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Fioricet is a combination medication containing butalbital, 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, Esgic, Zebutal, Vtol LQ
Barbiturate / Analgesic / Adenosine antagonist
What is Fioricet?
How Fioricet works
Fioricet is a combination of three medications that work together to help relieve headache pain.
- Butalbital is a barbiturate that works by raising the levels of chemicals that cause your brain to relax.
- Acetaminophen is an analgesic. It stops the production of certain chemicals in your brain, which can help relieve pain.
- Caffeine is an adenosine antagonist. It blocks a natural chemical in your body called adenosine. It’s unclear exactly how caffeine works to treat headaches, but it’s thought to boost the pain-relieving activity of acetaminophen.
What is Fioricet used for?
- Tension headaches
Typical dosing for Fioricet
There are several manufacturers and brand names of this medication. The dose might differ slightly and each pill might contain different amounts of acetaminophen depending on which manufacturer and formulation of the medication you’re using.
Be sure to check your prescription for specific instructions. In general:
Fioricet and its generic: Each pill contains 50 mg of butalbital, 300 mg of acetaminophen, and 40 mg of caffeine.
- Adults and children 12 years and older: The typical dose is 1 to 2 capsules by mouth every 4 hours as needed for pain. The maximum dose is 6 capsules in a 24-hour period.
Zebutal, Esgic, and generic tablets: Each pill contains 50 mg of butalbital, 325 mg of acetaminophen, and 40 mg of caffeine.
- Adults and children 12 years and older: The typical dose is 1 to 2 capsules or tablets by mouth every 4 hours as needed for pain. Don’t take more than 6 pills in a 24-hour period.
Vtol LQ oral solution: Each tablespoonful (15 mL) contains 50 mg of butalbital, 325 mg of acetaminophen, and 40 mg of caffeine.
- Adults and children 12 years and older: The typical dose is 15 mL (1 tablespoon) to 30 mL (2 tablespoons) by mouth every 4 hours. Don’t take more than 90 mL (6 tablespoons) in a 24-hour period.
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- Quala Cet®
Brand names of combination products
- Esgic® Plus (containing Acetaminophen, Butalbital, Caffeine, Codeine)
- Geone® (containing Acetaminophen, Butalbital, Caffeine)
- Orbivan® (containing Acetaminophen, Butalbital, Caffeine)
- Fioricet® with Codeine (containing Acetaminophen, Butalbital, Caffeine, Codeine)
- Phrenilin® with Caffeine and Codeine (containing Acetaminophen, Butalbital, Caffeine, Codeine)
What are the side effects of Fioricet?
With any medication, there are risks and benefits. Even if the medication is working, you may experience some unwanted side effects.
Contact your doctor immediately if you experience any of the following:
- Signs of overdose: not responding to sound or touch, extreme sleepiness, slowed breathing, nausea, vomiting, sweating, tiredness, restlessness, shaking, confusion, stomach pain, dark urine, yellowing of your skin or eyes, loss of consciousness
- Withdrawal: seizures, delusions, restlessness, trouble sleeping, shakiness
- Serious allergic reaction: trouble breathing, hives, swelling of the face, mouth, tongue, or throat
- Serious skin reaction: painful skin rash, blisters, skin itching or peeling
The following side effects may get better over time as your body gets used to the medication. Let your doctor know immediately if you continue to experience these symptoms or if they worsen over time.
Common side effects
- Loss of awareness (sedation)
- Trouble breathing
- Stomach pain
- Feeling “high” (intoxicated)
Other side effects
- Feeling agitated
- Excessive sweating
- Difficulty swallowing
- Muscle weakness
- Fast heart rate
What is a Fioricet High?
The belief is that the Fioricet high is caused by the fact that butalbital can increase the inhibition neurotransmitters in the brain called GABA.
It can bind to certain receptor sites and ultimately central nervous system activity is depressed.
What are the risks and warnings for Fioricet?
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
- 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.
So what does a Fioricet high feel like?
For the most part, it’s likely to feel similar to other central nervous system depressant effects. There is some evidence pointing to the fact that taking Fioricet can feel similar to the effects of drinking alcohol, particularly when the prescription drug is taken at higher levels.
The following are some of the common experiences that people say come along with a Fioricet high:
- Fioricet can reduce anxiety and some people with anxiety disorders may take it for this reason, although this is not what it’s approved for. There is the potential for Fioricet to decrease feelings of anxiety even when it’s taken at a normal dose, and this is because of the impact of butalbital on GABA. For some people, a Fioricet high is actually just equated with a reduction in anxiety.
