Fioricet 50 325 40

SIDE EFFECTS: See also Warning section.Nausea, vomiting, abdominal pain, shaking (tremor), shortness of breath, increased urination, lightheadedness, dizziness, drowsiness, or trouble sleeping may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To reduce your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: mental/mood changes, fainting, seizures, fast/irregular heartbeat.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: See also Warning section.Before taking this medication, tell your doctor or pharmacist if you are allergic to acetaminophen, caffeine, or butalbital; or to other barbiturates (such as phenobarbital) or xanthine derivatives (such as theophylline); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: severe breathing problems (such as bronchopneumonia), a certain enzyme disorder (porphyria), liver disease, kidney disease, personal or family history of regular use/abuse of drugs/alcohol, mental/mood disorders, abdominal/stomach problems (such as stomach ulcer).This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages.Liquid products may contain alcohol, sugar and/or aspartame. Caution is advised if you have diabetes, alcohol dependence, liver disease, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially drowsiness and trouble falling asleep. These side effects can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Using it for long periods or in high doses near the expected delivery date is not recommended because of possible harm to the unborn baby. Discuss the risks and benefits with your doctor. Infants born to mothers who have used this medication for an extended time may have withdrawal symptoms such as irritability, abnormal/persistent crying, vomiting, seizures, or diarrhea. Tell your doctor immediately if you notice any of these symptoms in your newborn.This drug passes into breast milk and could have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.



Medically speaking, the term “myalgia” refers to what type of pain? See Answer

acetaminophen, butalbital, caffeine, and codeine (Fioricet with Codeine)

Brand Names: Fioricet with Codeine, Phrenilin with Caffeine and Codeine

Generic Name: acetaminophen, butalbital, caffeine, and codeine

  • What is this acetaminophen, butalbital, caffeine, and codeine (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?
  • What are the possible side effects of this medicine (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?
  • What is the most important information I should know about this medicine (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?
  • What should I discuss with my healthcare provider before taking this medicine (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?
  • How should I take this medicine (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?
  • What happens if I miss a dose (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?
  • What happens if I overdose (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?
  • What should I avoid while taking this medicine (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?
  • What other drugs will affect acetaminophen, butalbital, caffeine, and codeine (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?
  • Where can I get more information (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?

What is this acetaminophen, butalbital, caffeine, and codeine (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?

Codeine is an opioid pain medication (sometimes called a narcotic). Acetaminophen is a less potent pain reliever. Butalbital is a barbiturate that relaxes muscle contractions. Caffeine is a stimulant that relaxes blood vessels to improve blood flow.

Acetaminophen, butalbital, caffeine, and codeine is a combination medicine used to treat tension headaches.

Acetaminophen, butalbital, caffeine, and codeine may also be used for purposes not listed in this medication guide.


capsule, blue/white, imprinted with WATSON, 3220


capsule, blue/gray, imprinted with V, 3109


capsule, blue/gray, imprinted with B073

APAP-Butalbital-Caffeine-Codeine Cap-WAT

capsule, blue/white, imprinted with WATSON, 3220

Fioricet with Codeine

capsule, blue/gray, imprinted with FIORICET CODEINE, LOGO

What are the possible side effects of this medicine (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

In rare cases, acetaminophen may cause a severe skin reaction that can be fatal, even if you have taken acetaminophen in the past and had no reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. If you have this type of reaction, you should never again take any medicine that contains acetaminophen.

Opioid medicine can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Call your doctor at once if you have:

  • noisy breathing, sighing, shallow breathing;
  • a slow heart rate or weak pulse;
  • extreme drowsiness, feeling like you might pass out;
  • chest pain, fast or pounding heart rate, feeling short of breath;
  • confusion, unusual thoughts or behavior;
  • low cortisol levels– nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness; or
  • liver problems–nausea, upper stomach pain, itching, tiredness, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Serious side effects may be more likely in older adults and those who are overweight, malnourished, or debilitated.

Long-term use of opioid medication may affect fertility (ability to have children) in men or women. It is not known whether opioid effects on fertility are permanent.

Common side effects include:

  • drowsiness, dizziness, feeling “drunk”;
  • headache, tiredness; or
  • nausea, vomiting, stomach pain, constipation.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about this medicine (Fioricet with Codeine, Phrenilin with Caffeine and Codeine)?

MISUSE OF OPIOID MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it.

Do not give this medicine to anyone younger than 12 years old, or anyone under 18 who recently had surgery to remove the tonsils or adenoids.

