Will Gabapentin affect pregnancy or breastfeeding?

This article will help you know if Gabapentin is safe for use during pregnancy or breastfeeding.

Gabapentin and pregnancy

The answer to the question whether taking Gabapentin is safe or not during pregnancy is still not known. Some say yes while other says no. When you decide on this factor, it becomes important to find out how necessary is the use of Gabapentin for you during pregnancy? Also you should calculate the risks to your baby and you and it will depend on how many weeks/months pregnant you are. The main objective during pregnancy is to be healthy while taking care of your unborn baby. Also we cannot ignore the fact that epilepsy should be controlled during pregnancy as seizures can lead to complications in unborn child and mother. In such cases it becomes necessary for some pregnant women to go for Gabapentin therapy.

It is recommended that women who are trying to conceive or are in first trimester of their pregnancy should take high doses of folic acid that is 5mg/day and high doses should be recommended by the doctor.

If you are suffering from epilepsy and taking Gabapentin, then do not stop taking the medication suddenly as it can lead to complications to you and your baby. Do not make any changes in your dose without talking to your doctor. The studies conducted do not show any signs of birth defects in babies born to mothers who used Gabapentin in their pregnancy. There are no evidences available that support any facts that can cause miscarriage or preterm birth too.

Since there are no evidences available that help us know whether Gabapentin is safe or not during pregnancy, pregnant women are asked to get diagnostic ultrasonography done before 20th week of their pregnancy to assess the development of foetus or if the termination of pregnancy is necessary.

So if you are pregnant and taking Gabapentin or planning to use Gabapentin, speak to your doctor as your doctor can examine your current medical condition and depending on your health status he can let you know whether you can use this medication or not. You can take a wise decision with the help of your doctor so that you can be stress free all throughout your pregnancy.

Gabapentin and breastfeeding

Gabapentin passes in the breast milk. There are no evidences available that claim that Gabapentin is not safe while breastfeeding. The manufacturers generally recommend that Gabapentin should be only used during breastfeeding if the benefits of the medications are higher than the risks. Therefore talk to your doctor to know about the benefits and risks. There are very few reports that say that use of Gabapentin by breastfeeding moms didn’t lead to any problems in infants. Normally healthy new born babies easily tolerate amounts of medication (Gabapentin) transferred through breast milk.

If your doctor thinks that Gabapentin is beneficial for you during breastfeeding, make sure you monitor your baby closely for any possible side effects.  Check for signs of feeding problems, drowsiness, slow development and weight gain.

Gabapentin- Drug interactions that can affect your health

Drug interactions should be considered before you start using Gabapentin. You should check with your doctor to know about various drugs that can interact with Gabapentin. If you are using additional medicines other than Gabapentin, let your doctor know as those medicines can interact with Gabapentin to affect your health. Let your doctor know if you are using herbal preparation, dietary supplements or any other medications.

Gabapentin with Opioids


Using Gabapentin and hydrocodone together can decrease hydrocodone exposure. The power for changing the hydrocodone exposure and its effect should be determined when Gabapentin is discontinued or started in a patient using hyrdocodone.


While using morphine and Gabapentin together, the patients should be monitored for signs of CNS depression like sedation, somnolence and respiratory depression.

Maalox (magnesium hydroxide and aluminium hydroxide)

The efficacy of Gabapentin was decreased by nearly 20% with combined use of Maalox (antacid) consisting of aluminium and magnesium hydroxides. So, Gabapentin should be taken at least 2 hours after using Maalox.


Using Gabapentin with naproxen can elevate the Gabapentin amount absorbed in your body. Although the increased amount is quite low to cause any severe side effects, still extra caution should be taken while using the two medications together. Such patients tend to experience some side effects as well.


Using Gabapentin and cimetidine together can reduce the renal secretion of the medication resulting in increased level of Gabapentin in the blood. However small decrease in Gabapentin cannot result in adverse effects.

