Menu Close


Brands: Fioricet, Zebutal, Capacet, Vanatol LQ, Vanatol S, and Esgic

Key Points of Fioricet

Fioricet is a medication commonly prescribed for the treatment of tension headaches and migraine headaches. It contains a combination of three active ingredients: acetaminophen, butalbital, and caffeine. Here are key points to know about Fioricet:

  1. Ingredients: Fioricet contains three active ingredients:
    • Acetaminophen: A pain reliever and fever reducer.
    • Butalbital: A barbiturate that helps relax muscle contractions and alleviate tension.
    • Caffeine: A central nervous system stimulant that can enhance the effects of acetaminophen.
  2. Headache Treatment: Fioricet is primarily used for the treatment of tension headaches and migraine headaches. It is not intended for the routine treatment of other types of pain or headaches.
  3. Prescription Medication: Fioricet is available only with a prescription from a healthcare provider. It is essential to follow the prescribed dosage and instructions carefully.
  4. Short-Term Use: Fioricet is typically recommended for short-term use to relieve headache symptoms. Long-term or excessive use may lead to medication overuse headaches or dependence.
  5. Dosage: The dosage of Fioricet is determined by a healthcare provider and should be based on the patient’s specific condition and response to treatment. The usual dosage may range from one to two tablets every four to six hours as needed for pain relief.
  6. Potential Side Effects: Fioricet may cause side effects, including drowsiness, dizziness, lightheadedness, nausea, vomiting, and abdominal pain. It may also lead to physical and psychological dependence when misused or overused.
  7. Caution: Fioricet should be used with caution in individuals with a history of substance abuse, as butalbital is a barbiturate and can be habit-forming.
  8. Avoid Alcohol: It is advisable to avoid alcohol while taking Fioricet, as it can increase the risk of side effects and adverse reactions.
  9. Not for Everyone: Fioricet is not suitable for everyone, and it should not be used by individuals with certain medical conditions or allergies to its components. It is crucial to inform the healthcare provider about any existing health conditions or medications being taken.
  10. Withdrawal: If Fioricet has been used regularly and is abruptly stopped, withdrawal symptoms may occur. A healthcare provider should be consulted for guidance on discontinuing the medication safely.
  11. Pregnancy and Breastfeeding: The safety of Fioricet during pregnancy and breastfeeding should be discussed with a healthcare provider, as acetaminophen is generally considered safe in pregnancy, but butalbital and caffeine may have risks.
  12. Storage: Fioricet should be stored at room temperature away from moisture and heat. It should be kept out of reach of children and not shared with others.

Acetaminophen, Butalbital, and Caffeine

Mikart Fioricet
Mikart Fioricet

pronounced as (a set a mee’ noe fen) (byoo tal’ bi tal) (kaf’ een)

Why Fioricet Prescribed?

This combination of drugs is used to relieve tension headaches.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Off-label Usage of Fioricet

Fioricet is primarily prescribed for the treatment of tension headaches and migraine headaches. However, healthcare providers may occasionally consider off-label use for certain conditions when they believe it may provide therapeutic benefits. Off-label use means using a medication for a purpose other than its approved or indicated use. It’s essential to note that off-label use should only be done under the guidance and supervision of a healthcare provider. Some potential off-label uses of Fioricet may include:

  1. Cluster Headaches: While Fioricet is not specifically approved for the treatment of cluster headaches, some healthcare providers may prescribe it in certain cases to alleviate the pain associated with these severe and recurrent headaches.
  2. Other Types of Headaches: Fioricet may be considered for other types of headaches when conventional treatments have been ineffective. However, the decision to use Fioricet off-label for these conditions should be based on a careful assessment of the individual’s medical history and response to treatment.
  3. Fibromyalgia: Some healthcare providers may prescribe Fioricet off-label to individuals with fibromyalgia who experience severe muscle tension and headaches as part of their symptoms. The butalbital component of Fioricet may help relax muscle contractions.
  4. Muscle Tension and Spasms: Fioricet’s muscle relaxant properties may lead to off-label use for individuals experiencing muscle tension or spasms unrelated to headaches.
  5. Chronic Pain: In certain cases, Fioricet may be considered for off-label use to manage chronic pain conditions when other pain relievers have not been effective. However, this should be done with caution and close monitoring due to the potential for dependence on the butalbital component.

It’s important to emphasize that off-label use of Fioricet should only occur after a thorough evaluation by a healthcare provider who can assess the potential benefits and risks.

How Does Fioricet Work ?