Taking opioid medicine during pregnancy may cause life-threatening withdrawal symptoms in the newborn.

Fatal side effects can occur if you use opioid medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing.

One of the key active ingredients responsible for the so-called Fioricet high is butalbital. Butalbital is a barbiturate that’s considered short-to-intermediate acting, and it can relieve symptoms of anxiety, reduce pain, relax muscles and act as a sedative. There are many neuropsychological effects of butalbital, some of which aren’t clearly understood to this day.

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. This can lead to what feels like a buzz or to some people possibly a high.

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.


Medically reviewed by Sanjai Sinha, MD Last updated on Feb 10, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Tips
  • Interactions
  • More

What is Fioricet?

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.

Fioricet may also be used for purposes not listed in this medication guide.

Important information

You should not use Fioricet if you have porphyria, or if you have recently used alcohol, sedatives, tranquilizers, or other narcotic medications.

Do not use Fioricet if you have taken a MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

Do not take more Fioricet than is recommended. An overdose of acetaminophen can damage your liver or cause death. Call your doctor at once if you have nausea, pain in your upper stomach, itching, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of your skin or eyes).

In rare cases, acetaminophen may cause a severe skin reaction. Stop taking Fioricet and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling.

Before taking this medicine

Do not use Fioricet if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

You should not use Fioricet if you are allergic to acetaminophen, butalbital, or caffeine, if you have porphyria, or if you have recently used alcohol, sedatives, tranquilizers, or other narcotic medications.

To make sure Fioricet is safe for you, tell your doctor if you have:

  • liver disease, cirrhosis, a history of alcoholism or drug addiction, or if you drink more than 3 alcoholic beverages per day;

  • kidney disease;

  • asthma, sleep apnea, or other breathing disorder;

  • stomach ulcer or bleeding;

  • a history of skin rash caused by any medication;

  • a history of mental illness or suicidal thoughts; or

  • if you use medicine to prevent blood clots.

It is not known whether Fioricet will harm an unborn baby. If you use butalbital while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant.

This medicine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

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.

Butalbital may be habit-forming. Never share Fioricet with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. Selling or giving away Fioricet is against the law.

Take Fioricet 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.

What should I avoid while taking Fioricet?

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol. It may increase your risk of liver damage while taking acetaminophen.

Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP.

While you are taking this medication, avoid taking diet pills, caffeine pills, or other stimulants (such as ADHD medications) without your doctor’s advice.

Fioricet side effects

Get emergency medical help if you have signs of an allergic reaction to Fioricet: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

In rare cases, acetaminophen may cause a severe skin reaction that can be fatal. This could occur even if you have taken acetaminophen in the past and had no reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. If you have this type of reaction, you should never again take any medicine that contains acetaminophen.

Stop using this medicine and call your doctor at once if you have:

  • confusion, seizure (convulsions);

  • shortness of breath;

  • a light-headed feeling, like you might pass out; or

  • nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common Fioricet side effects may include:

  • drowsiness, dizziness;

  • feeling anxious or restless;

  • drunk feeling; or

  • sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Fioricet?

Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking Fioricet with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with acetaminophen, butalbital, and caffeine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Fioricet only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 6.02.

Medical Disclaimer

More about Fioricet (acetaminophen / butalbital / caffeine)

  • Side Effects
  • During Pregnancy
  • Dosage Information
  • Patient Tips
  • Drug Images
  • Drug Interactions
  • Compare Alternatives
  • Support Group
  • Pricing & Coupons
  • En Español
  • 144 Reviews
  • Drug class: analgesic combinations
  • FDA Alerts (4)

Consumer resources

  • Fioricet
  • Fioricet Oral (Advanced Reading)

Other brands: Esgic, Esgic-Plus, Dolgic LQ, Geone, … +9 more

Professional resources

  • Fioricet (FDA)
  • … +1 more

Other Formulations

  • Fioricet with Codeine

Related treatment guides

  • Headache

Fioricet is a brand name pharmaceutical drug used to treat moderate to severe headaches.

While the drug isn’t immediately addictive, habitual use can develop into severe physical addiction quietly over the course of a few weeks or months.

There are two compounds in the drug that can cause overdose — each one with a unique set of symptoms.

Here we’ll explore Fioricet addiction and overdose in more detail.

What makes Fioricet addictive? What happens during a Fioricet overdose? What can you do if someone you love overdoses on Fioricet?

As previously mentioned, Fioricet is used to treat headaches — but not just any headaches. It’s specifically targeted for tension headaches, post-dural puncture headaches, and muscle contraction headaches.