Some other drugs that can interact with Gabapentin are as given below

  • Magnesium Trisilicate
  • Magnesium Carbonate
  • Ginkgo
  • Dihydroxyaluminum Aminoacetate
  • Aluminium Carbonate, Basic
  • Morphine Sulfate Liposome
  • Magnesium Oxide
  • Magaldrate
  • Aluminium Phosphate
  • Dihydroxyaluminum Sodium Carb

Although the above medications should not be taken with Gabapentin, there are some cases where the combination of the medications is required in spite of the different interactions that take place. In such cases, your doctor may change your dose or ask you to take necessary precautions. Also your doctor should be aware of other medicines you are taking so that you can use the combination safely.  The combination of the drugs might be the better option for the treatment so your doctor will help you know how to use the drugs safely.

The drugs also have some other interactions with certain foods, tobacco or alcohol. So discuss with your doctor if you are drinking alcohol, using tobacco etc.

Drug interactions lead to many complications depending upon the severity of the interaction. If you are using any other medications, it is necessary for your health care provider to know about the drugs so that he can check for possible drug interactions and suggest you whether you can take the drug or not. He can also make dosage adjustment so that you get maximum benefits from combination of drugs.

Always consult your doctor before making any changes to your dose and do not stop any medication without consulting your doctor.

Gabapentin – Dosage information for RLS, Epilepsy and Postherpetic Neuralgia

The Gabapentin dosage differs in each individual depending upon the age of the person, current medical condition and patient’s tolerance to the medicine. This article will help you know about the general Gabapentin dosage information for RLS, Epilepsy and Postherpetic Neuralgia. Again the dosage can differ thus you should take Gabapentin as recommended by your doctor.

Normal Dose for Epilepsy- In Adults

Initial dose: 300mg to be taken orally on first day

300 mg to be taken orally two times a day on the second day

300mg to be taken orally thrice a day on third day

Maintenance dose: 300-600mg to be taken orally thrice a day

Maximum dose: 3600mg to be taken orally daily in 3 split doses

Maximum time gap between doses in a schedule wherein the patient is taking the medicine thrice a day should not be more than 12 hours

Note:  Gabapentin can be taken with/without food

If you have not used the half tablets (broken) within 28 days after breaking, the tablet should be disposed.

Normal Dose for Postherpetic Neuralgia – In Adults

Initial dose: 300mg to be taken orally on first day

300 mg to be taken orally two times a day on the second day

300mg to be taken orally thrice a day on third day

The dosage can be adjusted as required

Maintenance dose: 1800mg/day (600mg to be taken orally three times a day)

Note: Gabapentin can be taken with/without food

If you have not used the half tablets (broken) within 28 days after breaking, the tablet should be disposed

Gabapentin available under the brand name GRALISE(R)

Maintenance dose: GRALISE(R) should be adjusted to 1800mg to be taken orally once in a day during meal.

Recommended dosage schedule

Day 1: 300 mg to be taken orally with meal in the evening

Day 2: 600 mg to be taken orally with meal in the evening

From Day 3 to day 6: 900 mg to be taken orally with meal in the evening

From Day 7 to day 10: 1200 mg to be taken orally with meal in the evening

From Day 11 to day 14: 1500 mg to be taken orally with meal in the evening

Day 15: 1800 mg to be taken orally with meal in the evening

Gabapentin (enacarbil extended release tablets) are sold under brand name HORIZANT (R)

The recommended dosage – 600 mg to be taken orally twice a day

Therapy should be started at a dose of 600mg to be taken orally in the morning till 3 days of therapy and can be increased up to 600mg to be taken twice a day and 1200 mg/day on fourth day.

Normal Dose for Restless Leg Syndrome- In Adults

600mg to be taken orally once daily during 5 PM with food

The medication is used to treat mild to severe RLS in adults

The above dosage information is general dosage information that can vary from person to person depending upon his/her medical condition and age. Your doctors can advice the right dose for you.

Gabapentin- An anticonvulsant used to treat seizures

Gabapentin is an anticonvulsant or an anti-epileptic medicine used to treat seizures. The generic name is Gabapentin and the brand names are Gabarone, Neurontin and Gralise. It influences the nerves and chemicals present inside our body that cause pain or seizures.

