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acetaminophen/butalbital/caffeine (Fioricet, Esgic)

325 mg acetaminophen + 50 mg butalbital + 40 mg caffeine. Indications: - relief of symptomatic complex of tension or muscle contraction headache Contraindications: - patients with porphyria pregnancy-category C safety in lactation ? Dosage: 1-2 tabs PO every 4 hours; max 6 tabs/day. Tabs: - new tablets (2014) with 300 mg of acetaminophen (rather than 325 mg) [3] Pharmacokinetics: elimination: liver > kidney. Adverse effects: - dizziness, drowsiness, nausea, dyspepsia, mental depression, paradoxical excitement, anemia, dyspnea, anaphylaxis, hypotension, hallucinations, hepatotoxicity, thrombocytopenia, leukopenia, anemia, respiratory depression Drug interactions: 1) decreased effect of: - phenothiazines, haloperidol, quinidine, cyclosporine, tricyclic antidepressants (TCA), theophylline, warfarin, oral contraceptives, doxycycline, beta blocker 2) increased effect of: - propoxyphene, benzodiazepines, CNS depressants, valproic acid, methylphenidate, chloramphenicol Mechanism of action: - similar to other barbiturates: generalized CNS depression

Interactions

drug interactions

General

analgesic combination

Database Correlations

PUBCHEM cid=3081207

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998. - not on National VA formulary
  3. Prescriber's Letter 21(3): 2014 (subscription needed) http://www.prescribersletter.com

Components

acetaminophen (Tylenol, Paracematol, Panadol, Tempra, Datril, APAP, non-Aspirin) butalbital; allylbarbital (Profundol, Sandoptal) caffeine (NoDoz, Vivarin)