Fioricet for the treatment of migraine headaches: an introduction

Fioricet is a combination of acetaminophen (Tylenol’s main ingredient), caffeine and butalbital. Fioricet is a member of the barbiturate class of medications. Because it contains acetaminophen and caffeine, it is also a pain reliever and a stimulant.

How Fioricet for migraines works

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 the migraine symptoms.

Learn more about how Fioricet works, officially called the mechanism of action.

Forms of Fioricet available to treat migraines

Fioricet, which is a brand-name medication, is available only as a tablet. Other medications containing the same active ingredients are available as liquids and may contain different strengths of acetaminophen.

Other names for this combination of drugs:

• Amaphen^®
• Anoquan^®
• Butace^®
• Endolor^®
• Esgic^®
• Fioricet^®
• Medigesic^®
• Repan^®

Most common side effects of Fioricet tablets

Fioricet is a combination of three drugs, therefore each ingredient may result in different side effects.

The most common side effects seen from butalbital are:

• Dizziness
• Sedation
• Drowsiness
• Lightheadedness
• Shortness of breath
• Dulled senses
• Abdominal pain
• Nausea and/or Vomiting

Possible side effects from the acetaminophen:

• Allergic reactions
• Rash
• Low blood cell count

Possible side effects from the caffeine:

• Rapid heart rate
• Irritability
• Dependence
• Shaking
• Poisonous effect on the kidneys
• Increased blood sugar

Serious side effects

Some people may experience serious side effects when they take Fioricet. The maximum daily dose of acetaminophen for adults without liver problems is 4,000 mg or 4 grams per day.  Seek immediate medical attention immediately if you have any of the following symptoms of liver damage:

• Persistent nausea or vomiting
• Yellowing of the eyes or skin
• Dark-colored urine
• Severe abdominal pain or stomach pain
• Extreme fatigue

Barbiturates, including Fioricet, can cause dangerous and potentially life-threatening dependency. Consuming alcohol while taking Fioricet is dangerous. Because Fioricet can be addictive, it should only be taken while under a doctor’s supervision and the medicine should be stopped gradually, not abruptly.

Like many painkillers used for treating migraines, if Fioricet is taken often over a long time it can lead to a rebound headache, which is also called medication overuse headache. This results in headaches worsening.

Go to drugfx.com to learn more about side effects of Fioricet and other medications.

Who should not take Fioricet for migraines

Fioricet may interact with other medicines you are taking. Therefore, as always, you must inform your doctor of all other medications you are currently taking including over-the-counter drugs and any natural remedies.

Let your doctor know if you are taking certain antidepressants called MAO inhibitors, drugs that act on the central nervous system, alcohol, antihistamines, sleep aids, anti-anxiety medications, muscle relaxants, narcotic pain killers or drugs for mental illness.

Fioricet should not be used if you take sodium oxylate, a drug for narcolepsy, if you suffer from porphyria or if you drink alcohol.

Fioricet interacts with several other drugs including:

• Adenosine
• Anti-seizure drugs
• Beta agonists (such as albuterol) used to treat asthma
• Birth control pills (oral contraceptives)

Fioricet also interacts with drugs that affect liver enzymes, including:

• Erythromycin
• Cimetidine
• Disulfiram
• Valproic acid
• Fluvoxamine
• Isoniazid
• Lithium
• Methoxyflurane
• Phenothiazines (such as chlorpromazine)

Fioricet can also speed up the removal of other drugs from your body by affecting your liver enzymes including:

• Blood thinners (such as warfarin)
• Cyclosporine (used for organ transplant)
• Corticosteroids (such as prednisone)
• Estrogen (a female sex hormone)
• Felodipine (a calcium-channel blocker)
• Metronidazole (an antibiotic)
• Quinidine (used to treat irregular heart rate)
• Certain beta blockers (such as metoprolol)
• Theophylline (used for asthma)
• Doxycycline ( a type of tetracycline antibiotic)

Women who are pregnant, may become pregnant or who are breastfeeding should not take Fioricet without first consulting a doctor.

As always, the best source for advice on treating your migraines is your own migraine specialist. These medication descriptions are provided only for informational purposes. You should begin no medication regimen without first checking with your physician. Again, this information should in no way substitute or be mistaken for medical advice.

Written by: Otesa Miles / Reviewed by: John-Claude Krusz, PhD, MD | Last review date: November 2010. Click the References Link below for a complete list of references.

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