- Depersonalization may be another effect of the so-called Fioricet high, although this isn’t necessarily something people find pleasant. It can lead to feelings of confusion and sluggishness, and this is one of the reasons Fioricet isn’t frequently used
- Drowsiness and sedation may also be side effects of a Fioricet high, particularly when it’s taken in larger amounts. While Fioricet has a stimulant component which is caffeine when larger doses are taken the central nervous system depressant effects may override the stimulant effects.
- Some people may obtain a sense of euphoria when taking Fioricet, although it’s not as pronounced as what would occur with something like prescription opioids. As with most other drugs, if someone does experience euphoria with a Fioricet high, it’s likely to dissipate after using the drug a few times as they build a tolerance.
- While not everyone who takes Fioricet says they experience euphoria, some people say that it does improve their mood. This can be because of the GABA-related effects of butalbital, but also the inclusion of the acetaminophen and the caffeine. There’s also the element of stimulation that can occur with caffeine, so some people may feel this is a Fioricet high when they experience it.
- Lightheadedness and dizziness are common side effects of Fioricet, and these may also be symptoms that people associate with a Fioricet high.
- One of the primary reasons people will abuse Fioricet and take high doses is to achieve relaxation, which occurs because of the slowdown of the central nervous system. People who take this drug may feel relaxed and also tranquil. Some of this is because of the loosening up of muscles the drug can stimulate.
Not everyone will associate the use of this drug with the Fioricet high. Some of the factors that determine whether or not a person will experience a Fioricet high can include the dosage they take and their tolerance. Newer users may be more likely to experience what they would describe as the Fioricet high. Other factors that could influence this include the specific formulation of the drug and whether or not other substances are taken with it.
Some people may try to extract the butalbital from Fioricet and remove it from the caffeine and acetaminophen for a greater high. This is not only drug abuse, but might not even achieve the effects the person is looking for.
It’s important to realize that there can be serious and deadly consequences associated with trying to achieve a Fioricet high. This can include addiction, adverse reactions, brain damage, emotional crashes, and overdose. Since Fioricet has acetaminophen, if people abuse it to get high they may also sustain liver damage or failure.
This branded product is no longer on the market. Generic alternatives may be available.
Fioricet Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if any of the following side effects occur:
- shortness of breath
Incidence not known
- Abdominal or stomach pain
- black, tarry stools
- bleeding gums
- blistering, peeling, or loosening of the skin
- blood in the urine or stools
- blurred vision
- change in the frequency of urination or amount of urine
- difficulty with breathing
- difficulty with swallowing
- dry mouth
- fast, pounding, or irregular heartbeat or pulse
- flushed or dry skin
- fruit-like breath odor
- hives, itching, or skin rash
- increased hunger
- increased thirst
- increased urination
- joint or muscle pain
- loss of appetite
- nausea or vomiting
- pinpoint red spots on the skin
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- red skin lesions, often with a purple center
- red, irritated eyes
- shakiness in the legs, arms, hands, or feet
- sore throat
- sores, ulcers, or white spots in the mouth or on the lips
- swelling of the feet or lower legs
- tightness in the chest
- trembling or shaking of the hands or feet
- troubled breathing
- unexplained weight loss
- unusual bleeding or bruising
- unusual tiredness or weakness
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
- Confusion as to time, place, or person
- dark urine
- difficult or painful urination
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- general feeling of discomfort or illness
- holding false beliefs that cannot be changed by fact
- increased sweating
- irregular, fast or slow, or shallow breathing
- light-colored stools
- loss of appetite
- pale or blue lips, fingernails, or skin
- sudden decrease in the amount of urine
- trouble sleeping
- unpleasant breath odor
- unusual excitement, nervousness, or restlessness
- vomiting of blood
- yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Relaxed and calm
Incidence not known
- continuing ringing or buzzing or other unexplained noise in the ears
- excess air or gas in the stomach or intestines
- false or unusual sense of well-being
- full feeling
- hearing loss
- heavy eyelids
- high energy
- hot spells
- pain in the leg
- passing gas
- stuffy nose
- tingling sensation
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Some products that may interact with this drug include:
- sodium oxybate
- phenothiazines (such as chlorpromazine)
This drug can speed up the removal of other drugs from your body by affecting certain liver enzymes. These affected drugs include doxycycline, estrogen, felodipine, lonafarnib, quinidine, rilpivirine, tamoxifen, theophylline, voriconazole, “blood thinners” (such as warfarin), certain beta blockers (such as metoprolol), corticosteroids (such as prednisone), among others.
Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), other drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).
Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain caffeine or ingredients that cause drowsiness. Also keep in mind that certain beverages (such as coffee, colas, tea, energy drinks) contain caffeine. Ask your pharmacist about using those products safely.
This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use additional reliable birth control methods while using this medication. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.
This medication may interfere with certain medical/laboratory tests, possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, slow/shallow breathing, severe dizziness, nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, dark urine.