including Fioricet, as schedule III controlled substances under the Iowa uniform Controlled Substances Act.
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.
Acetaminophen APAP Caffeine
Taking too much acetaminophen can cause liver damage, sometimes serious enough to require liver transplantation or cause death. You might accidentally take too much acetaminophen if you do not follow the directions on the prescription or package label carefully, or if you take more than one product that contains acetaminophen.
To be sure that you take acetaminophen safely, you should
not take more than one product that contains acetaminophen at a time. Read the labels of all the prescription and nonprescription medications you are taking to see if they contain acetaminophen. Be aware that abbreviations such as APAP, AC, Acetaminophen, Acetaminoph, Acetaminop, Acetamin, or Acetam. may be written on the label in place of the word acetaminophen. Ask your doctor or pharmacist if you don’t know if a medication that you are taking contains acetaminophen.
take acetaminophen exactly as directed on the prescription or package label. Do not take more acetaminophen or take it more often than directed, even if you still have fever or pain. Ask your doctor or pharmacist if you do not know how much medication to take or how often to take your medication. Call your doctor if you still have pain or fever after taking your medication as directed.
be aware that you should not take more than 4000 mg of acetaminophen per day. If you need to take more than one product that contains acetaminophen, it may be difficult for you to calculate the total amount of acetaminophen you are taking. Ask your doctor or pharmacist to help you.
tell your doctor if you have or have ever had liver disease.
not take acetaminophen if you drink three or more alcoholic drinks every day. Talk to your doctor about the safe use of alcohol while you are taking acetaminophen.
stop taking your medication and call your doctor right away if you think you have taken too much acetaminophen, even if you feel well.
Talk to your pharmacist or doctor if you have questions about the safe use of acetaminophen or acetaminophen-containing products.
Acetaminophen 325 mg, butalbital 50 mg, and caffeine 40 mg:
1 or 2 tablet(s), capsule(s), or tablespoonful(s) orally every 4 hours.
Maximum daily dose: 6 doses
Acetaminophen 500 mg, butalbital 50 mg, and caffeine 40 mg:
1 tablet or capsule orally every 4 hours.
Maximum daily dose: 6 doses
Acetaminophen 750 mg, butalbital 50 mg, and caffeine 40 mg:
1 tablet orally every 4 hours.
Maximum daily dose: 5 tablets
Usual Pediatric Dose of Fioricet for Headache:
12 years and older:
Acetaminophen 300 mg, butalbital 50 mg, and caffeine 40 mg:
1 or 2 capsule(s) orally every 4 hours as needed. Maximum daily dose: 6 doses.
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.
While Butalbital is the addictive ingredient in Fioricet, Acetaminophen is the ingredient which is liable to cause an overdose. Unfortunately, people who misuse Fioricet as a recreational drug or as a way to suppress withdrawal are most likely to suffer an overdose.
When a person overdoses on Fioricet, the Acetaminophen will damage their liver. In severe cases, an overdose can even provoke fatal liver failure. For this reason, it is dangerous to take Fioricet together with another medication which contains Acetaminophen because it increases the risk of overdose and death. Furthermore, drinking alcohol while taking Fioricet may also inflict liver damage.
A Fioricet overdose is a medical emergency, so it’s important to know the symptoms. An overdose on Fioricet may cause jaundice, a yellowing of the skin and eyes. Other symptoms of an overdose include:
Confusion
Convulsions and seizures
Fainting
Irregular heartbeat
Lack of appetite
Nausea and vomiting
Restlessness
Stomach pain
Sweating
Tremors
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of Fioricet 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.
A single or multiple drug overdose with this combination product is a potentially lethal polydrug overdose, and consultation with a regional poison control center is recommended. Immediate treatment includes support of cardiorespiratory function and measures to reduce drug absorption.
Oxygen, intravenous fluids, vasopressors, and other supportive measures should be employed as indicated. Assisted or controlled ventilation should also be considered.
Gastric decontamination with activated charcoal should be administered just prior to N-acetylcysteine (NAC) to decrease systemic absorption if acetaminophen ingestion is known or suspected to have occurred within a few hours of presentation.
Serum acetaminophen levels should be obtained immediately if the patient presents 4 hours or more after ingestion to assess potential risk of hepatotoxicity; acetaminophen levels drawn less than 4 hours post-ingestion may be misleading.
To obtain the best possible outcome, NAC should be administered as soon as possible where impending or evolving liver injury is suspected. Intravenous NAC may be administered when circumstances preclude oral administration.
Vigorous supportive therapy is required in severe intoxication. Procedures to limit the continuing absorption of the drug must be readily performed since the hepatic injury is dose dependent and occurs early in the course of intoxication.
Fioricet can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options
Liver damage
Risk factors: Drinking alcohol | Taking other medications containing acetaminophen | Taking too much Fioricet | History of liver problems
Taking too much acetaminophen can cause liver damage that can be permanent and life-threatening. For adults, the maximum amount of acetaminophen is 3 or 4 grams in a 24-hour period, depending on your provider’s instructions.
Speak to your provider before using Fioricet if you have liver problems since it can cause further damage to your liver. Also, avoid drinking alcohol while taking Fioricet because this combination can harm your liver too.
Signs of liver problems include dark urine, feeling tired, upset stomach or stomach pain, or yellowing of the skin or whites of the eyes. If you notice any of these symptoms, call your provider right away.
Difficulty concentrating and extreme sleepiness
Risk factors: Taking high doses of Fioricet | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Fioricet can cause extreme sleepiness and lower your ability to think, react, and focus. Don’t drink alcohol or take other medications that can cause sleepiness or “brain fog”, such as pain medications or antidepressants, with Fioricet. Doing so can worsen these side effects. Make sure you know how this medication affects you before driving a car or doing activities that require your concentration. Talk to your healthcare provider right away if you feel too sleepy from taking Fioricet.