Gabapentin is used to treat nerve pain that occurs due to shingles or herpes virus in adults. The horizant brand of this medication is used to treat RLS(restless leg syndrome)

The Neurontin brand of this medication is used to treat seizures in children aged 3 years and adults as well.

Some important information

Take the right form and brand of Gabapentin as recommended by your doctor and check the medicine every time you buy a refill to make sure you got the correct form of this drug.

Check the label and read the instructions mentioned on the label carefully and inform your doctor about any other medicines you use, you medical conditions and allergies.

Avoid using this  medicine if you are suffering from

  • diabetes
  • kidney disease or if you are on dialysis
  • seizure disorder or epilepsy
  • liver disease
  • heart disease
  • history of mood disorder, depression, drug abuse, suicidal actions or thoughts
  • Suffering from RLS (if you sleep during the day as you at work in a night shift)

Some people get suicidal thoughts while using this medication. Your doctor will check your progress at regular intervals while you are using Gabapentin. Your caregivers or family members also need to be alert to monitor any changes in your mood.

Take Gabapentin as prescribed by the doctor. Do not use Gabapentin in smaller or larger amounts than recommended and also do not use the medication for a prolonged period than advised by your doctor.

Taking the Horizant brand during the day should be avoided. To get positive effects, use Horizant with food at 5.00 in the evening. Both Horizant and Gralise should be taken with food. Neurontin can be taken with/without food.

If you had broken a Neurontin tablet and used only half tablet, then take the other half at the next dose. Any broken tablet should not be kept for too long, so use the tablet as soon as you can or    within a couple of days. If you are using liquid form of this medicine, then measure the medicine using the dosing syringe enclosed with the medicine or use dose measuring cup or spoon.

Do not halt the use of Gabapentin all of a sudden, even if you feel you are well. Halting suddenly can lead to increased seizures. Ask your doctor for dose adjustment or change in dose.

Store the medicine away from moisture and light in a room temperature. Store the liquid form of medication in refrigerator but do not freeze.

If you have to undergo a urine protein lab test while you are using Gabapentin, let your laboratory staff know that you are using Gabapentin as Gabapentin can cause false positive result of urine protein test.

Common, Major and Minor side effects of Gabapentin

Well, talking about the side effects of Gabapentin, in this article we are going to discuss about the common, major and minor side effects.

Let us start with the common side effects first

Common side effects

  • drowsiness
  • sedation
  • dizziness
  • fatigue
  • fever
  • nystagmus
  • ataxia
  • viral infection
  • tremor
  • blurred vision
  • xersotomia
  • irritability
  • peripheral edema
  • diplopia
  • amblyopia

Some Major side effects that need immediate medical attention are

More Common

  • unsteadiness or clumsiness
  • uncontrolled, rolling, continous eye movements

More common effects in children

  • crying
  • anxiety
  • depression
  • behavioural problems like aggressiveness etc
  • constant change in moods
  • increase or hyperactivity in body movements
  • restlessness
  • distrust or suspiciousness
  • overacting, reacting too emotional or too quickly
  • concentration problems or in change in performance at school

Less Common

  • chills
  • cough
  • chest pain
  • memory loss
  • fever
  • irritability, depression or other changes in moods
  • swelling or pain in legs or arms
  • unusual weakness or tiredness
  • difficult or painful urination
  • swollen glands
  • breathlessness
  • unusual bruising or bleeding
  • sore throat
  • tarry, black stools
  • ulcers, sores or white spots in the mouth or lips

Occurrence not known

  • coma
  • dark urine
  • confusion
  • diarrhoea
  • headache
  • increased thirst
  • convulsions
  • joint pain
  • dizziness
  • appetite loss
  • muscle pain or ache
  • nausea
  • irritated or red eyes
  • yellow skin or eyes
  • irregular or fast heartbeat
  • decreased volume of urine
  • hive like or large swelling on eyelids, throat, tongue, feet, sex organs, hands, lips or face

