What is Fioricet?

Fioricet is a combination of three medications that work together to help relieve headache pain.

  • Butalbital is a barbiturate that works by raising the levels of chemicals that cause your brain to relax.
  • Acetaminophen is an analgesic. It stops the production of certain chemicals in your brain, which can help relieve pain.
  • Caffeine is an adenosine antagonist. It blocks a natural chemical in your body called adenosine. It’s unclear exactly how caffeine works to treat headaches, but it’s thought to boost the pain-relieving activity of acetaminophen.

What is Fioricet used for?

  • Tension headaches
White Fioricet
White Fioricet

Fioricet dosage forms




Typical dosing for Fioricet

There are several manufacturers and brand names of this medication. The dose might differ slightly and each pill might contain different amounts of acetaminophen depending on which manufacturer and formulation of the medication you’re using.

Be sure to check your prescription for specific instructions. In general:

Fioricet and its generic: Each pill contains 50 mg of butalbital, 300 mg of acetaminophen, and 40 mg of caffeine.

  • Adults and children 12 years and older: The typical dose is 1 to 2 capsules by mouth every 4 hours as needed for pain. The maximum dose is 6 capsules in a 24-hour period.

Zebutal, Esgic, and generic tablets: Each pill contains 50 mg of butalbital, 325 mg of acetaminophen, and 40 mg of caffeine.

  • Adults and children 12 years and older: The typical dose is 1 to 2 capsules or tablets by mouth every 4 hours as needed for pain. Don’t take more than 6 pills in a 24-hour period.

Vtol LQ oral solution: Each tablespoonful (15 mL) contains 50 mg of butalbital, 325 mg of acetaminophen, and 40 mg of caffeine.

  • Adults and children 12 years and older: The typical dose is 15 mL (1 tablespoon) to 30 mL (2 tablespoons) by mouth every 4 hours. Don’t take more than 90 mL (6 tablespoons) in a 24-hour period.

What are the risks and warnings for Fioricet?

Fioricet is a combination medication containing butalbital, acetaminophen, and caffeine. It’s taken by mouth as needed, typically every 4 hours, to treat tension headaches. But it’s not a first-choice option because it can become habit-forming and can worsen headaches if taken too frequently. In addition, Fioricet can cause side effects, such as sleepiness and dizziness. It’s available as pills and an oral syrup.


Fioricet, Esgic, Zebutal, Vtol LQ


Barbiturate / Analgesic / Adenosine antagonist


Controlled in some states. See FAQs below.


Lower-cost generic available


Prescription only

Fioricet can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options

Liver damage

  • Risk factors: Drinking alcohol | Taking other medications containing acetaminophen | Taking too much Fioricet | History of liver problems

Taking too much acetaminophen can cause liver damage that can be permanent and life-threatening. For adults, the maximum amount of acetaminophen is 3 or 4 grams in a 24-hour period, depending on your provider’s instructions.

blank warning iconSpeak to your provider before using Fioricet if you have liver problems since it can cause further damage to your liver. Also, avoid drinking alcohol while taking Fioricet because this combination can harm your liver too.

blank warning iconSigns of liver problems include dark urine, feeling tired, upset stomach or stomach pain, or yellowing of the skin or whites of the eyes. If you notice any of these symptoms, call your provider right away.

Difficulty concentrating and extreme sleepiness

  • Risk factors: Taking high doses of Fioricet | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness

Fioricet can cause extreme sleepiness and lower your ability to think, react, and focus. Don’t drink alcohol or take other medications that can cause sleepiness or “brain fog”, such as pain medications or antidepressants, with Fioricet. Doing so can worsen these side effects. Make sure you know how this medication affects you before driving a car or doing activities that require your concentration. Talk to your healthcare provider right away if you feel too sleepy from taking Fioricet.

Serious skin or allergic reactions

  • Risk factors: History of serious skin reactions | Allergy to acetaminophen (Tylenol)

Fioricet contains acetaminophen (Tylenol), which can rarely cause life-threatening skin reactions and allergic reactions. If you’re allergic to acetaminophen, don’t take Fioricet. If you develop symptoms of an allergic reaction, such as swelling of the face, mouth, or throat, trouble breathing, itchy red rash (hives), or vomiting, stop taking Fioricet and call for emergency medical help right away. If you develop symptoms of a skin reaction, such as a reddening or peeling of the skin, painful rash, or fluid-filled blisters, stop taking Fioricet and go to the emergency room right away.