Fioricet is a combination medication that contains three active ingredients: acetaminophen, butalbital, and caffeine. Each of these components contributes to the overall therapeutic effect of Fioricet in the treatment of tension headaches and migraines. Here’s how Fioricet works:

  1. Acetaminophen (Paracetamol): Acetaminophen is a pain reliever (analgesic) and fever reducer (antipyretic). While the exact mechanism of how acetaminophen works is not fully understood, it is believed to primarily act within the central nervous system (CNS). Acetaminophen is thought to reduce the production of prostaglandins, which are chemicals involved in pain perception and fever response. By inhibiting prostaglandin production in the CNS, acetaminophen helps alleviate pain and reduce fever.
  2. Butalbital: Butalbital is a barbiturate, a class of drugs known for their central nervous system depressant effects. Butalbital exerts its action by enhancing the inhibitory effects of gamma-aminobutyric acid (GABA), a neurotransmitter that regulates communication between brain cells. By increasing GABA’s inhibitory effects, butalbital can induce muscle relaxation and a general sense of sedation. This muscle relaxation is believed to help relieve tension associated with headaches.
  3. Caffeine: Caffeine is a central nervous system stimulant. It has several effects that can contribute to the efficacy of Fioricet:
    • Vasoconstriction: Caffeine can cause blood vessels in the brain to constrict (narrow), reducing blood flow and oxygen tension. This vasoconstrictive effect may help alleviate headaches, especially migraines, where blood vessels tend to dilate and contribute to pain.
    • Enhancing Analgesia: Caffeine may enhance the pain-relieving effects of acetaminophen, improving the overall pain relief provided by Fioricet.
    • Alertness: Caffeine can increase alertness and reduce drowsiness, which may be beneficial for individuals experiencing headaches.

In combination, these three active ingredients work synergistically to address various aspects of headache symptoms. Acetaminophen provides pain relief and fever reduction, butalbital induces muscle relaxation and sedation, and caffeine contributes to vasoconstriction and enhanced pain relief. This combination aims to alleviate the pain, tension, and discomfort associated with tension headaches and migraines.

How Should Fioricet be Used?

The combination of acetaminophen, Butalbital, Caffeine comes as a capsule and tablet to take by mouth. It usually is taken every 4 hours as needed. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take acetaminophen, Butalbital, Caffeine exactly as directed. Do not take more than six tablets or capsules in 1 day. If you think that you need more to relieve your symptoms, call your doctor.

This medication can be habit-forming. Do not take a larger dose, take it more often, or for a longer period than your doctor tells you to.

What Special Precautions Should I Follow Before Taking Fioricet ?

Before taking Fioricet, it’s essential to follow certain special precautions and discuss your medical history and current medications with your healthcare provider. Here are some key precautions to consider:

  1. Medical History: Inform your healthcare provider about your complete medical history, including any existing medical conditions such as liver disease, kidney disease, substance abuse, mental/mood disorders, and a history of alcohol dependency.
  2. Allergies: Ensure that you discuss any allergies you may have, especially if you are allergic to acetaminophen, butalbital, caffeine, or other medications.
  3. Medication Interactions: Provide a list of all medications, including prescription, over-the-counter (OTC), and herbal supplements, that you are currently taking. Fioricet can interact with various drugs, including MAO inhibitors, antidepressants, sedatives, and medications that affect liver enzymes.
  4. Pregnancy and Breastfeeding: If you are pregnant, planning to become pregnant, or breastfeeding, discuss the risks and benefits of Fioricet with your healthcare provider. Acetaminophen is generally considered safe during pregnancy, but butalbital and caffeine may have risks.
  5. Liver Function: Fioricet contains acetaminophen, which is processed by the liver. If you have liver disease or a history of liver problems, your healthcare provider may need to adjust your dosage or recommend an alternative treatment.
  6. Kidney Function: In individuals with kidney disease or impaired kidney function, the dosage of Fioricet may need to be adjusted to prevent the accumulation of butalbital and its metabolites.
  7. Alcohol and Other Substances: Fioricet can cause drowsiness and impair your ability to concentrate. Avoid consuming alcohol while taking Fioricet, as it can increase the risk of side effects and central nervous system depression.
  8. Dependence and Tolerance: Fioricet contains butalbital, which is a barbiturate and can be habit-forming. It should be used only as prescribed, and long-term or excessive use should be avoided to prevent dependence and tolerance.
  9. Driving and Operating Machinery: Fioricet may cause dizziness and drowsiness. It’s important to refrain from activities that require mental alertness, such as driving or operating heavy machinery, until you know how the medication affects you.
  10. Medical Monitoring: Regularly follow up with your healthcare provider for monitoring and evaluation while taking Fioricet, especially if you are using it for an extended period.
  11. Medication Overuse Headaches: Prolonged or excessive use of Fioricet can lead to medication overuse headaches. Discuss any concerns or changes in headache patterns with your healthcare provider.

