Fioricet is a prescription medication used to relieve tension headaches. It works by relaxing muscle contractions that can result in mild to moderate head pain.
Fioricet is a combination of three ingredients: the pain reliever acetaminophen; butalbital, a barbiturate; and caffeine, a stimulant.
The Food and Drug Administration (FDA) approved Fioricet in 1984. Novartis Pharmaceuticals was the original manufacturer. In 2003, Watson Pharmaceuticals bought the rights to Fioricet (Watson is now known as Actavis).
Fioricet is currently available from many manufacturers as a generic.
The original formulation of Fioricet included 50 milligrams (mg) of butalbital, 40 mg of caffeine, and 325 mg of acetaminophen.
However, in 2011 the FDA asked makers of prescription combination drugs with acetaminophen to limit the amount of that drug to no more than 325 mg in each tablet by 2014. This action was taken to protect consumers from severe liver damage, a risk linked with taking too much acetaminophen.
Today Fioricet includes 320 mg of acetaminophen, though some versions of the product sold online still have 325 mg.
The Fioricet ‘High’ and Abuse
The butalbital in Fioricet belongs to a class of drugs called barbiturates, a central nervous system depressant. Like other barbiturates, it has the potential to cause physical and psychological dependence, which can lead to abuse.
Those who use too much Fioricet may report feeling so relaxed and stress-free that they seek out the drug as a way to get high. Some describe it as feeling intoxicated. However, users can feel depressed and “crash” once the effects wear off.
Fioricet with Codeine
Another formula, Fioricet with codeine, is also made by Actavis to treat tension headaches. It contains 30 mg of codeine in addition to the other three drugs, and has an increased acetaminophen dose of 325 mg.
Fioricet with codeine carries a black-box warning about liver toxicity, and about the risk of respiratory problems and death in children caused by codeine.
Fioricet carries a black-box warning cautioning users about the link of acetaminophen to acute liver failure. In some cases, users of Fioricet have needed a liver transplant; in other cases, use of Fioricet has proven fatal.
Most problems have occurred with an acetaminophen dose of more than 4,000 mg a day. Those affected are often taking more than one product containing acetaminophen at the same time or have underlying liver disease.
Another caution concerns butalbital, which may be habit-forming and therefore has the potential to be abused.
Those with a condition known as porphyria, a rare hereditary blood disorder, should not use Fioricet.