In February of 2018, a pharmacy technician in North Carolina was arrested for allegedly stealing some pills from the store. The pharmacist of the store found there was a shortage in their supply of three drugs including phentermine, alprazolam, and Fioricet. While phentermine is similar to an amphetamine and alprazolam is used in treating anxiety disorders caused by depression, Fioricet is commonly used in treating headaches, like tension headaches and migraines.

Migraine has affected 39 million people in the United States and a billion worldwide. The Migraine Research Foundation says it is the third most prevalent illness in the world where nearly one in four households in the US have at least one family member who suffers from a migraine.

With a number of prescription drugs commonly misused these days, it is not surprising if some people are more conscious in taking prescription drugs. So, is it possible that a person can get addicted to a migraine medicine like Fioricet?


What’s in Fioricet?

Fioricet is a tablet which contains three active ingredients, including 325 mg acetaminophen, 50 mg butalbital, and 40 mg caffeine. The drug was approved by the Food and Drug Administration in 1984. But the FDA in 2011 advised drug manufacturers to limit acetaminophen to not more than 325 mg to prevent consumers from developing severe liver damage that was associated with too much acetaminophen.

Acetaminophen acts as a pain reliever and helps in reducing the patient’s fever. Butalbital, on the other hand, relaxes muscle contractions that develop in a tension headache. Similar to butalbital, caffeine, a widely used psychoactive drug, also helps patients to relax muscle contractions and improve blood flow.

The patients who used Fioricet reported varying effects. Some patients reportedly find it effective in managing migraine. A 50-year-old patient said she didn’t find any side effects whenever she used the drug at the onset of her migraine. She said the medicine works after about 20 minutes of taking Fioricet. However, a 34-year-old patient found it “considerably effective” and noted some moderate side effects after taking the drug. The patient took one to two tablets of Fioricet every four hours for the six months. She said each time she takes more than one pill since she finds the first dose ineffective in improving migraine, she will feel very dizzy and will be incapacitated until the effect has worn off. Some patients also reported having the feeling of agitation, insomnia, withdrawal syndrome and hallucination after taking Fioricet.

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Can A Person Get High on Fioricet?

Among the ingredients of Fioricet, butalbital is the most common and it is potential for abuse. Butalbital is an intermediate-acting barbiturate, which can cause physical and psychological dependence.

In an article published in the Journal of Forensic Science in 2013, butalbital is said to have a central nervous system (CNS) depressant properties, like sedation and the feeling of intoxication. This is the reason why it contributes to driving impairment. Its effect is similar to CNS depressant intoxication which affects the person’s motor coordination. CNS drugs like tranquilizers, sedatives, and hypnotics are among the three classes of medications that are commonly misused.

How does it function? Butalbital mimics the inhibitory effects of the gamma-aminobutyric acid (GABA) which is a neurotransmitter. It binds to GABA receptors which facilitate the effect of feeling relaxed, sedated, and/or drowsy. A research in 2013 said the effects of butalbital on the body make it a controversial drug.

Aside from butalbital, caffeine can also form a dependency on the drug. Caffeine is needed in Fioricet because it can help improve the constriction of the cerebral blood vessels. It also counteracts the sedating effect of butalbital. But caffeine should only be used in low dosage. The World Health Organization even recognizes caffeine dependence as a clinical disorder.

Whether it should be continued to be prescribed to patients in the United States due to its potential for abuse remains a question but clearly, like most drugs, Fioricet should not be used on a daily basis. Even when you are sure that taking Fioricet will help you treat your tension headache, it is better to know the side effects of taking Fioricet to be more aware of its negative effects on the body.

Here are some of them:

  • The potential for abuse – Barbiturates is one of the most addictive drugs due to its relaxing effects. However, its overdose may affect a person’s speech, judgment, and breathing. It may lead to kidney failure and death.

  • Effect on the unborn child – There was also a study which found butalbital products to have a possibility of causing birth defects such as congenital heart problems.

  • Intoxication – While patients who use Fioricet on low dosages find it to be safe for use, higher dosages of Fioricet are linked to induced intoxication which could render a person incapacitated until the effect of the drug wore off.

  • Tolerance – Frequent usage of Fioricet may lead to drug tolerance and would need to take a larger dosage to stimulate the GABAergic effect.

  • No scientific evidence – While some users would say that Fioricet works for them in coping with a migraine, there is no scientific basis to back that Fioricet can help manage a migraine. Even the FDA has not approved it as a treatment for a migraine so if you are suffering from a migraine you may ask your doctor to prescribe you with a better option.

  • Undesirable long-term effects – Since butalbital acts like benzodiazepines which are linked to dementia, the long-term and frequent use of Fioricet may also increase a person’s chance of developing neurodegeneration.

  • Rebound headaches – After discontinuing the use of Fioricet, some users find themselves suffering from rebound headaches.

  • Liver damage – The acetaminophen in Fioricet can damage the liver when used frequently. That’s why it should not be taken by patients who are suffering from liver disease and cirrhosis.

  • Other side effects – The other side effects of Fioricet may also include shortness of breath, nausea, vomiting, upset stomach, skin rash, itching, hives, dry mouth, heartburn, leg pain or sore muscles, and fever.

Fioricet, like other drugs that have butalbital and drugs containing opioids, is found to make headaches worse, according to the American Board of Internal Medicine. Its side effects also include withdrawal symptoms when a patient stops using it suddenly. Even the ABIM would suggest that a patient with a migraine should find better drugs as these kinds of medications have risks.

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