What Should I do if I Forget a Dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What is the Side Effects of Taking Fioricet ?

Fioricet, like any medication, can cause side effects. Not everyone will experience these side effects, and some individuals may experience them to varying degrees. It’s essential to be aware of potential side effects and consult with your healthcare provider if you have concerns. Common side effects of Fioricet may include:

  1. Drowsiness: Fioricet can cause drowsiness or sedation. It’s important to avoid activities that require mental alertness, such as driving or operating machinery, until you know how the medication affects you.
  2. Dizziness: Some individuals may experience dizziness while taking Fioricet.
  3. Lightheadedness: Fioricet may lead to feelings of lightheadedness or a sensation of being off-balance.
  4. Nausea and Vomiting: Gastrointestinal side effects, including nausea and vomiting, can occur in some individuals.
  5. Upset Stomach: Fioricet may cause an upset stomach or abdominal discomfort.
  6. Dry Mouth: Some people may experience a dry mouth while taking the medication.
  7. Insomnia: Although caffeine is a stimulant, Fioricet can lead to difficulty sleeping (insomnia) in some individuals.
  8. Nervousness or Restlessness: Fioricet contains caffeine, which can lead to feelings of nervousness or restlessness in some people.
  9. Heart Palpitations: Caffeine can cause an increase in heart rate (tachycardia) and palpitations in some individuals.
  10. Dependency and Tolerance: Fioricet contains butalbital, a barbiturate, which can be habit-forming. Prolonged or excessive use may lead to physical and psychological dependence and tolerance, where larger doses are needed to achieve the same effect.
  11. Medication Overuse Headaches: Long-term or excessive use of Fioricet can lead to medication overuse headaches, where headaches become more frequent and severe. This is a potential side effect of using this medication.
  12. Allergic Reactions: While rare, some individuals may experience allergic reactions to Fioricet, which can include itching, rash, swelling, severe dizziness, and difficulty breathing. Seek immediate medical attention if you experience these symptoms.

If you experience any of the following symptoms, call your doctor immediately:

  • skin rash
  • itching
  • difficulty breathing

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online ( or by phone (1-800-332-1088).

What Should I Know About Storage and Disposal of This Medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature, away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website ( for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach.

What is the Signs of Taking too Much Fioricet ?

Taking too much Fioricet can lead to an overdose, which can be dangerous and even life-threatening. It’s crucial to recognize the signs of a Fioricet overdose and seek immediate medical attention if you suspect an overdose. Signs of taking too much Fioricet may include:

  1. Severe Drowsiness: An overdose of Fioricet can cause extreme drowsiness or sedation, to the point where the individual may have difficulty staying awake or remaining conscious.
  2. Confusion: Overdose may result in confusion, disorientation, and impaired cognitive function.
  3. Slurred Speech: Individuals who have taken an excessive amount of Fioricet may exhibit slurred speech or difficulty speaking clearly.
  4. Impaired Coordination: Overdose can lead to impaired motor coordination, making it difficult to walk or perform tasks that require physical coordination.
  5. Muscle Weakness: An overdose may cause muscle weakness or a feeling of heaviness in the limbs.
  6. Nausea and Vomiting: Severe nausea and vomiting are possible signs of Fioricet overdose.
  7. Pale or Bluish Skin: Overdose can result in changes in skin color, including paleness or bluish discoloration, especially around the lips or fingertips.
  8. Difficulty Breathing: An overdose can lead to respiratory depression, where breathing becomes slow, shallow, or difficult. This is a medical emergency.
  9. Irregular Heartbeat: Fioricet overdose may cause an irregular heart rate (arrhythmia) or palpitations.
  10. Loss of Consciousness: In severe cases, an overdose can lead to loss of consciousness or coma.
  11. Seizures: While less common, seizures may occur as a result of Fioricet overdose, particularly in cases of extreme intoxication.
  12. Hypotension: Overdose can lead to low blood pressure (hypotension), which may cause dizziness or fainting.

It’s essential to remember that Fioricet contains butalbital, a barbiturate that can be habit-forming. Overdose is a significant risk, particularly if the medication is misused or taken in larger quantities than prescribed. If you or someone you know exhibits any signs of a Fioricet overdose, seek immediate medical attention by calling emergency services or going to the nearest emergency room. Prompt medical intervention is crucial to prevent potentially life-threatening complications associated with Fioricet overdose, such as respiratory failure or seizures.

