Fioricet is a combination medication that contains three medicines: butalbital, acetaminophen, and caffeine.1 Doctors prescribe this medicine to people who struggle with headaches, particularly tension headaches. It’s the 187th most-prescribed medication in the United States.2 Doctors prescribed an estimated 3.1 million prescriptions for Fioricet in 2019.2
Fioricet has the potential to be addictive. Doctors do not recommend taking it more than twice a week, as taking the drug more often can increase the potential of addiction and abuse.3 Developing a tolerance to Fioricet is possible. Withdrawal symptoms can occur if the drug is taken too often and then suddenly stopped.
Addiction to a substance like Fioricet causes a loss of control over how much and how often the drug is taken. While addiction may initially be easy to conceal, it ultimately causes problems in daily life, often from a financial, work, family, or friends standpoint.3
Fioricet has three major components:
Butalbital: This is a sedative medication that may help a person feel more relaxed and also sleepy.
Acetaminophen: This is a medication that can help relieve pain and discomfort.
Caffeine: This is a substance (like that found in coffee or sodas) that can help extend the effects of acetaminophen.1
Butalbital is a type of sedative that belongs to the drug class barbiturates. Another example of a barbiturate is phenobarbital. These medications were popular for anxiety relief before the invention and mass-production of benzodiazepines, such as Xanax or Valium.1
Barbiturates work by slowing down the central nervous system, increasing feelings of relaxation.3.This increases a person’s feelings of relaxation.
Caffeine included in the medication is a “xanthine derivative.” Other examples of medicines that incorporate xanthine derivatives include theophylline.
Currently, it doesn’t appear on the federal drug schedule, although some states may have it on their individual schedule. Some medical experts find it unusual that Fioricet isn’t on the drug schedule because a similar medication called Florinal is a Schedule III controlled substance on the drug schedule.
Fioricet contains the following components: 300 milligrams of acetaminophen, 50 milligrams of butalbital, and 40 milligrams of caffeine. By comparison, Fiorinal contains 325 milligrams of aspirin, 50 milligrams of butalbital, and 40 milligrams of caffeine. While there do not appear to be many differences in terms of how much butalbital and caffeine are present, Fioricet is not currently on the drug schedule.
It’s a safe medication when taken as a doctor recommends. There is a risk for overdose including when taken with other medications, such as opioid painkillers. A risk for acetaminophen overdose exists, as well.3 This can cause life-threatening liver damage.
Due to safety concerns, the medication is banned in most European countries.
Sometimes, doctors will prescribe codeine-containing formulations of Fioricet to enhance pain relief, which makes it more likely to find codeine-containing medications on the street, as Fioricet alone doesn’t usually produce the sensation of feeling high as codeine-containing formulations can.
“Barb” is the most common street name for any codeine medication, including Fioricet.
Doctors prescribe it to relieve tension headaches.3 This headache type causes tension and pressure in the neck and scalp.3 Some people who experience tension headaches describe the feeling as if they have a rubber band wrapped around their head and the rubber band is squeezing tightly around them.3
In many instances, tension headaches can be resolved with non-prescription medications. Examples of ways to relieve tension headaches include drinking plenty of water, reducing stress, resting, and taking over-the-counter pain-relieving medications, such as acetaminophen or ibuprofen. However, these medicines sometimes don’t provide relief for tension headaches. As a result, doctors may prescribe Fioricet.
When doctors prescribe the medication, they usually intend it as a short-term remedy, or as-needed for headaches.3 Doctors don’t usually intend the use of this the medication daily or past a few weeks when a history of tension headaches is prevalent.
Ideally, if it’s taken to relieve headaches. The most immediate effects should be headache relief and feelings of relaxation.1
However, it can cause other short-term effects which may be more worrisome. First, an allergic reaction to one or more of the medications may occur. Signs of an allergic reaction include the following:
Swelling, especially of the tongue and throat1
Other, less-serious short-term effects may include:
A physician’s input should be sought if any of these effects or symptoms appear. The doctor may wish to prescribe a different medicine that doesn’t cause the same side effects.
The liver is responsible for metabolizing or breaking down Fioricet.3 It’s possible that it could cause long-term liver damage in the presence of other medical concerns or when combining other medications. Also, it’s important to remember that it contains acetaminophen, and so do many other medications, such as hydrocodone or oxycodone, which increases the risks for liver damage.
Some signs and symptoms of liver damage include the following:
Dark appearance to the urine
Easy or unexplained fatigue
Swelling of the abdomen
Yellowed appearance to the skin and eyes
Consulting a physician is necessary if there is a chance of liver damage.3
Another concern is that taking it too much can cause something called a medication overuse headache.3 This occurs when a person takes a medicine too often, and the medicine causes a headache instead of helping it.
One of the key symptoms of a medication overuse headache is that little to no medications will help reduce the symptoms. Medication overuse headache is likely if the medication is taken three times a week or more or used for more than ten days out of a month.3 This is why doctors recommend limiting the medication to using it two times a week at the most.
Yes, it is possible to overdose. Some of the symptoms that a person may be overdosing include the following:
Slowed or no breathing, which may cause a person to turn blue in appearance
Yellowing of the skin or eyes
These indicate a medical emergency, and 911 should be called at the first signs of overdose.
Fioricet usage should not be stopped without a doctor’s recommendation. Depending on the dosage, symptoms will vary in individual cases.
Talking to a doctor before stopping taking the medicine can help establish a treatment plan that reduces the risks of a withdrawal seizure.
If Fioricet has been abused, withdrawals will usually begin about eight to 36 hours after the last dose of Fioricet taken.3 Doctors usually recommend a medical treatment facility for withdrawal because as a central nervous system depressant, Fioricet can cause life-threatening seizures.3
Other withdrawal symptoms that a person can go through after abusing Fioricet include:
Fioricet can cause symptoms that are similar to excess alcohol consumption. Its withdrawal symptoms also closely resemble those of alcohol withdrawals, according to an article in the journal JAMA Neurology.4
Those who struggle with Fioricet abuse should seek treatment at a medical facility, such as a hospital or rehabilitation facility. There, a doctor can establish a tapering plan, slowly stopping the dosage. Tapering the medication is extremely important to avoid a higher risk for seizure. According to JAMA Neurology, most doctors will recommend reducing a person’s overall daily dose by ten percent a day until the person stops taking the medicine entirely.4
Benzodiazepines, such as midazolam, may be prescribed for those withdrawing from Fioricet. This reduces the risk of a withdrawal seizure. However, it is still always possible that a seizure may occur.
Addiction can be more than just a physical dependence on a particular drug-there may be a mental connection to how the medication makes the person feel. When this is the case, it’s important to seek counseling and sometimes a support group that can help navigate the strong cravings present for the drug. A counselor or therapist can help teach other, healthier ways of coping with anxiety or headaches that can reduce the risks of a return to Fioricet abuse.
Fioricet is a headache medicine intended for infrequent use but has been abused as a remedy to treat headaches or as a means to increase the relaxation and slowed-down feelings that alcohol or illegal drugs can produce. While it is not on the drug schedule across the country, some states have it on their drug schedule. This means the substance may be more tightly controlled for prescribing across those particular states.
If you or someone you love suffers from Fioricet addiction, seek medical treatment. Trying to withdraw or quit “cold turkey” could cause seizures, which may be life-threatening.