Butalbital-acetaminophen-caffeine: uses and side effects

Headaches are common sources of pain that affect almost everyone on the planet at some point. There are several types of headaches, and they have different causes and treatments.

A tension headache is the The most common type of headache. Chances are you’ve felt its characteristic pain in your neck, head, or behind your eyes. You may also feel like someone is putting a blindfold around your head and pulling it tight.

Tension headaches can be due to stress or tension in your neck or other causes. They are more common in women, and they often begin in their 20s and peak in their 40s. They may occur once in a while or several times over several months.

If your headaches are particularly severe or persist for a long time, sometimes healthcare professionals may prescribe a medication containing acetaminophen, caffeine, and butalbital.

Butalbital is a barbiturate, a controlled substance that has a sedative effect on your brain. It is better at relieving psychological tension and anxiety than the other two ingredients alone.

But butalbital can be addictive in some people. This is why butalbital-acetaminophen-caffeine (BAC) is available by prescription only and usually comes with limited refills.

BAC is available under many brand names, of which Fioricet is the most common. Fioricet has:

  • 50 milligrams (mg) of butalbital
  • 300 mg of acetaminophen
  • 40mg caffeine

Some combinations may also include codeine, an opiate used for pain. Codeine also carries a risk of addiction.

Different medications contain different amounts of acetaminophen, but usually the same amount of butalbital and caffeine.

Some medications containing BAC include:

  • Anor 300
  • Cephadyn
  • Esgic
  • Esgic-Plus, which contains more acetaminophen than Esgic
  • Fiorinal, which contains aspirin instead of acetaminophen
  • Fioricet
  • Fioricet with codeine
  • Orbivan CF
  • Phrenilin Forte

A doctor may prescribe BAC to help relieve the symptoms of tension headaches. They may also prescribe the combination to treat migraine, although it is not approved by the Food and Drug Administration (FDA) for this use.

You should use the BAC sparingly to avoid medication overuse headaches. Taking more medication than prescribed and for longer than expected can lead to these types of headaches, also called rebound headaches.

Side effects of BAC can include:

  • drowsiness
  • stomach ache
  • vomiting
  • stomach pain
  • the Depression
  • stunning
  • confusion
  • medication overuse headaches

If a doctor prescribes BAC for you, here are some things to keep in mind:

  • It can make you sleepy. Be careful when driving and using heavy machinery.
  • Alcohol can add to drowsiness.
  • It can cause stomach upset. Try taking it with food or milk.
  • If you miss a dose, do not take a double dose. Take a missed dose as soon as you remember. If you are close to the next dose, take it then.
  • Keep out of reach of children to avoid accidental poisoning.
  • It may pass into your breast milk if you are breastfeeding.
  • It carries a risk of addiction if used more frequently or for longer than prescribed.

In pregnant women

A older study from 2014 found that women who used butalbital at the time of conception were more likely to deliver babies with congenital heart defects. More research is needed before butalbital can be considered safe for pregnant women.

Often headaches get better during the second or third trimester of pregnancy. If not, talk to your healthcare team. They may suggest other interventions such as:

  • lifestyle changes
  • stress reduction
  • ibuprofen
  • acetaminophen

Small amounts of barbiturates and caffeine can pass into breast milk. Discuss with a healthcare professional if you plan to breastfeed or breastfeed.

BAC is available as capsules, tablets or liquid. The number of capsules or tablets you take varies depending on the medicine.

In capsule form, the recommended dosage is usually one to two tablets every 4 hours as needed.

In liquid form, this is usually 15 milliliters (mL) or 30 mL of oral suspension every 4 hours, up to a certain amount per day.

Be sure to read the prescribing instructions.

The BAC can become addictive. To reduce the risk, doctors recommend that you not:

  • take a larger dose
  • take it more often than a doctor has prescribed
  • take it for a longer period of time than prescribed by a doctor

Use it exactly as directed and for a limited time. If you think you need more than the prescribed amount for your symptoms or need to take longer, contact your healthcare team to discuss this.

The BAC is not for everyone. Your doctor may not prescribe BAC if:

  • You are allergic to acetaminophen, butalbital or caffeine.
  • You are taking certain other medicines, including:
    • blood thinners such as warfarin (Coumadin)
    • certain antidepressants
    • antihistamines
    • painkillers
    • sedatives, sleeping pills or tranquilizers
    • certain vitamins
  • You are already taking medication containing acetaminophen. Too much of this medicine can damage your liver.
  • You have or have had liver disease, porphyria or depression.
  • You are pregnant, planning to become pregnant or breastfeeding.
  • You drink alcohol, which adds to the drowsiness that BAC can cause.
  • You are a child. experts do not know yet the effects of this drug on the developing brain.

If you are unable to take your BAC, a healthcare professional may suggest one or more of the following interventions:

  • lifestyle changes, including staying hydrated, getting enough sleep, and reducing stress
  • over-the-counter medications such as aspirin, acetaminophen, or ibuprofen, with or without caffeine
  • other prescription medications, depending on the underlying cause of your headache, such as:
    • ketorolac
    • naproxen
    • antidepressants
    • beta-blockers

Is butalbital-acetaminophen-caffeine available over the counter?

No, the BAC is only available by prescription. Your number of recharges will also be limited.

Is butalbital-acetaminophen-caffeine available as a generic drug?

Yes, many of the prescriptions on the market are generics.

Is butalbital-acetaminophen-caffeine a controlled substance?

BAC itself is not a federally controlled substance. Although it contains butalbital, it is on the Drug Enforcement Agency’s (DEA) list of exempt prescription products. But some states classify BAC as a controlled substance.

Other combinations containing BAC or similar to BAC may be controlled substances. The DEA classifies Fiorinal, which contains butalbital, aspirin and caffeine, as a Schedule III drug. This means that there is a low to moderate risk of addiction or overuse.

In April 2022, the DEA proposed removing the exemption for BAC. The proposed rule change would add all products containing butalbital to its list of Schedule III controlled substances.

Should I take butalbital-acetaminophen-caffeine with food?

You do not have to take the BAC with food. Still, it can irritate your stomach. Taking BAC with food may lessen this side effect.

Can I take Fioricet with Tylenol?

Fioricet contains 300 mg of acetaminophen, the active ingredient in Tylenol. Taking Fioricet or any BAC product with Tylenol can have serious side effects. It can damage your liver and other organs.

Also, make sure you don’t take more Fioricet than your doctor has prescribed. It can also lead to an overdose of acetaminophen.

About Rhonda Lee

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