In case of emergency/overdose

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

What other information should I know?

Keep all appointments with your doctor.

Do not let anyone else take your medication. This medication is a controlled substance. Prescriptions may be refilled only a limited number of times; ask your pharmacist if you have any questions.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand Names of Fioricet

  • Alagesic®
  • Americet®
  • Anolor®
  • Anoquan®
  • Arcet®
  • Dolgic®
  • Dolmar®
  • Endolor®
  • Esgic®
  • Ezol®
  • Femcet®
  • Fioricet
  • Fiorpap®
  • G-1®
  • Ide-cet®
  • Isocet®
  • Margesic®
  • Medigesic®
  • Minotal®
  • Mygracet®
  • Nonbac®
  • Pacaps®
  • Pharmagesic®
  • Quala Cet®
  • Repan®
  • Tenake®
  • Tencet®
  • Triad®
  • Two-Dyne®
  • Zebutal®

Brand names of combination products

  • Esgic® Plus (containing Acetaminophen, Butalbital, Caffeine, Codeine)
  • Geone® (containing Acetaminophen, Butalbital, Caffeine)
  • Orbivan® (containing Acetaminophen, Butalbital, Caffeine)
  • Fioricet® with Codeine (containing Acetaminophen, Butalbital, Caffeine, Codeine)
  • Phrenilin® with Caffeine and Codeine (containing Acetaminophen, Butalbital, Caffeine, Codeine)

This branded product is no longer on the market. Generic alternatives may be available.

What is the Drug Interaction of Fioricet ?

Fioricet can interact with various medications and substances, potentially affecting their effectiveness or increasing the risk of side effects. It’s essential to inform your healthcare provider about all the medications, including prescription, over-the-counter (OTC), and herbal supplements, that you are currently taking. Your healthcare provider can assess potential drug interactions and adjust your treatment plan accordingly. Here are some common drug interactions associated with Fioricet:

  1. Monoamine Oxidase Inhibitors (MAOIs): Combining Fioricet with MAOIs or within 14 days of stopping MAOI therapy can lead to severe interactions, including hypertensive crisis. MAOIs are a class of antidepressants and other medications used to treat various conditions.
  2. Antidepressants: Fioricet may interact with certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), potentially increasing the risk of serotonin syndrome, a potentially life-threatening condition characterized by symptoms like agitation, confusion, rapid heart rate, and high blood pressure.
  3. Sedatives and Sleep Medications: Fioricet contains butalbital, a sedative. Combining Fioricet with other sedatives, including prescription sleep medications, can enhance the sedative effects and increase the risk of drowsiness, dizziness, and impaired coordination.
  4. Alcohol: Consuming alcohol while taking Fioricet can increase the risk of drowsiness, dizziness, and impaired cognitive function. It’s essential to avoid alcohol while using this medication.
  5. CYP450 Enzyme Inhibitors: Medications that inhibit specific cytochrome P450 (CYP450) enzymes can affect the metabolism of Fioricet components, potentially leading to altered drug levels and effects.
  6. Anticoagulants: Fioricet may enhance the effects of anticoagulant medications (blood thinners), increasing the risk of bleeding.
  7. Medications that Affect Liver Enzymes: Fioricet contains acetaminophen, which is metabolized by the liver. Medications that affect liver enzymes can influence how acetaminophen is processed in the body, potentially leading to adverse effects or altered medication levels.
  8. Other Caffeine-Containing Products: Fioricet contains caffeine. Combining it with other caffeine-containing products or excessive caffeine intake may lead to increased caffeine-related side effects, such as nervousness, restlessness, rapid heartbeat, and insomnia.
  9. Anticonvulsant Medications: Fioricet may interact with anticonvulsant medications, affecting their metabolism or therapeutic effects.
  10. Certain Antibiotics: Some antibiotics may affect the metabolism of Fioricet components.

It’s crucial to discuss your complete medication list with your healthcare provider before starting Fioricet or making changes to your treatment plan. Your healthcare provider can provide guidance on managing potential drug interactions and may adjust your medication regimen as needed to ensure your safety and therapeutic effectiveness. Additionally, always follow your healthcare provider’s dosing instructions and guidance for Fioricet use to minimize the risk of interactions and side effects.


Is Fioricet Dependent ?

Fioricet is a medication that contains three active ingredients: acetaminophen (paracetamol), butalbital, and caffeine. Butalbital is a central nervous system depressant, and it can potentially lead to physical and psychological dependence if not used as prescribed or abused.