Serious skin or allergic reactions
Risk factors: History of serious skin reactions | Allergy to acetaminophen (Tylenol)
Fioricet contains acetaminophen (Tylenol), which can rarely cause life-threatening skin reactions and allergic reactions. If you’re allergic to acetaminophen, don’t take Fioricet. If you develop symptoms of an allergic reaction, such as swelling of the face, mouth, or throat, trouble breathing, itchy red rash (hives), or vomiting, stop taking Fioricet and call for emergency medical help right away. If you develop symptoms of a skin reaction, such as a reddening or peeling of the skin, painful rash, or fluid-filled blisters, stop taking Fioricet and go to the emergency room right away.
Misuse, dependence, and withdrawal
Risk factors: Taking Fioricet longer than prescribed | Taking higher doses of Fioricet than prescribed | Taking Fioricet more often than prescribed
Fioricet contains butalbital, which can be habit-forming. Misuse of Fioricet can lead to dependence, accidental overdose, and even death. Doing so can also cause withdrawal symptoms, like seizures, restlessness, trouble sleeping, and shakiness, if you lower your dose or stop taking the medication suddenly. To lower the risk of physical dependence, don’t take Fioricet longer than prescribed, at higher doses than prescribed, or more often than prescribed.
Call for emergency medical help if you have any symptoms of taking too much butalbital, including sleepiness, trouble breathing, dizziness, confusion, or loss of consciousness. If you no longer want to take Fioricet, talk to your healthcare provider so they can instruct you on how to stop taking the medication safely. Speak to your healthcare provider about alternative treatments if you have concerns about taking Fioricet.
You might be able to take other pain medications, like ibuprofen (Advil, Motrin) or naproxen (Aleve), with Fioricet if you need more relief for your headache. These medications work differently to ease pain and they can help lower the amount of Fioricet you need to relieve your symptoms.
Taking less Fioricet means you’re not as likely to experience the dangers or side effects of taking this medication. But don’t take other medications containing acetaminophen (Tylenol). Fioricet already contains acetaminophen, and you might accidentally take too much acetaminophen if you take these other medications and Fioricet together.
This can lead to serious liver damage. Before using other pain medications with Fioricet, speak with your healthcare provider to make sure it’s safe for you to do so. Other pain medications still carry risks that shouldn’t be ignored (e.g., heart risks, kidney problems).
Antidepressants, especially MAOIs like isocarboxazid, phenelzine, tranylcypromine, and selegiline
Antihistamines
Benzodiazepines
Carbamazepine
Isoniazid
Medications for pain like pentazocine, buprenorphine, butorphanol, nalbuphine, tramadol, and propoxyphene
Muscle relaxants
Naltrexone
Phenobarbital, phenytoin, and fosphenytoin
Phenothiazines like perphenazine, thioridazine, chlorpromazine, mesoridazine, fluphenazine, prochlorperazine, promazine, and trifluoperazine
Voriconazole
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
It’s recommended to limit caffeine because Fioricet already contains caffeine. The maximum dose of Fioricet is 6 doses per day, which equates to 240 mg of caffeine. For comparison, an 8-ounce cup of coffee contains 95 mg to 165 mg of caffeine.
According to the FDA, 400 mg of caffeine is considered a safe amount for adults that won’t cause dangerous side effects. Too much caffeine can lead to nervousness, shakiness, restlessness, trouble sleeping, and a fast heart rate. If you experience these symptoms, avoid other sources of caffeine and use the lowest possible amount of Fioricet.
Fioricet
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)2
What are the ingredients in Fioricet?
The active ingredients in Fioricet are acetaminophen, caffeine, and butalbital.
How does Fioricet work?
The acetaminophen in Fioricet is a pain reliever, the caffeine works as a stimulant to increase the acetaminophen’s effectiveness, and the butalbital is a sedative that decreases anxiety while causing relaxation and sleepiness. These actions are believed to ease migraine symptoms, but there is limited evidence that barbituates ease migraine symptoms.
The most common side effects from Fioricet include:
Drowsiness
Upset stomach
Vomiting
Stomach pain
Depression
Lightheadedness
Confusion3
The following side effects could be signs of allergy or more serious complications and should be reported to health provider immediately:
Skin rash
Itching
Difficulty breathing2
This is not an exhaustive list of all potential side effects of Fioricet.
For more information, consult your doctor or healthcare provider. Patients should talk to their doctor about what to expect with treatment with Fioricet. If you notice any new or worsening side effects, contact your doctor or healthcare provider immediately.
Fioricet can be habit-forming, so you should use extreme caution if you decide to take it. Additionally, some people who take barbituates or opioids for extended periods can experience rebound headaches, which can increase in severity. These are also known as MOH, or medication overuse headaches.
Barbituates can cause drowsiness, and their effect can be increased by alcohol use. It is important not to drive or use heavy machinery until you know how this drug affects you.2
Before taking Fioricet, tell your doctor if you:
Are allergic to any ingredients in the medication
Are taking blood thinners, antidepressants, antihistamines, or other sedatives like sleeping pills or tranquilizers.
Are taking pain medications. Many over-the-counter pain relievers contain acetaminophen, and too much of this drug can be harmful.
Have ever had liver disease, porphyria, or depression
Are pregnant, plan to become pregnant, or are breastfeeding2
You should begin no medication or supplement without first checking with your health care provider and should let them know of any other prescriptions, OTCs, and herbals you are taking to ensure there are no interactions.
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.
This combination of drugs is used to relieve tension headaches.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Unlike acetaminophen, aspirin also treats inflammation and swelling. Neither medication is considered a first-choice option for treating tension headaches. Another difference is that while Fiorinal is a schedule III controlled substance, Fioricet might or might not be classified as a controlled substance in your state. This is because Fioricet is currently on the DEA list of exempted prescription products, meaning it’s up to the individual states how they regulate it.
Fioricet is a popular medication approved to treat symptoms of tension headaches. Migraines affect close to one billion people worldwide. More than an intense headache, people with migraines know well that the symptoms can linger for days and disrupt their daily life. While there are many treatment options for treating migraines, approximately 6% of patients use Fioricet to control the symptoms. If you suffer from migraines or someone you know takes Fioricet, keep reading to learn about addiction’s side effects and risk factors.
