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Fioricet
acetaminophen/butalbital/caffeine (oral) (a seet a MIN oh fen and boo TAL bi
tall and CAFF een)
What is the most important information I should know about Fioricet?
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Use caution when driving, operating machinery, or performing other
hazardous activities. Butalbital will cause drowsiness. If you
experience drowsiness or dizziness, avoid these activities. |
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Avoid sleeping pills, sedatives, and tranquilizers except under the
supervision of your doctor. These may also make you drowsy. |
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Avoid alcohol. Alcohol taken during therapy with Fioricet can be very
damaging to your liver and can increase drowsiness and dizziness. |
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Check the acetaminophen content of other over-the-counter and
prescription products while taking this medication. You should not
exceed 4 grams (4000 mg) of acetaminophen per day. |
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Never take more Fioricet than is prescribed for you. If your pain is
not being adequately treated, talk to your doctor. |
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Acetaminophen is a pain reliever and fever reducer. |
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Butalbital is in a class of drugs called barbiturates that slow down
your central nervous system (brain and nerve impulses) causing
relaxation. |
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Caffeine is believed to constrict dilated blood vessels that may
contribute to tension headaches. |
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Together, acetaminophen, butalbital, and caffeine are used to relieve
complex tension (muscle contraction) headaches although precisely how it
works is unknown. |
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Fioricet may also be used for purposes other than those listed in this
medication guide. |
What should I discuss with my healthcare provider before taking
Fioricet?
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This medication is habit forming and should only be used under close
supervision. Take this drug only for as long as it is prescribed , in
the amounts it is prescribed, and no more frequently than prescribed. |
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Do not take Fioricet without first talking to your doctor if you drink
more than three alcoholic beverages per day or if you have had alcoholic
liver disease. You may not be able to take Fioricet, or you may require
a lower dose. |
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Do not take Fioricet if you have porphyria. |
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Before taking this medication, tell your doctor if you have |
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You may not be able to take Fioricet, or you may require a lower dose
or special monitoring during treatment if you have any of the conditions
listed above. |
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This drug combination is in the FDA pregnancy category C. This means
that its effects on an unborn baby are not known. Do not take this
medication without first talking to your doctor if you are pregnant. |
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This drug combination passes into breast milk and may harm a nursing
infant. Do not take this medication without first talking to your doctor
if you are breast-feeding a baby. |
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Fioricet has not been approved for use in children younger than 12
years of age. |
How should I take Fioricet?
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Take Fioricet exactly as directed by your doctor. If you do not
understand these directions, ask your pharmacist, nurse, or doctor to
explain them to you. |
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Take each dose with a full glass of water. |
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Take Fioricet with food or milk if it upsets your stomach. |
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Never take more Fioricet than is prescribed for you. If your pain is
not being adequately treated, talk to your doctor. |
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Store Fioricet at room temperature away from moisture and heat. |
What happens if I miss a dose?
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Take the missed dose as soon as you remember. Do not take a
double dose of this medication. Wait the prescribed amount of time
before taking your next dose. |
What happens if I overdose?
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Seek emergency medical attention. |
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Symptoms of an Fioricet overdose include insomnia, restlessness,
tremor, nausea, vomiting, diarrhea, abdominal pain, sweating, seizures,
drowsiness, decreased breathing, dizziness or fainting, confusion, an
irregular heartbeat, and coma. |
What should I avoid while taking Fioricet?
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Use caution when driving, operating machinery, or performing other
hazardous activities. Butalbital will cause drowsiness or dizziness. If
you experience drowsiness or dizziness, avoid these activities. |
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Avoid sleeping pills, antihistamines, sedatives, and tranquilizers
except under the supervision of your doctor. These may also make you
drowsy. |
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Avoid alcohol. Alcohol taken during therapy with Fioricet can be very
damaging to your liver and can increase drowsiness and dizziness. |
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Check the acetaminophen content of other over-the-counter and
prescription products while taking this medication. You should not
exceed 4 grams (4000 mg) of acetaminophen per day. |
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Avoid taking too much caffeine. Check the caffeine content of other
over-the-counter and prescription products as well as beverages (coffee,
tea, and colas) while taking this medication |
What are the possible side effects of Fioricet?