The FDA hasn’t approved the medication for migraines, though many users take the drug off-label for this anyway and in many cases, it appears to work.

Fioricet is a Combination of Three Chemicals:

1. Butalbital (50 mg)

Butalbital is classified as a barbiturate — a class of highly addictive central nervous system depressants. Barbiturates are powerful anti-anxiety medications and subsequently, destructive drugs of abuse. This class is rarely used in modern medicine anymore due to high incidences of abuse and addiction.

It’s added to the formula for its ability to induce relaxation and sedation — and has plenty of evidence to support its use for tension or post-dural puncture headaches.

2. Acetaminophen (300 mg)

Acetaminophen is the active compound in the common painkiller Aspirin. Also referred to as Paracetamol, this compound works by inhibiting an enzyme responsible for causing inflammation. Through this effect, acetaminophen can reduce inflammation and the pain that results. It also has the added benefit of reducing body temperature during a fever.

3. Caffeine (40 mg)

Caffeine is best known for its presence in coffee and tea. It’s also a useful medicinal compound due to its ability to constrict the blood vessels and stimulate the brain. It’s added to the formula to constrict blood vessels in the brain and counteracts the sedative effects of butalbital.

4. Additional Ingredients

There are some versions of Fioricet that also contain codeine (30 mg per dose) for added pain relief.

This combination of substances works together to block headaches and promote muscle relaxation.

What Are the Side-Effects of Fioricet?

Fioricet does come with a list of side-effects. All three of the drugs included in the formula can contribute to the side-effects — therefore the side-effects can be sporadic and contradictory. For example, Fioricet can cause both oversedation (from the butalbital), and overstimulation (from the caffeine).

Side Effects of Fioricet Include:

  • Abdominal pain
  • Dependence
  • Dizziness
  • Euphoria
  • Insomnia
  • Intoxication
  • Lightheadedness
  • Nausea
  • Sedation/Stimulation
  • Shortness of breath
  • Vomiting

Fioricet Can Cause Headaches

Using the drug for long periods of time has the paradoxical side-effect of causing headaches — often worse than the headaches that were originally being treated.

This is more common when taking higher doses of the drug, or after taking the drug for long periods of time.

Fioricet & Steven Johnson Syndrome

One of the most serious side-effects of Fioricet is a condition called Steven Johnson Syndrome (SJS).

Although very rare, this condition is life-threatening and can land those affected in a hospital for several weeks — suffering extreme pain and discomfort.

Steven Johnson Syndrome is an allergic skin reaction to certain classes of medications. It’s uncommon, but severe in most cases.

The condition begins with flu-like symptoms, followed by burning eyes and throat. About a day or two after these symptoms are discovered, the skin will begin breaking out in ulcers, mostly around the face and groin .

The condition can vary a lot in severity, and if the medication is stopped early enough, serious side-effects can be avoided.

Other Medications Known to Cause Steven Johnson Syndrome

  • Allopurinol (Anti-gout medication)
  • Barbiturates (Anxiolytics)
  • Carbamazepine (Anticonvulsant)
  • Lamotrigine (Anticonvulsant)
  • Modafinil (Narcolepsy medication)
  • Nevirapine (HIV medication)
  • Sulfonamide antibiotics (Antibiotic)
  • Tetracycline (Antibiotic)

Fioricet Addiction

Fioricet is a useful medication, but also brings the risk of dependency and addiction.

Addiction to this drug can be sinister, with most people not realizing they have a problem until it’s too late. It can take months to recover from a Fioricet addiction — patients often suffer severe headaches, and anxiety as a result of dependency on the drug.

What Makes Fioricet Addictive?

The addiction begins through habit formation. If taking the drug regularly for treating chronic headaches, it becomes routine to take the drug at the first sign of a headache.

With regular use, the body begins to become physically dependent. As the drug exerts its effects on the body day after day, our body begins to resist the drug by blocking the specific receptors Fioricet exerts its effects upon.

This causes the user to require larger doses of the drug to receive the desired effects.

Additionally, once this change begins, the motivations for taking the drug begins to change.

Instead of taking it to treat a headache, we take it in order to prevent withdrawal symptoms. As soon as we stop the medication, withdrawal symptoms cause severe headaches, forcing us to take more of the drug just to prevent this from happening.

Signs of Fioricet Addiction

  • Worsening headaches with Fioricet use
  • Lack of response from Fioricet
  • Cravings for Fioricet
  • Sleep problems
  • Doctor shopping — trying to find new sources of the drug

It’s a red flag for Fioricet addiction when someone says that they can’t function without the drug. This should be ringing alarms in anybody who hears this’ head to seek help before the problem becomes worse than it already is.