If you or a loved are in need of a drug addiction treatment program in Florida, contact Lighthouse Recovery Institute today at 866.326.4317 for more information about your options and to learn how we can help.
What Is Fioricet?
Fioricet is the brand for a combination medication with FDA approval to treat some types of tension headaches. It helps relax muscle contractions involved with tension headaches and has been used extensively off-lave; for migraines. Fioricet contains a blend of:
Butalbital (50mg): A type of barbiturate that helps with muscle relaxation
Acetaminophen (300mg): An over-the-counter analgesic that helps to relieve pain
Caffeine (40mg): Added to enhance the effects of acetaminophen
Some types of Fioricet also contain codeine, a potent narcotic and opioid used to treat pain.
Side Effects of Fioricet
This medication can cause severe side effects. While taking Fioricet, you should avoid drinking alcohol, as mixing alcohol and acetaminophen can increase your risk of liver disease. People with asthma, kidney disease, and a history of mental illness or suicidal thoughts should also avoid using this medication. It may also negatively interact with other medications that have a sedating effect. Combining sedatives can slow breathing and heart rate to dangerous levels. It’s important to disclose all medications to your doctor or pharmacist to avoid risks of drug interactions. In rare cases, acetaminophen can cause a severe skin allergic reaction that can turn lethal. Fioricet can also pass into breast milk, so pregnant women should seek medical advice about any side effects. Common side effects include:
Drowsiness
Dizziness
Anxiety
Restlessness
Insomnia
Loss of appetite
Drink feeling
Confusion
Shortness of breath
A light-headed feeling
Nausea
Upper stomach pain
Dark urine
Yellowing of the skin or eyes
Is Fioricet Addictive?
Although Fioricet is a valid prescription medication, it has the potential to cause addiction. When someone follows their prescription guidelines and directions, the risk of addiction is shallow. However, if someone exceeds their dosage, they may develop tolerance to its effects. Particularly, the active ingredient butalbital may be habit-forming. Fioricet can make you feel very relaxed or high when taken in high doses, as with other prescription drugs. Again, these effects are largely produced from the butalbital and codeine in Fioricet. Barbiturates are central nervous system depressants, so taking more than prescribed can produce a high that feels similar to alcohol intoxication.
Withdrawal
Most symptoms of Fioricet withdrawal last anywhere between 8 hours to three days. However, factors like ingesting alcohol, metabolism, and using other substances may extend the withdrawal timeline. Rebound headaches are the most common sign of withdrawal. Other symptoms include:
Anxiety
Dizziness
Insomnia
Muscle spasms
Nausea and vomiting
Mood swings
Tremors
Weakness
Overdose
Interestingly enough, while butalbital is the habit-forming ingredient in Fioricet, acetaminophen is the most likely to cause an overdose. An overdose is a medical emergency that can be fatal without medical assistance. Signs of overdose include:
Yellowing of the skin and eyes
Confusion
Convulsions
Fainting
Irregular heartbeat
Nausea and vomiting
Restlessness
Stomach pain
Sweating
Tremors
Fioricet and Codeine
In addition, some formulas of Fioricet contain codeine, a potent opioid. Codeine enhances the medication’s pain-relieving effects, but it also increases the risk of overdose and addiction. If you or someone you know needs a Fioricet prescription, be sure to ask for the opioid-free version of the drug. Misuse of Fioricet with codeine, either accidentally or intentionally, may lead to lethal respiratory depression. Shallow breathing, a slow heart rate, and intense confusion are other overdose symptoms from Fioricet with codeine. Fioricet with codeine should not be taken in combination with serotonergic drugs, like some types of antidepressants or anxiety medications.
Signs of Fioricet Addiction
Fioricet abuse signs are very similar to other prescription drugs. People who abuse prescription drugs tend to experience physical and behavioral changes that include:
Taking more medication than prescribed
Experiencing cravings and burgers for the drug
Taking more of the medication to get the same effects
Spending a lot of time getting, using, and recovering from the drug
Seeking out multiple doctors to get a new prescription
Using multiple pharmacies to feel their prescription
Physical Signs
Physical signs of addiction are very similar to alcohol abuse. Medications like sleeping pills and pain medicines have similar effects:
Drowsiness
Slurred speech
Confusion
Loss of motor skills
Coma
Psychological Signs
The behavioral signs of substance abuse resemble drunkenness and usually include:
Lack of inhibition
Paranoia
Impaired judgment
Irritability
Suicidal thoughts
Addiction Treatment Options
There are several options to treat prescription drug addiction. Since Fioricet causes withdrawal symptoms, most people will start their journey with a medical detox followed by inpatient or outpatient treatment.
Medical detox—Involves assisting the patient in removing all of the Fioricet and other substances from the body under a controlled environment to manage withdrawal symptoms.
Inpatient treatment—Allows patients to stay at a facility for an extended period of time to focus solely on their recovery.
Outpatient treatment—Provides more flexibility for patients who want to seek treatment but prefer to stay at home. Patients still attend individual and group therapy throughout the week.
Partial hospitalization program—A treatment option for Fioricet addiction lets patients attend treatment throughout the day but return home at night.
Dual diagnosis treatment—Ideal for patients with addiction and mental health disorders, dual diagnosis treatment helps treat both conditions simultaneously.
Seek Help at Lighthouse Recovery Institute
While Fioricet can be an effective treatment for tension headaches, it has its fair share of side effects and risks. Ask your doctor for medical advice on other treatment options that don’t cause withdrawal symptoms or the possibility of developing an addiction. Call your doctor about other medications, Botox, over-the-counter pain relievers, and other lifestyle support measures such as biofeedback, yoga, and acupressure that might help manage symptoms more safely.
At Lighthouse Recovery Institute, our admission specialists can walk you through a drug screening assessment to better understand your state. If you or someone you know is abusing prescription drugs, reach out to an addiction specialist today and stop your vicious cycle. Addiction can cost you your life, but recovery is widely available. Call 866.326.4317 today and start your recovery journey.
