Fiorinal: Difference between revisions
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| structure = | | structure = | ||
| classes = [[:Category:Barbiturates|Barbiturate (butalbital)]], [[:Category:NSAIDs|NSAID (aspirin)]], [[:Category:Methylxanthines|Methylxanthine (caffeine)]], [[:Category:Fixed-dose_combinations|Fixed-dose combination]], [[:Category:Schedule_III_controlled_substances|Schedule III controlled substance]] | | classes = [[:Category:Barbiturates|Barbiturate (butalbital)]], [[:Category:NSAIDs|NSAID (aspirin)]], [[:Category:Methylxanthines|Methylxanthine (caffeine)]], [[:Category:Fixed-dose_combinations|Fixed-dose combination]], [[:Category:Schedule_III_controlled_substances|Schedule III controlled substance]] | ||
| uses = <vote slug="tension-headache-use">Tension-type headache (limited evidence; falling out of favor due to | | uses = <vote slug="tension-headache-use">Tension-type headache (limited evidence; falling out of favor due to medicine-overuse headache and barbiturate dependence risk)</vote> | ||
| starting_dose = 1-2 capsules (50 mg butalbital / 325 mg aspirin / 40 mg caffeine each) PO every 4 hours as needed; maximum 6 capsules/d | | starting_dose = 1-2 capsules (50 mg butalbital / 325 mg aspirin / 40 mg caffeine each) PO every 4 hours as needed; maximum 6 capsules/d | ||
| preparations = 50/325/40 mg capsules | | preparations = 50/325/40 mg capsules | ||
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| bioavailability = Butalbital well-absorbed; aspirin 50-75%; caffeine ~100%<ref name="fiorinal-label" /> | | bioavailability = Butalbital well-absorbed; aspirin 50-75%; caffeine ~100%<ref name="fiorinal-label" /> | ||
| pregnancy = Avoided; barbiturate + aspirin teratogenicity and bleeding concerns.{{citation needed}} | | pregnancy = Avoided; barbiturate + aspirin teratogenicity and bleeding concerns.{{citation needed}} | ||
| legal = [[USLegal:Schedule III|Schedule III controlled substance]] in US (Fiorinal is scheduled federally; Fioricet with acetaminophen is unscheduled federally despite identical butalbital content | | legal = [[USLegal:Schedule III|Schedule III controlled substance]] in US (Fiorinal is scheduled federally; Fioricet with acetaminophen is unscheduled federally despite identical butalbital content, a regulatory quirk) | ||
| mechanism = <vote slug="fiorinal-mech-claim">Same as Fioricet but with aspirin substituted for acetaminophen as the non-opioid analgesic component. Butalbital positively modulates GABA-A; aspirin provides non-selective COX inhibition with anti-inflammatory effect; caffeine provides vasoconstriction and analgesic-absorption enhancement.</vote> Same concerns as Fioricet plus aspirin GI/bleeding risk; the only practical difference favoring Fiorinal is potential anti-inflammatory benefit in headaches with inflammatory component, though clinical guidance does not differentiate strongly between them<ref name="fiorinal-label" />. | | mechanism = <vote slug="fiorinal-mech-claim">Same as Fioricet but with aspirin substituted for acetaminophen as the non-opioid analgesic component. Butalbital positively modulates GABA-A; aspirin provides non-selective COX inhibition with anti-inflammatory effect; caffeine provides vasoconstriction and analgesic-absorption enhancement.</vote> Same concerns as Fioricet plus aspirin GI/bleeding risk; the only practical difference favoring Fiorinal is potential anti-inflammatory benefit in headaches with inflammatory component, though clinical guidance does not differentiate strongly between them<ref name="fiorinal-label" />. | ||
}} | }} | ||
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== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Barbiturates]] | |||
[[Category:NSAIDs]] | |||
[[Category:Methylxanthines]] | |||
[[Category:Fixed-dose combinations]] | |||
[[Category:Schedule III controlled substances]] | |||
Latest revision as of 10:43, 23 May 2026
Barbiturate (butalbital), NSAID (aspirin), Methylxanthine (caffeine), Fixed-dose combination, Schedule III controlled substance
Butalbital / Aspirin / Caffeine
Fiorinal; with codeine as Fiorinal with Codeine (Schedule III)
Experience
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Problems
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Summary
Classes
Common uses
Tension-type headache (limited evidence; falling out of favor due to medicine-overuse headache and barbiturate dependence risk)0
Pharmacy
Starting dose
1-2 capsules (50 mg butalbital / 325 mg aspirin / 40 mg caffeine each) PO every 4 hours as needed; maximum 6 capsules/d
Preparations
50/325/40 mg capsules
US FDA Max
6 capsules/d (300 mg butalbital, 1950 mg aspirin, 240 mg caffeine)
Pharmacology
Routes
Oral
Onset
30-60 minutes
Duration
4-6 hours
Half-life
Butalbital ~35 hours; aspirin (acetyl group) ~15 minutes, salicylate 2-3 hours; caffeine 3-7 hours[1]
Bioavailability
Butalbital well-absorbed; aspirin 50-75%; caffeine ~100%[1]
Pregnancy
Avoided; barbiturate + aspirin teratogenicity and bleeding concerns.[citation needed]
Legal status
Schedule III controlled substance in US (Fiorinal is scheduled federally; Fioricet with acetaminophen is unscheduled federally despite identical butalbital content, a regulatory quirk)
Purported mechanism
Same as Fioricet but with aspirin substituted for acetaminophen as the non-opioid analgesic component. Butalbital positively modulates GABA-A; aspirin provides non-selective COX inhibition with anti-inflammatory effect; caffeine provides vasoconstriction and analgesic-absorption enhancement.0 Same concerns as Fioricet plus aspirin GI/bleeding risk; the only practical difference favoring Fiorinal is potential anti-inflammatory benefit in headaches with inflammatory component, though clinical guidance does not differentiate strongly between them[1].
References
- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Fiorinal (butalbital / aspirin / caffeine), Allergan, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/008627s060lbl.pdf