Fioricet Withdrawal

Fioricet can cause withdrawal symptoms if taken for long periods of time.

Withdrawal happens as a result of physical changes to homeostasis. The body tries to maintain balance in all organ systems, which is forced to change when taking the Fioricet.

In order to maintain this balance, the body takes into account the effects of Fioricet to change the body’s equilibrium. Once the Fioricet is removed, the body falls out of equilibrium in the other direction, often becoming ill.

Symptoms of Fioricet Withdrawal

  • Nausea/vomiting
  • Mood changes
  • Seizures
  • Headaches
  • Anxiety
  • Irritability
  • Depression
  • Suicidal thought

Fioricet Overdose

As mentioned, Fioricet is a combination of three drugs, two of which are commonly associated with an overdose — butalbital and acetaminophen.

Caffeine can also cause overdose, however, the ratios of compounds contained in the tablet are more likely to result from toxic levels of the other two compounds first.

1. Barbiturate Overdose

The major concern with overdosing on Fioricet is severe central nervous system depression induced by the barbiturate content.

Breath rate begins to slow — eventually causing the body to starve for oxygen. When this happens, they will fall unconscious.

Without immediate medical attention, the body will begin to deteriorate as carbon dioxide levels in the blood rise, and the cells starve for oxygen.

2. Acetaminophen Overdose

The acetaminophen content can also result in the overdose of Fioricet.

As concentrations in the blood begin to rise, the liver and kidneys are tasked with metabolizing and removing it safely from the body.

In the event of an overdose, this can overload the liver, causing permanent damage. It only takes about 75 mg/kg of acetaminophen to induce irreversible liver and kidney damage. That’s about 3.3 g in a 100 pound (45 kg) person. As the dose increases, the chances of overdose increase exponentially.

That means that it takes about 11 tablets of Fioricet to cause life-threatening overdose on Fioricet. However, liver or kidney damage is likely to occur at much lower doses.

Older versions of Fioricet had higher levels of acetaminophen — but manufacturers were forced to reduce this in order to remain consistent with FDA rules on acetaminophen dosing regulations.

Some people are more sensitive to acetaminophen poisoning than others — this comes down to the genes inherited that control liver enzyme activity.

What Causes Fioricet Overdose?

Overdose on Fioricet can occur in a few different ways:

1. Accidental Overdose

Overdosing on Fioricet accidentally can happen as a result of tolerance formation, causing the user to require increasingly larger doses of the drug to receive the desired effects. In many cases, this dose may eventually exceed the safe dosage limits, causing overdose driven by either the acetaminophen or barbiturate components.

People taking liquid versions of the drug my accidentally receive a high dose if they don’t use the supplied measuring device.

2. Intentional Overdose

There have been a few cases of Fioricet overdose as an attempt at suicide. Fortunately, with rapid medical treatment, Fioricet overdose isn’t often lethal.

If the drug is mixed with alcohol, it becomes significantly more dangerous. The effects of the alcohol combined with the butalbital in Fioricet to powerfully inhibit the central nervous system.

Signs of Fioricet Overdose:

  • Unconsciousness
  • Slowed breathing
  • Slowed heart rate
  • Blue tinge to the lips and fingernail beds (hypoxia)
  • Low blood pressure

How is Fioricet Overdose Treated?

In the event of Fioricet overdose, most of the treatment is supportive. Medical practitioners will attempt to stabilize the patient according to the symptoms they present.

If the primary symptoms of overdose are due to the barbiturate effects (sedation, reduced respiratory rate), treatments include activated charcoal, bemegride, glucose, and thiamine are often given — however, most treatment is purely supportive.

The patient may need to be hooked up to an automatic respirator to ensure their body is receiving enough oxygen while they’re unconscious.

If instead, the primary symptoms appear to be the result of acetaminophen, a compound called N-Acetyl-Cysteine (NAC) is used.

NAC is an amino acid that serves as one of the primary precursors for liver enzymes responsible for metabolizing acetaminophen. It’s also thought to bind to and neutralize the toxic metabolite of acetaminophen (N-acetyl-p-benzoquinoneimine) to prevent further damage. By supplying this amino acid in high intravenous doses, the liver may be able to metabolize the drug more effectively, thus reducing the chances of permanent liver damage.

In some cases of extreme overdose, a liver transplant may be necessary.

