Fioricet

Despite a general perception that Fioricet is a safe, benign drug, it is potentially addicting. It contains butalbital, caffeine, and acetaminophen (generic for Tylenol). Butalbital is the active ingredient, and it’s one of the few barbiturates still prescribed in the U.S. Fioricet is usually prescribed for muscle tension headaches, but it’s a poor medication for this. It often causes rebound headaches if used more than a few times per month.

Why is it addicting?

Barbiturates, like all addicting drugs, affect the pleasure centers of the brain, and often produce a warm, relaxed feeling in the users. Though most people feel sedated and sleepy with barbiturates, some people feel a sense of energy and ease. Since this is a pleasant experience, the user is at risk for addiction. Barbiturates cause sedation through their effects on GABA receptors of the brain, just as benzodiazepines do. However, barbiturates cause overdoses much easier than benzodiazepines, and for that reason, doctors don’t use barbiturates much these days.

 Is Fioricet a Controlled Substance?

Yes. And no. It’s confusing. It also appears to depend on where you live. Butalbital, the active ingredient, is a Schedule III controlled substance, but when it’s combined with caffeine and Tylenol, it isn’t a controlled substance. I assume this is because there’s such a small amount of butalbital in each pill that the person taking enough pills to get high would also be taking too much caffeine and Tylenol. But just like with Lortab (a combination of hydrocodone and Tylenol), addicts often take more medication than they should, even knowing it may damage their livers

If codeine is added to the pill, then it’s a Schedule III Controlled Substance.

Drug interactions

Barbiturates have to potential to cause overdose and death when taken alone, or in combination with opioids, alcohol, or benzodiazepines. For this reason, I ask my patients for whom I prescribe methadone or buprenorhpine to avoid Fioricet, just as they should avoid benzodiazepines and alcohol.

I’ve seen many patients become addicted to this drug, and for some reason, most of them have been women. I suspect that’s because women are more likely to go to the doctor if they have a problem with headaches. They take these pills, and a small percent become addicted.

How should Fioricet addiction be treated?

Barbiturates cause a dangerous physical withdrawal syndrome, so a person who has been using them nearly daily should go to an inpatient detoxification unit, unless the physician decides the withdrawal can be handled as an outpatient with close follow up. Barbiturate withdrawal is treated like alcohol withdrawal, which makes sense, since both attach to the same brain receptors and cause similar effects. Usually a long-acting sedative is started, Fioricet stopped, and the long-acting sedative is slowly tapered over a period of months.

Untreated barbiturate withdrawal, if severe, can be fatal. The person can have seizures and delirium, just like alcohol addicts do.

After physical withdrawal is treated, the real recovery from addiction can begin, with all of the usual psychosocial therapies: individual counseling, group therapy, 12-step meetings, and others.

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7 responses to this post.

  1. Posted by Mamay' on July 1, 2011 at 1:54 pm

    Thank you for posting this information. I know a lot of people who are taking Buprenorphine along with Fioricet. I once took it for headaches and experienced all of the feelings you described above and abused it just as I had abused Opiates.
    Fioricet was easy for me to get and the majority of women that I know were prescribed it as well.
    I talked to a friend the other day who is a Suboxone patient and takes Fioricet. I tried to talk to her about it and the possible dangers of mixing the two medications. Her explanation to me was that it was “just a headache tablet”
    I appreciate the post.

    Reply

  2. Posted by ashley on January 13, 2013 at 9:47 am

    I work at a pain center, and have for years. A large percentage of our patients that take Fiorcet also take methadone, benzodiazepines, or other narcotics with this medication. In Alabama, fiorcet can be electronically called in, which means it is not controlled.

    Reply

  3. Posted by Jeanne on August 14, 2015 at 3:32 am

    my sister died from withdrawals off of fioricet while she was in the hospital because the doctors would not listen to family members that she needed this medication.she was taking this for over 20 years and they said they were giving it to her, but we got her records and they did not. She had major convulsions, stroke and later died. please be careful with this drug. Never quit cold turkey. and if the doctors don’t believe you and you have to be in the hospital, bring your own medicine (fioricet) in or leave the hospital.

    Reply

  4. Posted by Lee on November 14, 2015 at 5:13 am

    My Doctor and my LCPN both said that Fioricet is not a controlled substance, but my pharmacist said it is and they have had it on automatic refill for me. Now they won’t put it on auto refill because they say it is controlled like Fioronel. Please clear this up for me. I’m so confused. Thank you.

    Reply

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