I can only list some common over the counter medicines that contain Acetaminophen: Actifed, Alka-Seltzer, Plus Liquid Gels, Anacin, Cepacol, Contac, Coricidin, Dayquil, Dimetapp, Dristan, Excedrin, Feverall …
In some cases, Fioricet can interact with other drugs and create an adverse reaction or serious side effects. Fioricet should not be combined with any other drugs that contain butalbital, acetaminophen and caffeine to avoid accidental overdose.
Fioricet with Codeine should not be taken in combination with serotonergic drugs, like some types of antidepressants or anxiety medications.
Fioricet may also have a negative interaction with other medications that have a sedating effect. Combining sedatives can slow breathing and heart rate to dangerous levels. It’s important to disclose all medications to your doctor to avoid risks of drug interactions.
Some prescriptions that contain acetaminophen are: Ultrace, Fioricet, Oxycodone, Endocet, Tylox …
You also must know what drugs contain Butalbital: Bupap, Phrenilin, Tencon, Cephadyn; Fioricet, Esgic, Esgic-Plus; Fioricet with Codeine, Floricet with Codeine, Phrenilin with Caffeine and Codeine; Axotal; Fiorinal, Butalbital Compound, Farbital, Idenal; Fiorinal with Codeine, Fiorinal with Codeine III, Ascomp with Codeine, Fiortal with Codeine.
When you take more than one pain killer, you must read very carefully about their components. Never exceed the max dosage of acetaminophen and butalbital of all the medicines you are taking. Normally All the packages sent to you have the drug introduction and doctor names and phone number. Read the drug introduction very carefully and never share the medicines with your sisters, your brothers, your parents, or any friends. Always do not let the children touch the medicines.
Gabapentin may interact with other medications
Gabapentin oral capsule can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.
Below is a list of medications that can interact with gabapentin. This list does not contain all drugs that may interact with gabapentin.
Before taking gabapentin, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Opioids
When used with gabapentin, opioids can cause dangerous effects in the body. Some examples of these drugs include morphine, hydrocodone, and oxycodone.
Taking gabapentin with an opioid increases your risk for severe sleepiness, respiratory depression, coma, and even death.
Stomach acid drugs
When used with gabapentin, certain drugs used to treat stomach acid problems can reduce the amount of gabapentin in your body. This can make it less effective. Taking gabapentin 2 hours after taking these drugs can help prevent this problem. Examples of these drugs include:
aluminum hydroxide
magnesium hydroxide
Please donot drink any alcohol (Ethanol) with your Fioricet Because Ethanol together with acetaminophen will cause serious side effects that affect your liver, and Ethanol together with Butalbital will cause side effects of dizziness, drowsiness.
Please don’t take herb while you are taking Fioricet. Even Vitamins will have some interaction with Fioricet.
Be honest to place the current medicines you are taking in the health questionnaire form. The doctor will check whether you are OK to take Fioricet. If they think your current drugs or herbs have some interaction with Fioricet, they will phone you to discuss the situation with you. So please always leave us the correct phone number. We will never call you to promote you anything.
Most frequently checked interactions
View interaction reports for Fioricet (acetaminophen / butalbital / caffeine) and the medicines listed below.
There are 25 disease interactions with Fioricet (acetaminophen / butalbital / caffeine) which include:
alcoholism
liver disease
acute alcohol intoxication
drug dependence
liver disease
porphyria
rash
respiratory depression
cardiac disease
hypertension
liver disease
PUD
PKU
adrenal insufficiency
depression
hematologic toxicity
osteomalacia
paradoxical reactions
cardiotoxicity
bipolar disorders
psychiatric disorders
psychotic disorders
renal dysfunction
seizure disorders
GERD
Other Prescription Interactions
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
Ethanol
Tobacco
Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
Cabbage
Ethanol
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
Alcohol abuse, history of or
Drug dependence, or history of or
Weakened physical condition—Use with caution. May increase risk for more serious side effects.
Kidney disease or
Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
Porphyria (an enzyme problem)—Should not be used in patients with this condition.
Stomach problems—Use with caution. May make these conditions worse.
What drugs and food should I avoid while taking Fioricet (Acetaminophen, Butalbital, And Caffeine)?
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.
Muscle relaxers or muscle relaxants are medications used to treat acute muscle pain and discomfort caused by muscle spasms. Muscle spasms are involuntary contractions that cause excessive strain in muscles and are often associated with conditions such as lower back pain and neck pain.
Medications used as muscle relaxers can differ in their chemical structures and the way they work in the brain. In general, muscle relaxers act as central nervous system depressants and cause a sedative effect or prevent your nerves from sending pain signals to your brain. The onset of action is rapid and effects typically last from 4-6 hours.
Muscle Relaxants for Muscle Spasms
Muscle spasms are painful and may restrict mobility, which can limit your ability to perform even basic activities. Painful, tight muscles can also interfere with getting a good night’s sleep.
Muscle relaxants may help reduce pain, and improve movement and range of motion, but your doctor will likely recommend that you first try acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). In some cases, these over-the-counter medications will be enough to help alleviate your pain.
If your muscle pain persists, your doctor may prescribe a muscle relaxant in addition to your pain medication. Below are common muscle relaxants (the generic names are listed first, with a brand name example in parentheses):
Baclofen (Lioresal)
Carisoprodol (Soma)
Cyclobenzaprine (Amrix)
Metaxalone (Skelaxin)
Methocarbamol (Robaxin)
When You Might Need a Muscle Relaxer
Your doctor might first suggest you try an over-the-counter medicine like acetaminophen (Tylenol) or ibuprofen (Advil) to treat your pain. But if those don’t work, or you can’t take them because you have another issue like liver problems or ulcers, you may need to try a muscle relaxant.
Muscle relaxants are ideally prescribed for acute rather than chronic pain. They may be an option if pain is preventing you from getting enough sleep. Because muscle relaxants cause drowsiness, they can help you get rest when you take them at night.
