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Home » Butalbital-Acetaminophen-Caffeine: Uses and Side Effects – Healthline

Butalbital-Acetaminophen-Caffeine: Uses and Side Effects – Healthline

Headaches are common sources of pain that affect nearly every person on the planet at some point. There are several types of headaches, and they have different causes and treatments.
A tension headache is the most common type of headache. Chances are that you’ve experienced its characteristic pain in your neck, head, or behind your eyes. It can also feel like someone put a band around your head and is pulling it tight.
Tension headaches can be due to stress or tension in your neck or other causes. They’re more common in women, and they often start in your 20s and peak in your 40s. They can happen once in a while or many times over several months.
If your headache pain is especially bad or continues to occur over a long period, healthcare professionals may sometimes prescribe a medication that contains acetaminophen, caffeine, and butalbital.
Butalbital is a barbiturate, which is a controlled substance that has a sedating effect on your brain. It’s better at relieving psychological tension and anxiety than the other two ingredients alone.
But butalbital can lead to addiction in some people. That’s why butalbital-acetaminophen-caffeine (BAC) is prescription-only and usually comes with limited refills.
BAC is available under many brand names, of which Fioricet is the most common. Fioricet has:
Some combinations may also include codeine, an opiate used for pain. Codeine also carries a risk of addiction.
Different medications have different amounts of acetaminophen but generally the same amount of butalbital and caffeine.
Some BAC-containing medications include:
BAC is a combination of three medications that enhance each other’s effects. That’s to say, they work better together than they do alone.
A doctor may prescribe BAC to help relieve symptoms of tension headaches. They may also prescribe the combination to treat migraine, though it’s not Food and Drug Administration (FDA)-approved for this use.
You should use BAC sparingly to prevent medication overuse headaches. Taking more medication than prescribed and for longer than prescribed can lead to these types of headaches, also called rebound headaches.
Side effects of BAC can include:
The National Library of Medicine recommends calling your doctor right away if you’re taking this medication and experience:
If a doctor prescribes BAC to you, here are some things to keep in mind:
An older study from 2014 found that women who used butalbital around the time of conception were more likely to deliver babies with some congenital heart defects. More research is needed before butalbital can be considered safe for pregnant people.
Often, headaches improve by the second or third trimester of pregnancy. If they don’t, talk with your healthcare team. They may suggest other interventions such as:
Small amounts of barbiturates and caffeine can make it into breast milk. Talk with a healthcare professional if you plan to breastfeed or chestfeed.
BAC is available in capsules, tablets, or a liquid. The number of capsules or tablets you take varies by medication.
In capsule form, the recommended dosage is usually one to two pills every 4 hours as needed.
In liquid form, it’s 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 prescription directions.
BAC can become habit-forming. To lower risk, doctors recommend that you do not:
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 it for longer, contact your healthcare team to discuss.
Substance use disorder is a condition in which you keep using a substance despite adverse consequences and your desire to stop. It can result in failure to meet family, social, or work obligations. It can have financial, legal, and health consequences.
Substance use disorder is a complex but treatable health condition. If you feel that you’re becoming addicted, talk with a healthcare professional or trusted family and friends. You may also consider reaching out to one of these resources:
BAC is not for everyone. Your doctor may not prescribe BAC if:
If you’re not able to take BAC, a healthcare professional may suggest one or more of the following interventions:
No, BAC is only available by prescription. Your number of refills will also be limited.
Yes, several of the prescriptions on the market are generics.
BAC on its own is not a federally controlled substance. Although it contains butalbital, it’s on the Drug Enforcement Agency (DEA)’s list of exempted prescription products. But some states do classify BAC as a controlled substance.
Other combinations that contain BAC or are similar to BAC may be controlled substances. The DEA classifies Fiorinal, which contains butalbital, aspirin, and caffeine, as a Schedule III drug. That means that there’s a low to moderate risk of dependence or overuse.
In April 2022, the DEA proposed removing the exemption for BAC. The proposed rule change would add all products that contain butalbital to its list of Schedule III controlled substances.
You don’t have to take BAC with food. Still, it can irritate your stomach. Taking BAC with food may lessen this side effect.
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 cause damage to your liver and other organs.
Also, be sure not to take more Fioricet than your doctor prescribed. This can also lead to acetaminophen overdose.
Last medically reviewed on September 2, 2022
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