Summary Fioricet Addiction & Overdose

Fioricet is a useful drug doctors prescribe for treating certain types of headaches.

It’s a combination of caffeine, acetaminophen, and butalbital all working together.

The main addictive component of the drug is the butalbital, which can form tolerance and dependency over the course of several weeks or months. With frequent use, the drug can begin to cause physical dependence and addiction. Without taking the drug, it can cause uncomfortable withdrawal symptoms — ironically leading to severe headaches.

Fioricet overdose is serious, but with rapid medical attention can be treated effectively. Lasting side effects of a Fioricet overdose can result from the acetaminophen content, which damages the liver and kidneys.

If you or someone you love is addicted to Fioricet, it’s recommended that you seek immediate medical support to begin the healing process sooner than later.

Butalbital Overdose Symptoms and Treatment

Butalbital is a short- to immediate-acting barbiturate that decreases anxiety, resulting in drowsiness and relaxation. Butalbital is mixed with other drugs to form a relief for tension headaches. Butalbital overdose symptoms may also involve the symptoms of the other compounds used in the medications. Butalbital-containing medicines include:

  • Acetaminophen, caffeine and butalbital (Fioricet and Dolmar)
  • Aspirin, caffeine and butalbital (Fiorinal and Farbital)
  • Acetaminophen and butalbital (Axocet and Bucet)
  • Codeine, acetaminophen, caffeine and butalbital (Fioricet with codeine)

Although butalbital is mainly prescribed for tension headaches, it has also been effective for relief of migraine headaches. The doctor may prescribe the medication containing butalbital for other uses.

Dangers of Risky Butalbital Use

Butalbital, a generalized central nervous system depressant, may be habit-forming. Butalbital is a commonly misused and abused drug. In fact, consuming butalbital over a long period may result in tolerance, making it necessary to take increasing amounts to produce the same effect. Tolerance to a fatal dosage does not increase more than twofold. This causes the margin between taking a dosage that results in intoxication and taking a fatal dosage to shrink. Taking large quantities of butalbital can result in dangerous consequences, including death.

Recognize the Warning Signs of Misuse

An overdose on butalbital may result from an accidental or intentional act of taking more than the normal or recommended dosage. Overdoses on butalbital may result in toxicity. Signs of an overdose on butalbital include:

  • Confusion
  • Faulty judgment
  • Slowness of speech
  • Slurred speech
  • Extreme sleepiness
  • Sluggishness or hyporeflexia
  • Lack of coordination
  • Respiratory depression
  • Staggering
  • High blood pressure
  • Bradycardia
  • Hypovolemic shock
  • Hypothermia
  • Limp muscles
  • Apnea
  • Coma

“Butalbital overdose symptoms themselves are very serious.”Butalbital overdose symptoms themselves are very serious. A single overdose can result in permanent brain damage or death, particularly if a large amount of butalbital is ingested and treatment is delayed. You need to seek immediate addiction treatment if you experience any signs of an overdose on butalbital. Show your body an act of kindness and become free from butalbital.

Babies born to mothers who took medications containing butalbital while pregnant may exhibit withdrawal or addiction symptoms or breathing problems. Pregnant or nursing women should not take medications containing butalbital unless their doctor feels the benefits of the drug outweigh the risks. Taking butalbital while pregnant may result in miscarriage.

There is a high likelihood that combining butalbital with another drug or drugs will enhance its effects and those of the other drug(s). Individuals mixing this drug with alcohol or other drugs may experience life-threatening overdose symptoms. A lethal dose of butalbital is lower if alcohol is mixed with it. While taking butalbital, you should not consume alcohol or take other drugs not prescribed by your doctor. indicates approximately one in 10 people who have overdosed on a barbiturate, such as butalbital, or a mixture of drugs including barbiturates will experience fatal consequences because of heart and lung complications. The death rate of barbiturate overdoses can be higher than 10 percent if treatment is delayed. Numerous famous people have died because of barbiturate overdoses.

Emergency Treatment for Overdose

Re-establishing or maintaining sufficient respiratory exchange is crucial in butalbital overdose treatment. This can be accomplished through the use of medically assisted detox or controlled ventilation. Severe respiratory depression resulting from a butalbital overdose can be treated with the opioid antagonist naloxone hydrochloride. Naloxone hydrochloride is preferably administered intravenously and simultaneously with respiratory resuscitation efforts. Butalbital overdose treatment can also include the following as needed:

  • Oxygen
  • Induction of vomiting mechanically (individual is unconscious) or with syrup of ipecac (individual is alert)
  • Intravenously administered fluids
  • Intravenously administered vitamin K
  • Vasopressor agents, such as norepinephrine or phenylephrine hydrochloride
  • Intravenously administered norepinephrine bitatrate with serial blood pressure monitoring
  • Emptying the stomach to remove any unabsorbed butalbital
  • Urine alkalinization
  • Oral-activated charcoal
  • Other supportive measures

If the butalbital overdose results in methemoglobinemia that covers over 30 percent of the body, it should be treated with a slow intravenous administration of methylene blue.