Some of the common side effects of muscle relaxers include:
Dosage for Flexeril – For most patients, the recommended dose of Flexeril is 5 mg three times a day.
You shouldn’t drink alcohol while taking muscle relaxants. These medications make it hard to think and function normally, even if you take a low dose, so combining them with alcohol can increase your risk of an accident.
You also shouldn’t drive or operate heavy machinery while taking muscle relaxants. Some muscle relaxers start working within 30 minutes of taking them, and the effects can last anywhere from 4 to 6 hours
Muscle Relaxant Abuse
Muscle relaxers have a potential for abuse and addiction. Prolonged use can lead to increased tolerance and physical dependence, especially with Soma.3 For this reason, muscle relaxers are intended as a short-term treatment not to be prescribed for more than 2-3 weeks.
Unfortunately, many individuals take muscle relaxers alone or in combination with other illicit drugs for nonmedical reasons, such as to produce or enhance feelings of euphoria and dissociation. According to the Drug Enforcement Administration, Soma is one of the most commonly diverted drugs in the United States.2 Evidence also indicates prevalent misuse of Flexeril. In 2010 there were over 12,000 emergency room visits associated with Flexeril, and in 2016 over 10,000 calls to the Poison Control Centers had involved Flexeril.1
Muscle relaxer abuse can lead to serious dangers such as an increased risk of overdose, which can result in:
stupor
hallucinations
seizures
shock
respiratory depression
cardiac arrest
coma
death
Alcohol and Muscle Relaxers
Like muscle relaxers, alcohol also depresses the central nervous system. When alcohol is consumed with muscle relaxers the side effects are exacerbated. This can be very dangerous, leading to symptoms like:
Blurred vision
Urine retention
Extreme dizziness
Extreme drowsiness
Low blood pressure
Fainting
Memory problems
Liver damage
Increased risk of overdose
It is recommended to not drive or operate heavy machinery when under the influence of muscle relaxers. It is especially important to avoid drinking, as combining muscle relaxers with alcohol greatly increases your risk of an accident.
Withdrawal and Treatment
Regular use of muscle relaxers causes the brain to become used to its effects. If you attempt to suddenly stop using muscle relaxers you may experience withdrawal symptoms. Depending on the specific drug and how long you have been using it, there are various treatment options available to help you overcome your addiction.
For many people, Flexeril withdrawal causes mild symptoms such as nausea, headache, drowsiness, malaise, and discomfort. Symptoms tend to peak about 2-4 days after you last took the Flexeril, although in some people withdrawal symptoms may last for up to 1-2 weeks. For many people Flexeril detox can be done at home. However, if Flexeril addiction is accompanied by alcohol or opioid abuse the withdrawal symptoms from these other substances can be severe. In these situations, it may be best to undergo professional medical detox.
Soma withdrawal is usually more severe and can include symptoms like hallucinations and seizures. For your safety and comfort, it is often best to find an inpatient treatment program that includes a detox program to manage withdrawal symptoms. After detox patients can transition into the actual treatment phase of the program. Some people may not require a supervised detox program and will be able to undergo treatment on an outpatient basis.
Most inpatient and outpatient rehab programs include cognitive behavioral therapy that will help you learn the coping skills needed for long-term recovery.
Stiffness and soreness in your neck and back can be difficult to deal with, especially when sleeping. Maybe you have a new injury, or you’ve aggravated an old one. Either way, if you feel this kind of pain at night, you may not sleep well. And then you may have more pain when you wake up.
In some cases, muscle relaxants can help relieve this pain and get you through these tough days. They do exactly what their name says: relax muscles. Reducing muscle tightness may improve new (acute) neck and back pain, especially when used at night.
But you need a prescription for muscle relaxers. And the evidence is mixed regarding how well they work. Treatment guidelines don’t even agree on whether they should be prescribed.
Over-the-counter (OTC) pain relievers work better for neck and back pain than muscle relaxants alone. Examples of these are acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve). Plus, there are effective treatments that don’t involve any medication at all, like home exercises, physical therapy, and/or posture training. That said, some people may benefit from taking an NSAID and a muscle relaxer together, especially at night.
Muscle relaxers work in different ways. They act on the muscles, nerves, or central nervous system. There isn’t enough evidence to suggest one muscle relaxer is better than another. So let’s look at nine popular muscle relaxants, including how well they work and their side effects.
1. Methocarbamol
Methocarbamol (Robaxin) is a well-studied medication that treats back pain. Compared to other options, it’s inexpensive and less likely to make you sleepy (sedated).
Taken as needed, 1,500 mg every 6 to 8 hours is a cheap and well-tolerated option for people who have new neck and back pain. It’s less sedating than other options, like cyclobenzaprine and carisoprodol. However, it may be less effective. In one study, almost 20% of those taking it stopped because it wasn’t helping their pain go away.
2. Cyclobenzaprine
Cyclobenzaprine is a reasonable first choice because it’s a cheap generic. But it has more potential for side effects, like sedation. This limits how you can use it during the day. Cyclobenzaprine may also cause dry mouth, especially in older adults. If this is a concern, consider a better non-sedating option.
At the standard dose of 10 mg to 30 mg a day, cyclobenzaprine (formerly branded as Flexeril) will make you sleepy. If you use it during the day, you’ll want to break your 10 mg tab in half and take 5 mg to lessen the drowsiness. Interestingly, one study found that a lower dose (15 mg per day) worked just as well as a higher dose (30 mg per day). There may not be any benefit when you take it alongside an NSAID like naproxen.
3. Carisoprodol
Carisoprodol (Soma) is a Schedule 4 drug (similar to benzodiazepines Ativan, Valium, and Xanax). Because of this, it has the potential for misuse. For this reason, you should not use it if you have a history of substance use.
Many believe that carisoprodol should be phased out as a muscle relaxant in favor of much better options. If prescribed, you should only use it for short periods of 2 to 3 weeks. Scientists don’t know how effective it is when taken for longer periods. Carisoprodol may cause drowsiness and dizziness. People over age 65 should not use it.
