Fioricet® 50/325/40 mg for Migraine
Fioricet, introduced in the US in the 1960s, is a pain reliever and sedative used to relieve tension headaches, and sometimes other types of pain. Fioricet is often prescribed for abortive treatment of chronic headache unresponsive to “over the counter” analgesics or NSAIDs. Fioricet can be used with an NSAID (e.g. naproxen, ibuprofen) for complementary relief of inflammatory pain.
This analgesic consists of a fixed combination of butalbital 50 mg, acetaminophen 325 mg and caffeine 40 mg. Acetaminophen is a pain reliever and fever reducer (antipyretic). Butalbital is in a class of drugs called barbiturates that slow down central nervous system causing relaxation. Caffeine is believed to constrict dilated blood vessels that may contribute to tension headaches.
Fioricet Efficacy for Migraine Headaches
The role of Fioricet in migraines is controversial, but is crucial when circumstances preclude other analgesics. Practically 14-36% of diagnosed migraineurs are prescribed butalbital compounds.
For many migraineurs the trick is to take Fioricet as soon as a headache is coming on. If you wait until the migraine has gotten too far it does not help much, though will make the headache more tolerable.
The overuse of Fioricet may trigger rebound headache. So you have to be careful about how much and how long you take it. The best pattern is set Fioricet aside as a "last resort" remedy.
Butalbital/Acetaminophen/Caffeine vs Sumatriptan/Naproxen
Recent large high quality study4 compared sumatriptan/naproxen with butalbital/acetaminophen/caffeine in the treatment of moderate to severe migraine headache in patients who in the past had used a butalbital-containing medication. Compared with the butalbital/apap/caffeine the patients who took sumatriptan/naproxen achieved better relief of migraine pain and associated symptoms. More patients treated with sumatriptan/naproxen reported being pain free. Both sumatriptan/ naproxen and the butalbital combination were well tolerated.
1-2 tablets every 4 hours as needed. Total daily dosage should not exceed 6 tablets. Fioricet should be taken no more than 2 days per week. Prolonged continuous use of Fioricet is not recommended because of the potential for rebound headache and physical dependence.
Fioricet works within 15-20 minutes. Most headaches go away within an hour.
Mode of action
Butalbital has generalized depressant effect on CNS and, in very high doses, has peripheral effects. Acetaminophen has analgesic and antipyretic effects; its analgesic effects may be mediated through inhibition of prostaglandin synthetase enzyme complex. Caffeine is thought to produce constriction of cerebral blood vessels.