Minor Side effects

Some minor side effects of Gabapentin do not need medical attention. As the body adjusts to the medication the side effects vanish with time.  Your doctor can advise you on how to reduce or prevent such side effects. If the minor side effects turn bothersome or continue to last for a longer period, consult your doctor immediately

More common

  • dementia
  • delusions
  • blurred vision
  • flu or cold like symptoms
  • shaking or trembling
  • hoarseness
  • side or lower back pain
  • swelling of feet, lower legs and hands
  • loss or lack or strength

Less Common side effects

  • body pain or aches
  • full or bloated feeling
  • vision problems
  • congestion
  • constipation
  • earache
  • excessive tearing
  • eye discharge
  • impaired vision
  • increased hunger
  • in coordination
  • frequent urination
  • indigestion
  • ringing ears
  • increased sensitivity to touch and pain
  • sneezing
  • runny nose
  • chest tightness
  • trouble sleeping
  • passing gas
  • trouble thinking
  • twitching
  • weight gain
  • vomiting
  • loss of strength or weakness
  • unexpected weight loss
  • tingling in feet and hands
  • dry or flushed skin
  • excess gas or air in intestines or stomach
  • decreased sexual ability of desire
  • Itching, burning or dry eyes.

Right dosage of Acetaminophen and treatment for over dosage problems

Fioricet contains Acetaminophen.

Blue Fioricet Online
Blue Fioricet Online

Acetaminophen is a pain reliever and also treats many other types of pain ailments. The medicine still has its own set of drawbacks which can cause permanent damage to your liver or other health problems, if not taken in right doses. This article would help you know the right dosage of Acetaminophen and the effects of overdosing along with the treatment used to treat overdosing problem.

You need to store the medicine in room temperature and keep it away from moisture and heat. Stop using Acetaminophen can contact your doctor if

  1. The fever persist even after 3 days of its consumption
  2. The pain exist after seven days of using the medicine
  3. You develop skin rash, redness, swelling or constant headache.
  4. If the symptoms turn severe or you develop some other new symptoms.

What if you missed a dose?

Since Acetaminophen is used as required, you do not need to maintain a dosing schedule. If you are using the medicine regularly, you can always take the dose you missed as soon you come to know. Do not take extra dose of medicine to make up your missing dose.

What if you overdose?

You need to immediately call emergency medical help as overdose can be fatal. The initial symptoms of overdose of Acetaminophen can be vomiting, sweating, stomach pain, appetite loss, weakness or confusion.

Dosing Information

Dose for Adults – for fever

Adolescents and adults having body weight 50 kg or more

1000mg after every 6 hours or

650 mg every 4 hours

With a single dose of 1000 mg per day, you can take maximum 4000mg per day

Adolescents and adults having body weight less than 50 kg

15 mg after every 6 hours or

12.5 mg after every 4 hours

No adjustment of dose is necessary when changing between IV and oral Acetaminophen dosing in adolescents and adults. The highest dose of Acetaminophen per day entirely depends on all courses of administration like rectal, oral and intravenous and all types of products comprising of Acetaminophen.

Overdose of Acetaminophen and treatment

Overdose of Acetaminophen can affect your liver; many people are using Acetaminophen for pain relief or to reduce fever. Acetaminophen is an active ingredient in many other OTP products like the ones used for sleeping remedies, flu, cold etc., it is also an active ingredient in many pain relievers.

Overdose of Acetaminophen results in abnormal functioning of liver, liver failure, increased liver enzymes or even death. Acetaminophen leaves residues in your liver that are highly toxic and liver needs help to flush out the toxins from the body.

Acetaminophen overdose is a serious problem, which needs proper treatment. Treatment should be given to the patient immediately. Patients are treated by giving medicine like activated charcoal to absorb Acetaminophen that is still present in your stomach. Activated charcoal makes the patient vomit. This helps cleaning of gastric lavage and flush out Acetaminophen.

Sometimes antidote medicine is given to control and stop the effects of overdosing.

Acetaminophen drug interactions with different drugs explained

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.