4. Metaxalone
Taken as 800 mg tablets 3 to 4 times a day, metaxalone (Skelaxin) has the fewest reported side effects. It’s also the least likely of the muscle relaxants to make you sleepy. It may work better for chronic lower back pain that is flaring up, rather than for pain that is new.
Metaxalone is a generic alternative for the brand medication Skelaxin, but it still costs more than most others. Insurance companies often don’t cover it because there are cheaper alternatives. But it works as well as cyclobenzaprine and carisoprodol (more info on those above) with fewer side effects and less sedation. So, paying cash may be worth it.
5. Tizanidine
Tizanidine (Zanaflex) is often used for spasticity in people with multiple sclerosis or cerebral palsy. Spasticity is where the muscles contract continuously, which leads to tightness and stiffness. The FDA has not approved tizanidine to treat neck or back pain.
For multiple sclerosis or cerebral palsy, tizanidine tends to have fewer side effects than Baclofen. But either medication may not make much difference in new low back pain when compared with ibuprofen alone. Tizanidine is not a first choice for new neck or back muscle pain.
6. Baclofen
Similar to tizanidine, Baclofen (Gablofen, Lioresal) is primarily used for spasticity in people who have multiple sclerosis or spinal cord injuries. Up to 20% of people taking it have drowsiness. It’s not a first choice: There are better options for neck and back muscle pain. The FDA has not approved baclofen to treat neck or back pain.
7. Oxazepam and diazepam
Benzodiazepine medications like oxazepam (Serax, Zaxopam) and diazepam (Valium) are anti-anxiety medications. They are sometimes prescribed as muscle relaxants. But these really aren’t recommended because they don’t work well, are sedating, and can be habit-forming.
Plus, the FDA has not approved benzodiazepines for neck or back pain. Avoid these medications for neck and back muscle pain. There are much better options.
8. Chlorzoxazone
Chlorzoxazone (Lorzone) is not well studied for new low back and neck pain in adults. It wasn’t found to be effective for pain after spine surgery. Chlorzoxazone has also been reported as a rare cause of acute liver toxicity. Don’t choose this medication until you’ve exhausted all other options.
9. Orphenadrine
For neck and back pain in adults, the first four medications on this list work better than orphenadrine (Norflex), so save this as another last resort in the event the others don’t work.
Do muscle relaxers make you sleepy?
Yes, they can make you sleepy. In fact, sedation is one of the most common side effects reported. Dizziness and drowsiness are also commonly reported. That’s why they usually have a warning on the label that instructs you to avoid certain things while taking them, such as driving, caring for children, and operating heavy machinery.
Muscle relaxers can also cause other side effects and interact with other medications. It’s important to let your healthcare provider know about your medical history and which medications and supplements you’re taking.
Barbiturates may be habit-forming: Tolerance, psychological dependence, and physical dependence may occur especially following prolonged use of high doses of barbiturates.
The average daily dose for the barbiturate addict is usually about 1500 mg. As tolerance to barbiturates develops, the amount needed to maintain the same level of intoxication increases; tolerance to a fatal dosage, however, does not increase more than two-fold.
Fioricet contains 50mg Butalbital per pill. It is about 50mg X 30 tablets for fioricet abuse. As you know, the max dosage for Generic fioricet is six tablets. You can not abuse generic fioricet if you take fioricet by following the drug instruction.
The max dosage of acetaminophen(OTC drug) is 3000mg , it is about 325 X 8 tables Fioricet Dosage. Acetaminophen overdose can cause serious liver and heart damage. So never exceeding your max dosage of fioricet.
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.
Is it OK to donate blood if I take Fioricet(Butalbital APAP Caffeine)?
I have a prescription for Fioricet(Butalbital APAP Caffeine) for back and head pain and I was wondering if it’s still ok to donate blood? I have donated blood before, but not since I’ve been taking fioricet. Is it ok for me to donate still?
Best answer:
Answer by BloodDoc
There is no deferral from volunteer blood donation while taking Fioricet(Butalbital APAP Caffeine). However, you should be free of headaches prior to donation.
Thanks for such a generous gift.
What is the most important information I should know about Fioricet (Acetaminophen, Butalbital, And Caffeine)?
Do not use this medicine 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 acetaminophen, butalbital, and caffeine if you are allergic to it, if you have porphyria, or if you have recently used alcohol, sedatives, tranquilizers, or other opioids.
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 this medicine 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 breastfeeding a baby.
Not approved for use by anyone younger than 12 years old.
Yes, Fioricet contains butalbital, which is a mild narcotic. It is not as effective as other pain medications, but at my job as a neurologic assistant, I see many patients that have told me it improves their back pain.
Fioricet Blue and White Tablet
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.
But as Robert said, it is indicated for headaches.
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.
Acetaminophen, which is also known as paracetamol, is a commonly used OTC (over-the-counter) pain reliever (analgesic) and fever reducer (antipyretic). People use it for headaches, and minor aches and pain. Liver injury from acetaminophen overdose remains a serious public health problem despite ongoing regulatory and educational efforts over the past several years to improve the safe use of medicines that contain acetaminophen.
Fioricet contains acetaminophen 325 mg per tablet. The max dosage of an adult for acetaminophen goes down from 4000mg to 3000mg per day (http://www.medicalnewstoday.com/articles/231915.php). So only acetaminophen, you should not take more than eight tablet fioricet per day. IF you take more than eight fioricet tablet per day, you will hurt your liver.
From tylenol website, they lowered the maximum daily dose for single-ingredient Extra Strength TYLENOL® (acetaminophen) products sold in the U.S. from 8 pills per day (4,000 mg) to 6 pills per day (3,000 mg). The dosing interval has also changed from 2 pills every 4 – 6 hours to 2 pills every 6 hours.
Recommended dosages for this drug are based on someone’s age and weight and also the scheduled frequency of taking it.