Taking more than the prescribed dosage of the drug or taking it when it is not prescribed to you can cause serious butalbital overdose symptoms that may result in fatal consequences. Addiction to butalbital can have very serious or even fatal consequences. If you are worried that your use of the drug may cause you to experience butalbital overdose symptoms, look into your butalbital detox and withdrawal treatment options.

How to Avoid the Consequences of Addiction

  • Use painkillers, such as those containing butalbital, only as directed.
  • Do not take butalbital unless you have a prescription.
  • Store it in a secure place.
  • Dispose of it properly.
  • Seek assistance for substance abuse problems.

Did You Know?

In the 1860s, barbiturates were manufactured for the first time. In 1903, over 40 years after it was first made, a barbiturate was used for medical purposes.

Guide to Fioricet Abuse and Treatment

Fioricet is a prescription medication used to manage frequent or uncontrolled tension headaches.1 Fioricet may be helpful for someone struggling with tension headaches (although evidence supporting its effectiveness for recurring headaches is lacking); however, it must be used cautiously. Fioricet is a known drug of abuse that has the potential to bring about serious physical and mental health complications.1

Anyone who is unable to control their Fioricet use should consider substance abuse treatment. By consulting with an addiction professional or attending substance abuse treatment, a person can quit Fioricet safely and learn to address the thoughts and behaviors that keep them using in spite of the harm that doing so causes.2

Is Fioricet an Addictive Substance?

Fioricet is a potentially addictive medication.1 Fioricet is comprised of 3 separate substances:1

  • Butalbital – a barbiturate that slows certain central nervous system (CNS) processes via its interaction with brain receptors for the inhibitory neurotransmitter GABA.
  • Acetaminophen – a commonly used pain reliever and fever reducer (an active ingredient in many Tylenol products).
  • Caffeine – a common CNS stimulant.

Fioricet users may develop significant dependence to this barbiturate-containing drug. The risk of barbiturate dependence and, ultimately, addiction development increases when people consume it at larger doses for longer periods of time.1 In fact, the drug is not recommended for long-term use specifically because of its abuse potential.1 A person abusing or addicted to barbiturates like butalbital may consume incredibly high levels of the drug each day – average daily Fioricet doses in those compulsively misusing the drug have been known to approach 1,500 mg in a single day.1 One Fioricet tablet contains just 50 mg of butalbital.1

When Fioricet enters the brain, it acts similarly to several other CNS depressants (e.g., alcohol, benzodiazepines) by enhancing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA).3 GABA inhibits or slows certain processes in the brain and creates a relaxed feeling.3 For this reason, doctors frequently prescribe CNS depressants for their ability to promote sleep and reduce anxiety.3

Fioricet with Codeine is an opioid analgesic combination formulation of the drug. This combo contains the same medications at roughly the same doses as the other Fioricet formulation, with the addition of 30 mg of codeine.4 The added opioid component of Fioricet can further increase the reward associated with misuse and thereby increase the abuse liability.5

Because of its significant abuse potential, Fioricet with Codeine is listed as a Schedule III DEA-controlled substance.4 Fioricet alone is scheduled as a controlled substance in only a small number of states, not on a national level.

Is It Dangerous?

Yes. Fioricet and Fioricet with Codeine can both be dangerous, due to both their immediate drug effects and their addictive properties. They may be safe when used carefully as directed, but misuse of either drug may lead to physical and mental health hazards, such as addiction and overdose.1

Short-term Side Effects

Certain effects of Fioricet will come on right away. Some of these may occur even if you are taking the drug as directed. The most frequently reported side effects of Fioricet include:1

  • Drowsiness.
  • Lightheadedness and dizziness.
  • Sedation.
  • Nausea/vomiting.
  • Stomach pain.
  • Shortness of breath.

Additionally, there are more serious Fioricet side effects that occur less frequently like:1

  • Confusion.
  • Fainting.
  • Seizures.
  • Depression.