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

If you are using any narcotic drug, it is always better to know about its drug interactions with other products. This can help you use the drug safely and avoid using the products or medicines that have adverse effects when used with your drug.

A product that can interact with Acetaminophen is ketoconzole. This medication can interfere with some laboratory test resulting in incorrect lab results. Let your laboratory personnel know that you are using this drug.

Drug Interactions

Acetaminophen with Isoniazid

The information shared is generalized and not given as a medical advice. Consult your doctor before using or discontinuing any drug or starting any treatment.

Medical warning

Moderate risks. These drugs can results in some risks when consumed together. Contact your doctor for detailed information.

How the drug interaction occurs

Isoniazid can affect how the liver processes the medicine Acetaminophen.


The quantity of metabolite of Acetaminophen in the liver can increase or cause liver damage.

Let your doctor know that you are using these two medicines together. Your health care provider might suggest you to try some other pain reliever while consuming Isoniazid.  Also inform your doctor if you notice any signs of liver problems like nausea, vomiting, dark urine, yellowing of eyes or abdominal pain. Do not change, start or stop the current dosage on your own without talking to your doctor.


Acetaminophen with Busulfan

Medical warning

Moderate risks. These drugs can lead to some risks when used together. Contact your health care provider for detailed information.

How the drug interaction occurs

Acetaminophen can slow down the speed of your body to removing busulfan.

What can happen?

It might take a long time for your body to eliminate busulfan.

What should you know about the interaction (Acetaminophen with Busulfan)?

Inform your doctor that you are using the two medicines together. Your doctor might advise you to stop using Acetaminophen for three days prior to busulfan therapy and a few days after the busulfan therapy. If you are not sure whether your medicine consists of Acetaminophen, check with your pharmacist.

If you notice any signs like chills, fever, sore throat abdominal pain, yellowing of skin or eyes, vomiting, depression, mood changes, anxiety, hallucinations, irregular heartbeat, confusion and muscle cramps. Contact your doctor immediately.

Acetaminophen- Selected Anticoagulants

Medical warning

Moderate risks. These drugs can lead to some risks when used together. Contact your health care provider for detailed information.

How the drug interaction occurs

Acetaminophen when taken regularly can affect the ability of your body to make clots.

What can happen?

You may notice an increased bleeding including bleeding gums, nosebleed, dark stools and unusual bruising.

What should you know about the interaction?

Let your doctor know that you are using the two medicines together, the dose of Acetaminophen you use and how frequently you use Acetaminophen. You doctor may ask you that he wants to check the INR values closely. If you have stopped taking Acetaminophen, let your doctor know about it. If you observe any signs of nose bleeding, unusual bruising etc., immediately contact your doctor.

Understanding the side effects associated with Fioricet

Fioricet (Butalbital APAP Caffeine ) are helpful to treat many pain ailments, but they come with a plenty of side effects too.

If not used as prescribed by the doctor can lead to harmful and serious side effects too. Some of the side effects are mild and they vanish with time as your body gets used to the medicine, but some serious side effects like overdose of these drugs can be fatal too. Fioricet is also among the narcotic drugs having mild to serious side effects.

Let us understand about the possible side effects of Fioricet depending upon their severity.

Frequently observed side effects

Some of the adverse reactions of Fioricet observed frequently are

  • Nausea
  • Breathlessness
  • Dizziness
  • Sedation
  • Vomiting
  • Abdominal pain
  • Lightheadedness
  • Intoxicated feeling

Infrequent observed side effects

Listed below are some infrequently observed side effects of Fioricet

Central nervous system

  • Shaky feeling,
  • headache,
  • heavy eyelids,
  • fainting,
  • agitation,
  • hot spells,
  • seizure,
  • fatigue, high energy,
  • Sluggishness and numbness.

Excitement and mental confusion can occur due to sensitivity, especially in debilitated or elder patients or because of over dosage of butalbital.

Nervous system (Autonomic)

Dry mouth and hyperhidrosis


Heartburn, constipation, flatulence and difficulty in swallowing are some gastrointestinal related side effects seen in patients.


