Downsides of Taking Fiorinal or Fioricet for Headaches

A drug with a high risk of addiction

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People who suffer from tension-type headaches that do not respond to over-the-counter (OTC) medications may find relief with combination drugs that include butalbital. 

Commonly prescribed as Fioricet (butalbital/acetaminophen/caffeine) or Fiorinal (butalbital/aspirin/caffeine), butalbital is a sedative in the barbiturate class of medicines. While the drug causes intense relaxation and eases the pain of a tension headache, it is not without risks. 

Tension Headaches

The most common type of headache disorder, a tension headache occurs when neck and scalp muscles become tense, or contract, meaning they squeeze down. This causes pain, often described as a rubber-band-around-the-head feeling or a pressure sensation, on both sides of the head.

Tension headaches can be triggered by a number of factors including stress, hunger, lack of sleep, anxiety, and temperature changes. They may occur at any age but are most common in adults and older teens. Some people are more prone or vulnerable to developing tension headaches than others, although the reason behind this is not very clear.

The good news is that most tension headaches are mild in pain and can be easily alleviated with rest, fluids, removal of the trigger, and/or an over-the-counter medication like Motrin (ibuprofen) or Tylenol (acetaminophen). Behavioral therapies too can be effective like physical therapy or cognitive-behavioral therapy.

Butalbital

When recurring tension headaches do not respond to other treatments, your doctor may prescribe Fiorinal or Fioricet. Codeine may also be added to this combination of medicine. While this medication is very effective in the short-term, there are some things to watch out for.

Butalbital is a barbiturate, which means that it helps to slow down the central nervous system and relax the muscle tension believed to be associated with tension headaches.

Before taking medication containing butalbital, tell your doctor if you:

  • are allergic to any ingredients in the medication, such as acetaminophen or aspirin.
  • are currently taking blood thinners, antidepressants, antihistamines, or other sedatives such as sleeping pills or tranquilizers
  • have or previously had liver disease, porphyria, or depression
  • are pregnant, plan to become pregnant, or are currently breastfeeding

Dosing

Always take these medications as prescribed by your doctor. The typical dosing for Fioricet or Fiorinal is one to two tablets, every four to six hours as needed, not to exceed six tablets per day. These drugs should not be taken more than twice a week, as extended and repeated use of butalbital can lead to physical dependence.

  • Fioricet contains 300 mg of acetaminophen, 50 mg of butalbital, and 40 mg of caffeine.
  • Fiorinal contains 325 mg of aspirin, 50 mg of butalbital, and 40 mg of caffeine.

Side Effects

Fioricet and Fiorinal should be taken with food or milk to prevent gastric problems. The following side effects have been reported in people taking medications containing butalbital:

  • Confusion
  • Depression
  • Drowsiness
  • Lightheadedness
  • Stomach pain
  • Upset stomach
  • Vomiting

More serious side effects may occur and could be signs of an allergy or serious complications. See your doctor immediately if you experience any of the following:

  • Difficulty breathing
  • Itching
  • Rash

Risks

Butalbital-containing medications can be habit-forming and may lead to addiction and other problems. Risks of taking Fioricet and Fiorinal include:

Intoxication

Butalbital slows the central nervous system, leading to lack of coordination, problems with thinking and memory, slowness of speech, disinhibition, and emotional disturbances. Do not drive or operate heavy machinery while taking medicines containing butalbital.

Medication Overuse Headache

Medication overuse headaches, a type of headache disorder that occurs when a person takes medication too frequently to treat their headaches, are common in patients who take butalbital medications. 

With Fioricet or Fiorinal, a medication overuse headache or rebound headache can occur from taking it three times a week or 10 or more days a month.

In addition, medication overuse headaches are often not responsive to preventive headache medications. This lack of response to other medications is often a clue to doctors that a medication overuse headache has developed.

Medications containing butalbital should be limited to two days per week to avoid this rebound effect. 

Withdrawal

When taking butalbital, you may experience withdrawal symptoms 8 to 36 hours after the last dose. Withdrawal symptoms may include anxiety, muscle twitching, tremor, weakness, dizziness, nausea and vomiting, insomnia, weight loss, and even seizures when the medication is discontinued.

Due to the risk of seizures with a withdrawal from butalbital, medical treatment in a monitored setting under the care of a physician is indicated.

Tolerance and Addiction

Tolerance and addiction may also occur with butalbital. Tolerance means that a person needs more of the medication to achieve headache relief. Addiction to butalbital is characterized by persistent behaviors, like compulsions, to take a butalbital-containing medication.

These behaviors impair their life in some way, negatively impacting relationships and/or everyday functioning. 

Acetaminophen Overdose

Do not take Fioricet along with other medications that contain acetaminophen as it can be toxic to the liver.

A Word From Verywell

Fiorinal and Fioricet may be reasonable medications once in a while, such as when other headache medications are not working or cannot be used. Regardless, though, their use should be limited and when used, should be monitored carefully under the guidance of a physician. 

If you have any questions or worries about taking butalbital-containing medications, speak with your physician. Also, remember to not stop or change the dosage of medication without first consulting your doctor. 

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