Someone using large amounts of Fioricet may experience the adverse effects of both caffeine and barbiturate intoxication.1

Effects of caffeine intoxication may include:6

  • Restlessness.
  • Nervousness.
  • Excitement.
  • Insomnia.
  • Agitation.
  • Rambling thought and speech patterns.
  • Changes to heart rhythm.

Barbiturate intoxication leads to symptoms comparable to alcohol intoxication, such as:6

  • Slurred speech.
  • Poor coordination.
  • Balance problems.
  • Poor attention and memory.
  • Aggressive behavior.
  • Mood changes.
  • Impaired judgment.

Someone using Fioricet with Codeine may additionally experience opioid intoxication, which might consist of an initial period of euphoria followed by: 4,6

  • Low mood.
  • Lack of interest.
  • Drowsiness.
  • Slurred speech.
  • Poor judgment.
  • Nausea.
  • Vomiting.
  • Constipation.

Long-Term Side Effects

With prolonged use of Fioricet, the individual is more likely to experience tolerance, the need to consume more of the substance to achieve the wanted effects.1 Continuous use of higher and higher doses can lead to serious problems, including possible overdose (see below) and substance use disorder, which manifests with symptoms like:6

  • A strong desire/craving to use more of the substance.
  • Spending a lot of time getting, using, and recovering from Fioricet.
  • Failed attempts to cut back or end use.
  • Problems living up to expectations at home, work, and school.
  • Emerging issues with relationships.
  • Declining interest in social activities or once-enjoyed habits.
  • Continuing to use Fioricet even when faced with harmful outcomes including:
    • Poor physical health.
    • Worsening mental health.
    • Legal problems, such as from drug-seeking, driving under the influence, etc.
  • Going through withdrawal when trying to cut back (a sign of physical dependence).

It takes a much lower dose of a barbiturate to kill a user when they’ve added alcohol to the mix.It is common for abusers of barbiturates to abuse other substances as well, which may lead to eventual polysubstance addiction and additional physical and mental health dangers.7 For example, it takes a much lower dose of a barbiturate to kill a user when they’ve added alcohol to the mix.1

What Are the Signs of Overdose?

As tolerance builds and the individual consumes more Fioricet, the distance between an intoxicating dose and a dangerous dose shrinks, which makes an overdose more likely.1 Excessive use of both Fioricet and Fioricet with Codeine can result in:4

  • Barbiturate poisoning.
    • Drowsiness.
    • Slowed breathing.
    • Confusion.
    • Low blood pressure
  • Codeine poisoning.
    • Opioid overdose triad:
      • Depressed respiration (slowed or stopped breathing).
      • Pinpoint pupils.
      • Loss of consciousness.
    • Convulsions.
  • Acetaminophen overdose.
    • Serious liver damage.
    • Nausea/vomiting.
  • Caffeine poisoning.
    • Inability to sleep.
    • Severe restlessness.
    • Tremors.
    • Irregular heart rate.

While overdose may occur with any misuse of Fioricet or Fioricet with Codeine, the greatest risks come when someone combines this substance with other CNS depressants and alcohol.3,5 In the case of Fioricet with Codeine, it already combines two substances which have depressant effects on the CNS (butalbital and codeine), so adding another into the mix is a big—and possibly deadly—risk.

If you or someone you know is in danger from a Fioricet overdose, seek professional medical treatment immediately by calling 911 or going to the nearest emergency room. Medical treatment will focus on:4

  • Breathing support and airway management, if needed.
  • Cardiovascular support.
  • Decreasing toxic absorption with activated charcoal.
  • Administering naloxone, an opioid blocker, in the case of overdose from Fioricet with Codeine.

What Are the Withdrawal Symptoms?

Chronic excessive use of Fioricet may result in the development of significant physiological dependence. The unpleasant withdrawal syndrome that arises when a dependent person tries to quit can inhibit them from seeking the help they need to get off the drug. Symptoms can range from mild to very serious.

Fioricet withdrawal often begins with headaches, which people may see as a common headache instead of a withdrawal symptom. Unknowingly, they may use more Fioricet to manage the headache and restart the cycle of abuse.7 Someone who makes it past the initial headache stage of Fioricet withdrawal may have additional symptoms like:6

  • Hand tremors.
  • Fast or jerky movements.
  • Anxiety.
  • Rapid pulse.
  • Hallucinations.
  • Nausea/vomiting.
  • Grand mal seizures.

