Can you take Fioricet for migraines?

Migraines can be debilitating, and they affect more than 1 billion people globally. They have no cure, but they can be managed with the right medications. Fioricet (butalbital-APAP-caffeine) is a combination medication used to treat tension headaches, but it may also be prescribed for migraines. It is a mix of three different drugs: butalbital, acetaminophen (APAP), and caffeine. Other U.S. brand names for Fioricet include Dolgic LQ, Esgic, Esgic-Plus, Ezol, Geone, Margesic, Medigesic, and Nonbac.

How does Fioricet work?

Each of the drugs in Fioricet (butalbital, acetaminophen, and caffeine) plays a role in how the medication works. 

Butalbital belongs to a class of medicines known as barbiturates, which act on the central nervous system (CNS) to initiate sedative effects. “Butalbital slows nerve signals that transmit pain information. The drug class is called a short/intermediate-acting barbiturate. By analogy, one can say that butalbital calms down or soothes the neuron before it sends off the pain signal,” says Benjamin Gibson, PharmD, an adjunct professor at the University of Texas at Austin. 

Acetaminophen is an analgesic, or a pain reliever. It reduces the activity of the enzyme cyclooxygenase (COX), which is involved in causing pain and fever.

Caffeine is a natural CNS stimulant that boosts alertness. Caffeine is often paired with pain relievers to increase their effectiveness.

How does Fioricet treat migraine headaches?

Fioricet is used to relieve symptoms of tension-type headaches. Butalbital-containing combination (BCC) analgesics subside symptoms of psychological tension and anxiety associated with tension headaches better than just acetaminophen, codeine, or a placebo, according to a recent study.

However, Fioricet has not been studied for migraine in double-blind, placebo-controlled trials, which are clinical experiments involving human patients in which neither the experimenters nor the participants know which treatment they are receiving. Although a doctor may prescribe Fioricet when appropriate, it is not approved by the Food and Drug Administration (FDA) for treating migraine headaches. Still, clinical experience shows that it may be effective for mild or acute migraines. A healthcare provider may recommend Fioricet when a patient fails to respond to the usual migraine treatment and if a patient is not at risk of becoming dependent on the drug. Butalbital is habit-forming and causes physical and mental dependency. 

How long does Fioricet take to work?

“Fioricet typically commences its action within 30–60 minutes post-ingestion,” says Kevin Huffman, DO, a board-certified bariatric physician in Ohio. This timeframe is subject to slight variation, though, as individual metabolic rates, dosages, and symptom severity influence the length of time it takes for Fioricet to start working.

“For example, people with proficient liver function could metabolize the medication more swiftly than people with impaired liver functionality,” Dr. Huffman says. Fioricet’s efficacy could also be impacted by interactions with prescription and over-the-counter (OTC) medications, as well as dietary supplements and alcohol. “Such substances might interact with Fioricet, affecting its metabolization and therapeutic effectiveness.” Dr. Huffman advises patients to inform their healthcare providers of all consumed substances in order to reduce the risk of unfavorable interactions.

Fioricet dosage for migraines

Fioricet dosage will differ for each patient based on various factors, such as age, drug tolerance, and drug response. Typically, the dose ranges from one to two tablets taken by mouth every four hours as needed and not more than six tablets daily. 

High doses of Fioricet can elicit a more rapid and potent response but with an amplified risk of side effects. “Physicians, therefore, constantly strive to maintain equilibrium. They prescribe the least possible effective dose—aiming to reduce potential risks while still ensuring efficacy,” Dr. Huffman says.

When you miss a dose, take it as soon as you remember. But if it is almost time for the next dose, skip the missed dose and continue with your usual dosing schedule. It is essential to follow the dosage recommendations from your healthcare provider carefully. 

Fioricet interactions

Fioricet can cause drug interactions when taken with certain drugs. Drug interactions can reduce its effectiveness, cause unexpected side effects, or increase the levels of Fioricet in your system. Make sure you inform your healthcare provider of all other drugs you are taking because they can advise you on the best ways to take them in order to avoid the risk of drug interactions.