Here are some important points to consider regarding Fioricet and dependence:

  1. Risk of Dependence: Butalbital, one of the ingredients in Fioricet, is a barbiturate. Barbiturates are known to have a potential for dependence, especially when used in large doses or for extended periods. Dependence can manifest as both physical and psychological reliance on the drug.
  2. Prescription and Dosage: Fioricet is typically prescribed for the treatment of tension headaches and migraines. To minimize the risk of dependence, it should be used exactly as prescribed by a healthcare provider, and the recommended dosage and duration should not be exceeded.
  3. Tolerance and Withdrawal: Over time, the body can build up a tolerance to butalbital, which may lead individuals to take more of the medication to achieve the same effects. Additionally, abrupt discontinuation of Fioricet after prolonged use can lead to withdrawal symptoms, which can be uncomfortable and may include anxiety, restlessness, muscle tension, and more.
  4. Dependency Assessment: If you are concerned about the potential for dependence or have been using Fioricet regularly, it is important to consult with a healthcare professional. They can help assess your situation, determine if dependence is present, and provide guidance on how to safely discontinue or manage your medication.
  5. Alternative Treatments: Depending on the underlying condition (e.g., headaches), there may be alternative treatments or medications that are less likely to lead to dependence. Your healthcare provider can help explore these options with you.

In summary, while Fioricet can be effective in treating certain types of headaches, it contains a component (butalbital) that has the potential for dependence. It is crucial to use Fioricet only as prescribed by a healthcare provider and to discuss any concerns or issues related to its use with your doctor.

Is Fioricet Addictive ?

Yes, Fioricet has the potential to be addictive, especially when it is not used as prescribed or is abused. Fioricet contains three active ingredients: acetaminophen (paracetamol), butalbital, and caffeine. Butalbital is a central nervous system depressant and a barbiturate, which means it can lead to physical and psychological dependence when misused.

Here are some important points to consider regarding Fioricet and its potential for addiction:

  1. Risk of Dependence: Butalbital, one of the active ingredients in Fioricet, is a barbiturate. Barbiturates have a history of being habit-forming substances when used inappropriately or in high doses over an extended period.
  2. Tolerance: Over time, the body can develop tolerance to the effects of butalbital. This means that individuals may need to take higher doses to achieve the same level of pain relief, which can increase the risk of dependence.
  3. Withdrawal Symptoms: If a person becomes physically dependent on Fioricet and suddenly stops taking it, they may experience withdrawal symptoms. These symptoms can be uncomfortable and may include anxiety, restlessness, muscle tension, and more.
  4. Abuse Potential: Some individuals may misuse Fioricet by taking it more frequently or in higher doses than prescribed, which can increase the risk of addiction. Fioricet is sometimes used recreationally for its sedative effects, which can contribute to abuse.
  5. Medical Supervision: It is crucial to use Fioricet only as prescribed by a healthcare provider and to follow their instructions closely. If you have concerns about addiction or are experiencing difficulties managing your medication use, it’s important to seek help from a healthcare professional.
  6. Alternative Treatments: Depending on the underlying condition for which Fioricet is prescribed (e.g., tension headaches or migraines), there may be alternative treatments or medications with a lower risk of dependence that can be considered.

In summary, Fioricet can be addictive, particularly when it is not used as directed or is abused. If you are prescribed Fioricet or are using it for any reason, it’s crucial to follow your healthcare provider’s instructions closely, communicate any concerns or issues with them, and seek their guidance on managing your medication use to minimize the risk of addiction. If you or someone you know is struggling with Fioricet addiction, it is important to seek professional help and support for recovery.

Fioricet Controlled Substance Classification

Products that contain butalbital, caffeine, and aspirin are classified as Schedule III substances under the Controlled Substances Act (CSA).

Fioricet, due to it containing acetaminophen instead of aspirin and the ratio of butalbital to acetaminophen being smaller than that of aspirin (found in Fiorinal), makes it exempt from the Drug Enforcement Administration’s Scheduling system. There are a few states, however, that do classify Fioricet as a Schedule III controlled drug, meaning it is not available over-the-counter.


Drugs classified as Schedule III have a lower risk for dependence and addiction but can lead to both if abused. The butalbital in Fioricet is a sedative barbiturate that when abused in high doses can cause a euphoric effect.

Fioricet is safe when used as prescribed but those that abuse the drug regularly or in high doses may become dependent on the substance and can end up abusing prescriptions and acquiring the drug through illegal means when their prescription ends.

If you or someone you know is abusing Fioricet then speak to an addiction specialist near you to find out what treatment is available.

Related Entries