Acetaminophen overdoses happen when someone:
Takes too much of the pain medication at one time
Re-doses too soon
Takes multiple medications at the same time that also contain acetaminophen
For a healthy adult weighing at least 150 pounds, the maximum daily dose of acetaminophen is 4,000 milligrams (mg). However, you can experience liver damage even if you stay at or below 4,000mg if you take this maximum dose for an extended period.
As such, doctors often recommend a maximum daily dose closer to 3,000 mg. Read the drug label carefully and know exactly how much acetaminophen is in each tablet, capsule or liquid dose.
The following table further details acetaminophen dosage recommendations:
325mg
500mg
650mg (extended-release)
Take how many pills at a time?
1 or 2
1 or 2
1 or 2
Take how often?
Every 4 to 6 hours
Every 4 to 6 hours
Every 8 hours
Safest maximum daily dose for most adults
8 pills
6 pills
4 pills
Never take more than this in a 24-hour period
12 pills (3,900mg)
8 pills (4000mg)
6 pills (3,900mg)
For children, acetaminophen doses usually come in 80mg and 160mg, although many of the medications are delivered in liquids (syrups), not pills or chewable tablets.
Body weight plays more of a factor in dosing for kids than it does for adults. The smaller and younger a child is the more careful adults must be when giving the correct dosage. Get an updated weight on your child before administering acetaminophen or any medications that have acetaminophen in them.
Here are basic guidelines for children taking acetaminophen:
Child’s Weight
Syrup/Liquid (160mg)
Pills (80mg)
24 to 35 lbs
1 tsp
2 tablets
26 to 47 lbs
1.5 tsp
3 tablets
48 to 59 lbs
2 tsp
4 tablets
60 to 71 lbs
2.5 tsp
5 tablets
72 to 95 lbs
3 tsp
6 tablets
96 or more lbs
4 tsp
8 tablets
An important note: Children under the age of 6 should not take more than one medication at a time that has acetaminophen as an active ingredient.
If your child is younger than 2 years old, check with your pediatrician, an urgent-care physician or pharmacist before giving any medication that contains acetaminophen.
For adults and children, if the recommended dosages don’t relieve symptoms, consult with a doctor before making the decision to increase any dosages. Acetaminophen toxicity can lead to life-threatening acute liver failure.
How Often Can You Take Acetaminophen?
Dosing frequency is a crucial part of how much acetaminophen you can take at one time or during a one-day period. How long it takes acetaminophen to work, duration of its effects, and how long the medication stays in your body determine how often you should re-dose.
The recommended frequency is every four to six hours. After ingestion, it takes acetaminophen between 30 and 90 minutes to start working. Several factors, including formulation, other drug and alcohol intake influence the effects of acetaminophen.
If you have questions about acetaminophen and the right dose for you, speak with your doctor. Discuss other medications you may be taking and your overall health to determine the best plan for your needs.
How Long Does Acetaminophen Work For?
Acetaminophen typically lasts four hours for both pain relief and fever reduction. This is why the recommended dosing frequency is no more than every four to six hours.
The biological half-life of a drug plays an essential role in its effectiveness and safety. It is also an important factor for determining dosage recommendations.
How Long Does Acetaminophen Stay in Your System?
Scientists gauge the time it takes for your body to eliminate acetaminophen from the system by using the medication’s estimated half-life. A drug’s half-life is the time it takes for half a dose to be metabolized and eliminated from your bloodstream. Acetaminophen half-life elimination for therapeutic doses is between one and two-and-a-half (2.5) hours.
However, the expected half-life of acetaminophen can vary from person to person. Factors that affect its half-life include age, genetics, weight and overall health. Generally, a therapeutic dose of acetaminophen flushes fully from your system within 24 hours.
An acetaminophen overdose can extend the half-life of the drug to four and eight, meaning it may take up to three times longer for you to get the drug out of your body. If you re-dose too soon following even a small overdose period, it can lead to an acute case of severe acetaminophen toxicity.
How Much Acetaminophen Is Too Much?
Aside from determining how long acetaminophen works and how long it stays in your system, the drug’s half-life also determines how much is too much to take. The goal of medication is to achieve a steady state, at which point the amount of the drug you ingest and the amount that’s eliminated are equal.
Regardless of a drug’s half-life, it takes approximately four times longer for its concentration to reach a steady state in your body. Acetaminophen side effects often occur when you’re not in a steady state. A small amount of acetaminophen is metabolized into the compound NAPQI, which can cause liver toxicity in large amounts.
Taking too much acetaminophen can cause acute liver damage, which can be fatal. As such, you should not exceed the 4,000 mg maximum daily dose recommendation (you should ideally stay closer to 3,000 mg). Acetaminophen may also effect blood pressure. One 2022 clinical research study found that regular daily intake of 4 g acetaminophen increased systolic blood pressure in individuals with hypertension by about 5 mm Hg compared with a placebo.
Primary symptoms of acetaminophen overdose are:
Abdominal pain
Nausea
Vomiting
Diarrhea
Excessive sweating
Jaundice
Irritability
Seizures
Coma
In case you suspect someone took an overdose of acetaminophen or if you see someone exhibit the above symptoms, you should immediately call 911, emergency medical services, a poison control center or a doctor.
Emergency room treatment will depend on the presenting condition and other drugs that may have been taken. If you make it to the hospital just after taking an overdose, the doctor will attempt to empty your stomach.
Doctors like to prescribe a dose of activated charcoal within four hours of an overdose to bind drugs remaining in your gastro-intestinal tract. They also give N-Acetylcysteine, an antidote for acetaminophen toxicity, orally or intravenously within eight hours.
Emergency doctors recommend that anyone suspected to have taken an acetaminophen overdose get treatment as soon as possible, even before the symptoms occur. Early treatment of acetaminophen overdose can improve the outcome significantly.
Fioricet 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.
Avoid taking Fioricet with medications that affect your concentration, such as other narcotic pain relievers, general anesthetics, sleeping pills, anti-allergy medications, sedative-hypnotics, and tranquilizers (such as chlordiazepoxide). These may cause further drowsiness.