Severe butalbital withdrawal symptoms may begin about 16 hours after the last dose.1 The symptoms will then peak on the second day and will typically show a noteworthy improvement by day 5 and then gradually improve over the course of about 2 weeks.1

Seeking professional treatment for Fioricet withdrawal is crucial, not only because it will alleviate your discomfort to prevent you from relapsing, but also because withdrawal from this drug is associated with sometimes-lethal complications. As many as 30% of those who attempt withdrawal from drugs like Fioricet without treatment will experience a seizure.6

Additionally, withdrawal can spark intense depression, leading to suicidal thoughts and attempts. Depression may be worse among people stuck in patterns of frequent intoxication and repeated withdrawal attempts.6

Where Can I Get Help?

The best and most effective options for your Fioricet treatment will largely depend on several factors, including:8

  • The duration and intensity of your use.
  • If you abuse multiple substances.
  • Your environmental stressors and supports.
  • Existence of any mental health disorders.
  • Prior detox and treatment history.

Because withdrawal from this substance has the potential to be very serious, treatment should begin with a detox program in which you can receive professional medical supervision and care.8

Detox treatment may take place in a variety of settings with options ranging from intensive hospital care to programs that allow more freedom and less monitoring like scheduled visits to a doctor’s office.8 Programs can vary in length from a few days to a few weeks based on your needs.

There are several methods of detox, but the most common method involves stabilizing the individual on their current Fioricet dose before gradually reducing the dose amount and frequency over time.1 Other options involve:8

  • Ending all Fioricet use and prescribing other medications to treat withdrawal symptoms.
  • Switching from Fioricet to a longer-acting barbiturate or another sedating medication like a benzodiazepine and subsequently tapering the dose.

Detoxification is a necessary part of treatment, but someone seeking addiction recovery will require much more to remain drug-free.2 There is more to addiction than just physiological dependence, so addressing only this aspect is insufficient. For long-term abstinence, you should always seek additional treatment to discover ways to change the maladaptive thinking and behaviors that contribute to your substance abuse.

If you’re suffering from a particularly severe addiction, you may require additional inpatient or residential treatment after detox. These options involve you living in the treatment center and having limited contact with the outside world.2 Here, the goal is to spend as much time as possible working with staff on your recovery. Inpatient and residential options can last anywhere from a few days to a year (in the case of therapeutic communities).2

If your addiction is mild, outpatient treatment could be a good fit for you. Compared to inpatient or residential programs, outpatient treatment interventions are generally less time intensive. Outpatient treatment allows those in recovery to return home each night, to continue with work or school responsibilities, and to freely visit with loved ones and other sources of support.8 Outpatient treatments range from several hours each day to only a few hours each month and can include individual, group, and family sessions.8 Unlike their inpatient treatment counterparts, outpatient programs are unable to provide 24/7 supervision. However, they have no requirements for on-site living and are often significantly more affordable.

Better outcomes are associated with longer durations of care.As you move from one stage of treatment to the next, your treatment professionals will recommend and link you to other levels of care to suit your needs.8 This process is referred to as aftercare planning. For some, it will include 12-step or other recovery groups for continued support after treatment.2 It may also include moving to a sober living house where residents can practice new abstinence-supporting life skills in a sober environment. Better outcomes are associated with longer durations of care, so receiving ongoing treatment is the best way to maintain a life of abstinence.2

Alternative Methods of Treating Headaches

Someone who finds themselves abusing Fioricet may have begun taking it as a therapeutic remedy for headache, so when attempting to stop using, this underlying condition may still be a factor that needs to be addressed. Many treatment programs will initiate a process of non-pharmacological headache management, including:9

  • Mind and body approaches including:
    • Acupuncture.
    • Massage.
    • Relaxation.
    • Chiropractic care.
    • Tai chi.
  • Dietary supplements.

With natural approaches, finding an effective treatment or combination of treatments may take some time and several tries. You may wish to speak with your doctor about new ways to address the pain without returning to Fioricet or another potentially addictive medication.

  1. DailyMed: U.S. National Library of Medicine. (2016). Fioricet.
  2. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  3. National Institute on Drug Abuse for Teens. (2016). Prescription Depressants.
  4. DailyMed: U.S. National Library of Medicine. (2016). Fioricet with Codeine.
  5. National Institute on Drug Abuse for Teens. (2017). Prescription Pain Medications (Opioids).
  6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  7. Weaver, M. F. (2015). Prescription Sedative Misuse and Abuse. The Yale Journal of Biology and Medicine, 88(3), 247–256.
  8. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
  9. National Center for Complementary and Integrative Health. (2016). Headaches: In Depth.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *