Fioricet

  Fioricet and Esgic are brand name drugs made from a combination of acetaminophen (325 mg), butalbital (a barbiturate, 50 mg), and caffeine (40 mg). They are indicated for the treatment of tension headaches and muscle contraction headaches. Although not indicated, they are commonly used to treat migraines and other pain related ailments. Note that Fioricet (and some other pain medications) are implicated as causing repeat headaches with over-use (see NYT citaion below)

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Usage and dosage

Fioricet is indicated for the treatment of complex and muscle contraction headaches. It is also commonly prescribed for migraines although it is not FDA indicated for this use. The usual adult dose is 1-2 tablets every four hours as needed, not exceeding six tablets in a 24 hour period.

Mechanism of action

Butalbital has generalized depressant effect on central nervous system and, in very high doses, has peripheral effects. Acetaminophen has analgesic and antipyretic effects; its analgesic effects may be mediated through inhibition of prostaglandin synthetase enzyme complex. Caffeine is thought to produce constriction of cerebral blood vessels.

Butalbital has half-life of about 35 hours. Acetaminophen half-life is 1.25 to 3 hours, but may be increased by liver damage and following overdosage. Caffeine half-life is about 3 hours.

Side effects

Side effects for any drug are difficult to predict, but commonly reported side effects for Fioricet include:

• Dizziness
• Drowsiness
• Intoxicated feeling
• Light-headedness
• Nausea
• Vomiting
• Sedation
• Addiction
• Shortness of breath
• Abdominal pain

Variations

• Phrenilin is an equivalent combination of butalbital and acetaminophen, without the caffeine (325/50).
• Esgic Plus and Phrenilin Forte contains 500 and 650 miligrams of acetaminophen respectively, instead of 325 milligrams. Additionally, Esgic Plus contains 40 milligrams of caffeine.
• Fiorinal contains aspirin instead of acetaminophen.
• Fiorinal and Fioricet also come as a combination drug with codeine called Fiorinal with Codeine and Fioricet with Codeine which adds 30 milligrams of codeine phosphate to each mixture.