Here is a list of drugs that can interact with Fioricet, according to Mayo Clinic:

• Macrolide antibiotics, such as erythromycin, cimetidine, and disulfiram 
• MAO inhibitors, including isocarboxazid, methylene blue, phenelzine, and procarbazine
• Isoniazid
• Lithium
• Phenothiazines
• Blood thinners, such as warfarin
• Cyclosporine
• Doxycycline
• Estrogen
• Felodipine
• Metronidazole
• Quinidine
• Theophylline 
• Prednisone
• Codeine
• Hormonal birth control pills
• Antihistamines
• Antiseizure drugs
• Anxiety drugs
• Sleep medications

This is not a comprehensive list of all of the possible drugs that can interact with Fioricet. Keep in mind that you must inform your healthcare provider of your medical history before they can prescribe Fioricet. They should be aware of certain medical conditions that you may have, such as breathing problems (bronchopneumonia), an enzyme disorder (porphyria), diabetes, phenylketonuria, liver disease, kidney disease, personal or family history of excessive alcohol use or substance use disorder, mental disorders, and stomach problems (ulcers). They will advise you on how best to use Fioricet or suggest avoiding it completely in order to reduce the risk of drug-disease interactions.

Fioricet side effects

Butalbital-containing analgesics, such as Fioricet, are habit-forming and can cause psychological dependence, physical dependence or addiction, and severe withdrawal symptoms, especially if it is used for a long period. It is not marketed in some countries, such as the United Kingdom, France, Germany, and Australia.

Additionally, Fioricet can cause rebound headaches or medication overuse headaches (chronic headaches that are induced by overuse of headache medications) if it is used for five or more days monthly. Experts recommend only using Fioricet for three days or fewer per month to reduce the risk of such conditions.

Other possible side effects of Fioricet outlined by Mayo Clinic include the following:

• Lightheadedness
• Sleepiness or drowsiness
• Shortness of breath
• Abdominal pain or stomach pain
• Bleeding gums
• Blistering, peeling, or loosening of the skin
• Bloody urine or stools
• Blurred vision
• Change in the frequency of urination or amount of urine
• Cough and Chills
• Diarrhea
• Difficulty breathing
• Difficulty swallowing
• Irregular heartbeat or pulse
• Hives, itching, or skin rash
• Increased hunger

Consult your healthcare provider if you notice any of the above symptoms or any new ones.

Fioricet alternatives

The following are alternative migraine treatment options that your healthcare provider may prescribe for pain relief: 

• OTC nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, Tylenol, and naproxen
• Calcitonin gene-related peptide (CGRP) receptor antagonists, such as Ubrelvy and Nurtec
• Monoclonal antibodies, such as Aimovig, Ajovy, and Emgality
• Triptans, such as Imitrex (sumatriptan)
• Ditans, such as Reyvow
• Ergotamine-containing, products such as Cafergot (ergotamine-caffeine)
• Beta-blockers, such as propranolol HCl 
• Antiepileptics, such as Depakote (divalproex sodium) and Topamax (topiramate) 
• Neurotoxins, such as Botox 

Bottom line: 

Fioricet is not the first-line treatment for migraine headaches and may lead to drug dependence because one of its active ingredients, butalbital, is habit-forming. There are several alternatives for migraines, ranging from OTC medications like Ibuprofen and Tylenol to prescription drugs. Only use Fioricet when it has been prescribed by your healthcare provider, and follow their recommendations carefully. 

If you are prescribed Fioricet, Dr. Gibson advises patients to avoid alcohol for the first 5 days while taking this medication in order to prevent heartburn and drowsiness, adding that your healthcare provider may require you to come back for a liver test after taking Fioricet. That’s because the body uses more antioxidants whenever acetaminophen is swallowed.