Fioricet: Difference between revisions
| [unchecked revision] | [unchecked revision] |
MDElliottMD (talk | contribs) home-claude house-rule fix (terminology, Mark ruling) |
MDElliottMD (talk | contribs) home-claude category backfill (parser-claude gap closure) |
||
| Line 21: | Line 21: | ||
== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Barbiturates]] | |||
[[Category:Non-opioid analgesics]] | |||
[[Category:Methylxanthines]] | |||
[[Category:Fixed-dose combinations]] | |||
Latest revision as of 10:43, 23 May 2026
Barbiturate (butalbital), Non-opioid analgesic (acetaminophen), Methylxanthine (caffeine), Fixed-dose combination
Butalbital / Acetaminophen / Caffeine
Fioricet, Esgic; with codeine as Fioricet with Codeine (Schedule III)
Experience
No personal reports yet
No clinical reports yet
Log in to add your own experience.
Problems
No problems yet. Be the first to suggest one.
+ Add a problemTitration strategies
No titration strategies yet. Be the first to suggest one.
Effects
No effects listed yet. Be the first to suggest one.
Relevant anecdote
No anecdotes yet. Share a relevant one.
Relevant Literature
No literature entries yet.
Log in to submit relevant literature.
Summary
Classes
Common uses
Tension-type headache (limited evidence; falling out of favor due to medicine-overuse headache and barbiturate dependence risk)0, Migraine (off-label, rescue use)0
Pharmacy
Starting dose
1-2 capsules (50 mg butalbital / 325 mg acetaminophen / 40 mg caffeine each) PO every 4 hours as needed; maximum 6 capsules/d
Preparations
50/325/40 mg capsules and tablets; oral solution
US FDA Max
6 capsules/d (300 mg butalbital, 1950 mg acetaminophen, 240 mg caffeine)
Pharmacology
Routes
Oral
Onset
30-60 minutes
Duration
4-6 hours
Half-life
Butalbital ~35 hours (long; cumulative effects with frequent use); acetaminophen 1-3 hours; caffeine 3-7 hours[1]
Bioavailability
Butalbital well-absorbed; caffeine ~100%; acetaminophen 85-98%[1]
Pregnancy
Generally avoided; barbiturate exposure in late pregnancy can produce neonatal withdrawal and respiratory depression.[citation needed]
Legal status
Plain Fioricet is uncontrolled federally (the small butalbital dose was historically deemed insufficient for scheduling), but DEA-scheduled in some states. Fioricet with Codeine is Schedule III. Fiorinal (aspirin instead of acetaminophen) is Schedule III federally
Purported mechanism
Butalbital is a short-to-intermediate-acting barbiturate that positively modulates GABA-A receptors, producing sedation and muscle relaxation that may relieve tension-type headache. Acetaminophen provides non-opioid analgesia. Caffeine provides mild vasoconstriction (mechanistically attractive for vasodilatory headache) plus an enhancing effect on analgesic absorption.0 Concerns: barbiturate physical dependence with regular use, medicine-overuse headache (especially with >2 doses/week), and the seemingly persistent absence of high-quality RCT support for the combination's headache efficacy. Modern headache guidelines discourage routine use[1].
References
- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Fioricet (butalbital / acetaminophen / caffeine), Allergan, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/088762s019lbl.pdf