Muscle fatigue and leg pain




Fever, nasal congestion, tinnitus, pruritus, euphoria and other allergic reactions

There are some rare side effects associated with consumption of Fioricet, which are not known to patients. Let us know about them.

  • Decreased blood platelets
  • Decreased white blood cells
  • Liver failure (acute)
  • Extra heartbeat
  • Giant hives
  • Memory loss
  • Rickets
  • Trouble in breathing
  • Wheezing
  • Feeling restless
  • Fast heartbeat
  • Rash
  • Skin redness
  • Swelling in vocal cords
  • Skin inflammation
  • Hallucination
  • Throat tightness

The side effects can be mild to severe, but you should consult your doctor if any symptoms persist, so that you can treat the side effects. Many people using Fioricet do not have any severe side effects. It depends from person to person, so doctor is the right person to judge the side effects and adjust the dosage accordingly.

Do not ignore the side effects as they can be serious too. For lightheadedness and dizziness, you can try getting up slowly from your bed from a lying or sitting position.

For side effects like constipation, you can switch to a simple diet which can aid the process of digestion properly. You should trust your doctor as your doctor knows the right dosage for you. Do not try to change the dosage or stop taking the medicine on your own. Your doctor will help you adjust your dose and reduce side effects gradually.

Altering the dosage of Fioricet on your own can lead to various other problems that you might not be able to understand and deal with. Consult your doctor if your current dose is causing any side effects.

For serious side effects, you must consult your doctor immediately to avoid adverse effects.

Knowing about Fioricet medicine

Fioricet medicine is a popular brand name for a blend of three drugs, which comprise of caffeine, butalbital and acetaminophen. The combination of these three drugs is used to treat migraines, tension headaches and different types of other pain ailments. Fioricet is not clearly labeled as a common pain reliever. The medicine is  available only with your doctor’s prescription, but if you are suffering from tension headache, it is better to speak to your doctor about the effects of using Fioricet to manage serious or recurring headaches.

Fioricet was approved by FDA in 1984 and Novartis Pharmaceuticals was its original manufacturer. In 2003, Watson pharmaceuticals now known as Actavis, purchased the rights to sell Fioricet. Many manufacturers are now selling Fioricet in generic form as well. The original formulation of the medicine included

  • 50 milligrams butalbital
  • 40 mg of caffeine
  • 320 mg – acetaminophen

Mechanism of formulation

Butalbital is a type of sedative used as a muscle relaxer in Fioricet, the butalbital is used to alleviate the muscle tension that occurs due to tension headaches. One should take Fioricet as prescribed by the doctor and should avoid the dependency on drug. Do not exceed the recommended dose.

Caffeine is used in Fioricet to improve the efficacy of acetaminophen. When taking Fioricet, the patients should not take substances that contain caffeine to avoid overdose and nervousness caused by high consumption of caffeine.

Acetaminophen is a popular pain reliever, which is also available   over the counter. Since acetaminophen is easily available, the patients taking Fioricet should be familiar with the contents of any other medications, they are using to prevent overdose.

According to FDA guidelines, the manufacturers are recommended to restrict the dose of acetaminophen in different prescription products.

Fioricet plus codeine

Another formula which includes Fioricet and codeine is also discovered by Actavis to deal with tension headaches. It comprises of 30 mg- codeine along with other 3 drugs and contains increased dose of acetaminophen, which is 325mg.

The Fioricet plus codeine comes in a black box with a warning about how it can be toxic for your liver, lead to respiratory problems and death in kids caused by codeine.

Addiction and Abuse

In Fioricet, the sedative known as butalbital is present, which belongs to the class of certain drugs known as barbiturates, a depressant that can affect your central nervous system. It has the ability to cause psychological and physical dependence which can result in abuse.

Those who take too much medicine (Fioricet) may discover that they are stress free and feel relaxed. This makes them addictive to the drug as they start taking high doses to get the satisfactory results.  Some people say that they feel intoxicated. However, people can get into depression once the effect of medicine goes off.

Despite of its risks, Fioricet is an effective medicine to manage migraines and tension headaches. When used under the supervision of an experienced doctor and when taken as prescribed by the doctor can help people get great results.

Is it legal to buy Fioricet and Gabapentin Online ?

Yes, it is Legal to buy certain prescription drugs online if they are located and Licensed in the USA. The questionaire is what the Doctor needs to know BEFORE giving you a prescription. To just write out prescriptions would be illegal.

Fioricet and gabapentin are not controlled subsctance, so it is Ok to get your orders online. But you must complete your questionnaires very carefully and honestly. Your IP address also maybe reordered to check whether you are a legal US nature man or woman.

Controlled substances are not allowed online. But some countries controlled some medicines but some other countries even list it as over the counter medicines. You must follow your own country’s law.

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.

Take the medicine with food or milk if it upsets your stomach.

Store Fioricet at room temperature away from moisture and heat.

Keep track of the amount of medicine used from each new bottle. Butalbital is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of 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.

Why Fioricet is Controlled but Fiorinal is controlled ?

Fioricet contains: 325 mg of acetaminophen (APAP), 50 mg of butalbital, and 40 mg of caffeine.  The max dose of acetaminophen per day is 4000 mg, and since there’s only 325 mg in Fioricet, you’ll have to take a lot at once or take them for a long time to get the damage from acetaminophen, whereas someone on warfarin takes aspirin and isn’t aware of it the effects could be immediate….The fatal liver damage from acetaminophen comes when you take it with alcohol, so if you don’t take your Fioricet with a shot you should be ok at this dose

Fiorinal contains: 325 mg of aspirin (ASA), 50 mg of butalbital, and 40 mg of caffeine. Fiorinal is scheduled because drug abusers can easily perform an “acid wash” to remove the aspirin (acetylsalicylic acid) component. It is much more difficult to remove the acetaminophen component in Fioricet. 

The only difference between these two is the aspirin in Fiorinal vs acetaminophen in Fioricet.

The interesting thing is that Fiorinal is a scheduled class III substance, while Fioricet has a non-scheduled status. It seems really strange because both combinations contain equal amount of the controlled substance butalbital.

Exceptions from the scheduling have been made if the drug meets the requirements of section 811(g) (3) (A) of the Controlled Substances Act2. The exemption requires that one of the active ingredients be a non-narcotic controlled substance and one of the others be a non-scheduled compound. The potential for abuse is decreased if a sufficient amount of a non-controlled substance (e.g., aspirin or acetaminophenn) is added. The ratio required for exemption is 70 mg of acetaminophen to 15 mg of butalbital. In contrast, the ratio of aspirin to butalbital is 188 mg to 15 mg.

The acetaminophen to butalbital ratio is approximately 97 mg to 15 mg in Fioricet, thus it is exempt from scheduling1. In Fiorinal the aspirin to butalbital ratio is approximately 97 mg to 15 mg, which is less than the 188mg:15mg ratio, so it is classified as a Schedule III substance.

Citation: Section 811(g)(3)(A) Controlled Substances Act

**Please note: Under the following states law, Fioricet is classified as a Schedule III controlled drug. **

  1. Georgia
  2. Maryland
  3. New Mexico

 Alabama Pharmacy State Board Newsletter that gives somewhat of an explanation:

In the past, there has been confusion over the controlled status of Fioricet. Fioricet is not scheduled federally. In 1980, a federal panel set forth criteria to except certain compounds if they were combined with butalbital and fell within the proper ratio of acetaminophen and butalbital. Fioricet met the criteria to be an excepted compound and was excepted in 1980.

Fiorinal is a much older drug than Fioricet and was released at a time when all butalbital-containing drugs were listed as Schedule-III. Butalbital was later removed from that listing but brand name Fiorinal was never taken off of the list. Fioricet came along after butalbital was removed from the list and it therefore carries no control status. However, butalbital does still carry some danger of dependence and there is no difference in the dependence levels between butalbital with aspirin and butalbital with acetaminophen.