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 Fioricet, avoid taking diet pills, caffeine pills, or other stimulants (such as ADHD medications) without your doctor’s advice.
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.
Acetaminophen is the most common drug ingredient in America. 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.
More than 600 medicines contain acetaminophen. These include both prescription medicines and medicines available without a prescription, also called “over-the-counter,” or “OTC” medicines. To prevent acetaminophen overdose, you need to be able to read labels and recognize when their medicines contain acetaminophen.
The active ingredients in OTC medicines are clearly listed on the label, and the word “acetaminophen,” is listed on the front of the package or bottle and in the Active Ingredient section of the Drug Facts label. On prescription labels, acetaminophen is sometimes listed as “APAP,” “acetam,” or other shorted versions of the word.
To know what is in your medicines, read the list of active ingredients on the label each and every time you take a medicine.
You may be surprised to learn just how many medicines contain this acetaminophen:
Common Over-the-Counter Brand Name Medicines Containing Acetaminophen
Actifed®
Alka-Seltzer Plus LiquidGels®
Anacin®
Benadryl®
Cepacol®
Contac®
Coricidin®
Dayquil®
Dimetapp®
Dristan®
Excedrin®
Feverall®
Formula 44®
Goody’s®
Powders Liquiprin®
Midol®
Nyquil®
Panadol®
Robitussin®
Saint Joseph®
Aspirin-Free Singlet®
Sinutab®
Sudafed®
Theraflu®
Triaminic®
TYLENOL® Brand Products
Vanquish®
Vicks®
Zicam®
*And store brands
Common Prescription Medicines Containing Acetaminophen
Finding the best way to get muscular pain relief starts with figuring out the pain cause. That means determining exactly which muscle (or group of muscles) is causing your pain and how it occurred.
It may not always be obvious. Muscle strains, ligament sprains, tendinitis, bursitis, gout, several kinds of arthritis, sciatic nerve damage, nerve pain etc. – any of these conditions can feel like musclular pain. So until you have an accurate diagnosis, you can only guess how to get muscle pain relief.
Here are some generally accepted muscular pain relief options that offer some promise once you know what your problem is.
Muscular pain usually results from one of two things:
* wear or damage as a result of overuse, inappropriate use, or repetitive motion, and
* injury resulting from participation in competitive athletics, accidents or some other form of trauma.
In either case, your health care provider is likely to suggest medications. Non-prescription muscular pain relievers would probably include one of the following.
Acetaminophen – The better known brand names for this pain reliever are Tylenol and Aspirin Free Excedrin. Acetaminophen relieves soreness and pain because it acts on the parts of the brain that process “pain messages” from elsewhere in the body.
NSAIDs – NSAID is an abbreviation for nonsteroidal anti-inflammatory drugs. One of the more commonly known names in this category is ibuprofen There are many well-known over-the-counter brands, including Motrin, Aleve and Orudis KT. You can also ask your doctor to prescribe a stronger form of NSAID if your pain is severe.
Topical corticosteroids – Better known brands include Cortaid and Cortizone. These also relieve pain from certain forms of arthritis in addition to relieving muscle discomfort. Usually, they can be found in creams, lotions or sprays that are placed directly on the skin. Some of the better known brands include Aspercreme, Ben-Gay, Icy Hot and Capzasin-P.
Once again, your medical professional may suggest a prescription muscle pain reliever if your degree of pain is severe enough.
Prescription corticosteroids are another option. They’re available in pill or injection form. Corticosteroids are especially helpful where there’s swelling, redness, and allergic reactions. These require some care though because they sometimes cause side effects, including mood changes, irregular sleep, headaches and stomach problems.
Muscles in need of strengthening and repair can often benefit from physical therapy and exercise. Physical therapists work with their patients on how to build muscle strength and improve range of motion. They can also give you tips about ergonomic devices that make everyday chores safer or easier for your muscles to perform. Examples light be ergonomic chairs or kitchen knives that work more efficiently and cause less pain when you use them.
Exercise can help can provide relief from muscular pain by strengthening your muscles and improving your range of motion, which reduces your risk of re-injury.
Many people love a massage – even if they don’t have muscular pain. There’s no doubt a massage improves circulation, soothes aching muscles and helps you relax.
Acupuncture has many advocates who are convinced of it’s benefit in relieving muscular pain. Even though no one has definitively determined why acupuncture is effective, there appears to be little doubt that it can benefit some people. Some doctors think the needles may trigger certain substances in the body that give you a sense of well-being and freedom from pain. Other doctors remain skeptical and believe the benefits are mainly psychological: if you convince yourself that it works, then it will work.
Muscle relaxants (also called skeletal muscle relaxants) are a diverse group of medicines that have the ability to relax or reduce tension in muscle. Some (such as baclofen, methocarbamol, Cyclobenzaprine, and tizanidine, ) work in the brain or spinal cord to block over-excited neuronal (nerve) pathways. Others (such as dantrolene and botulinum toxin) act directly on muscle. Cannabis extract is thought to have a dual effect.
Muscle relaxants treat two main conditions: spasticity (stiff, rigid muscles) caused by conditions such as cerebral palsy, multiple sclerosis, and stroke; or muscle spasms which are typically temporary and associated with conditions such as tension headache, low back pain, or fibromyalgia.
Sometimes you get muscle pain from bad posture. Or you develop habitual movements (like an irregular gait) that cause your bones and muscles to work against each other. Chiropractors help you identify and correct problems. Chiropractors can also help those who have been born with an improper spinal alignment that can result in joint and muscular pain.
If your muscle pain is relatively minor, you can use some tried and true home remedies to get muscular pain relief.
Ice packs usually reduce swelling from a muscle injury or condition. You don’t need to use one of those commercial ice packs from your pharmacy – some ice cubes in a plastic bag is all you need. Even a big bag of frozen peas will do the trick. Your local pharmacy can undoubtedly supply you with a variety of braces, bandages and wraps that can be helpful.
But once again, it all begins with getting a proper diagnosis of the cause of your muscular pain in order to select the best relief option.