Misuse, dependence, and withdrawal

  • Risk factors: Taking Fioricet longer than prescribed | Taking higher doses of Fioricet than prescribed | Taking Fioricet more often than prescribed

Fioricet contains butalbital, which can be habit-forming. Misuse of Fioricet can lead to dependence, accidental overdose, and even death. Doing so can also cause withdrawal symptoms, like seizures, restlessness, trouble sleeping, and shakiness, if you lower your dose or stop taking the medication suddenly. To lower the risk of physical dependence, don’t take Fioricet longer than prescribed, at higher doses than prescribed, or more often than prescribed.

Call for emergency medical help if you have any symptoms of taking too much butalbital, including sleepiness, trouble breathing, dizziness, confusion, or loss of consciousness. If you no longer want to take Fioricet, talk to your healthcare provider so they can instruct you on how to stop taking the medication safely. Speak to your healthcare provider about alternative treatments if you have concerns about taking Fioricet.

What are the side effects of Fioricet?

With any medication, there are risks and benefits. Even if the medication is working, you may experience some unwanted side effects.

Contact your doctor immediately if you experience any of the following:

  • Signs of overdose: not responding to sound or touch, extreme sleepiness, slowed breathing, nausea, vomiting, sweating, tiredness, restlessness, shaking, confusion, stomach pain, dark urine, yellowing of your skin or eyes, loss of consciousness
  • Withdrawal: seizures, delusions, restlessness, trouble sleeping, shakiness
  • Serious allergic reaction: trouble breathing, hives, swelling of the face, mouth, tongue, or throat
  • Serious skin reaction: painful skin rash, blisters, skin itching or peeling

The following side effects may get better over time as your body gets used to the medication. Let your doctor know immediately if you continue to experience these symptoms or if they worsen over time.

Common side effects

  • Drowsiness
  • Lightheadedness
  • Dizziness
  • Loss of awareness (sedation)
  • Trouble breathing
  • Nausea
  • Vomiting
  • Stomach pain
  • Feeling “high” (intoxicated)

Other side effects

  • Headache
  • Shaking
  • Feeling agitated
  • Excessive sweating
  • Difficulty swallowing
  • Muscle weakness
  • Fast heart rate
  • Seizures
  • Confusion

Source: DailyMed

The following side effects have also been reported:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common


shortness of breath

Incidence not known

Abdominal or stomach pain

black, tarry stools

bleeding gums

blistering, peeling, or loosening of the skin

blood in the urine or stools

blurred vision

change in the frequency of urination or amount of urine




difficulty with breathing

difficulty with swallowing



dry mouth


fast, pounding, or irregular heartbeat or pulse

flushed or dry skin

fruit-like breath odor

hives, itching, or skin rash

increased hunger

increased thirst

increased urination

joint or muscle pain

loss of appetite

nausea or vomiting

pinpoint red spots on the skin

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

red skin lesions, often with a purple center

red, irritated eyes


shakiness in the legs, arms, hands, or feet

sore throat

sores, ulcers, or white spots in the mouth or on the lips


swelling of the feet or lower legs

tightness in the chest

trembling or shaking of the hands or feet

troubled breathing

unexplained weight loss

unusual bleeding or bruising

unusual tiredness or weakness


Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Confusion as to time, place, or person

dark urine

difficult or painful urination

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position


general feeling of discomfort or illness



holding false beliefs that cannot be changed by fact

increased sweating

irregular, fast or slow, or shallow breathing

light-colored stools

loss of appetite

pale or blue lips, fingernails, or skin


sudden decrease in the amount of urine


trouble sleeping

unpleasant breath odor

unusual excitement, nervousness, or restlessness

vomiting of blood

yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Relaxed and calm


Incidence not known




continuing ringing or buzzing or other unexplained noise in the ears



excess air or gas in the stomach or intestines

false or unusual sense of well-being

full feeling

hearing loss


heavy eyelids

high energy

hot spells




pain in the leg

passing gas


stuffy nose

tingling sensation

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.






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