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If you experience any of the following serious side effects, stop
taking Fioricet and seek emergency medical attention: |
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an allergic reaction (difficulty breathing; closing of your throat;
swelling of your lips, tongue, or face; or hives); |
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liver damage (yellowing of the skin or eyes, nausea, abdominal pain or
discomfort, unusual bleeding or bruising, severe fatigue); |
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blood problems (easy or unusual bleeding or bruising); or |
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low blood sugar (fatigue, increased hunger or thirst, dizziness, or
fainting). |
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These side effects are very rare and are not likely to occur during
proper treatment with acetaminophen and caffeine. If you experience any
unusual reactions, stop taking this medicine and seek the advice of your
doctor. |
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Other, less serious side effects may be more likely to occur. Continue
to take Fioricet and talk to your doctor if you experience |
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dizziness,, confusion or lightheadedness; |
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nausea, vomiting, abdominal pain, or decreased appetite; |
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tiredness, leg pain, or muscle weakness; |
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agitation, irritability, nervousness, anxiety or excitability; |
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Butalbital may be habit forming. |
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Side effects other than those listed here may also occur. Talk to your
doctor about any side effect that seems unusual or that is especially
bothersome. |
What other drugs will affect Fioricet?
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Do not take Fioricet if you have taken a monoamine oxidase inhibitor (MAOI)
such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine
(Parnate) in the last 14 days. Dangerous side effects could result. |
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Fioricet may increase the effects of other drugs that cause
drowsiness, including antidepressants, alcohol, antihistamines,
sedatives (used to treat insomnia), other pain relievers, anxiety
medicines, and muscle relaxants. Tell your doctor about all medicines
that you are taking, and do not take any medicine unless your doctor
approves. |
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Many other medicines contain acetaminophen, especially
over-the-counter pain, fever, cold, and allergy medications. Too much
acetaminophen can be very dangerous. |
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Drugs other than those listed here may also interact with Fioricet.
Talk to your doctor and pharmacist before taking any prescription or
over-the-counter medicines. |
Where can I get more information?
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Your pharmacist has additional information about Fioricet written for
health professionals that you may read. |
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Remember, keep this and all other medicines out of the reach of
children, never share your medicines with others, and use this
medication only for the indication prescribed. |
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Every effort has been made to ensure that the information provided by
Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete,
but no guarantee is made to that effect. Drug information contained
herein may be time sensitive. Multum information has been compiled for
use by healthcare practitioners and consumers in the United States and
therefore Multum does not warrant that uses outside of the United States
are appropriate, unless specifically indicated otherwise. Multum's drug
information does not endorse drugs, diagnose patients or recommend
therapy. Multum's drug information is an informational resource designed
to assist licensed healthcare practitioners in caring for their patients
and/or to serve consumers viewing this service as a supplement to, and
not a substitute for, the expertise, skill, knowledge and judgment of
healthcare practitioners. The absence of a warning for a given drug or
drug combination in no way should be construed to indicate that the drug
or drug combination is safe, effective or appropriate for any given
patient. Multum does not assume any responsibility for any aspect of
healthcare administered with the aid of information Multum provides. The
information contained herein is not intended to cover all possible uses,
directions, precautions, warnings, drug interactions, allergic
reactions, or adverse effects. If you have questions about the drugs you
are taking, check with your doctor, nurse or pharmacist. |
Tension-type Headaches in Children
and Adolescents
What are tension-type headaches?
Tension-type headaches are the most common type of headache in
adolescents. They are commonly referred to as muscle contraction
headaches, stress headaches, daily headaches, or chronic non-progressive
headaches.
A tension-type headache might occur periodically (episodic,
less than 15 days per month) or chronically (daily or > 15 days
per month). The headache is described as a mild to moderate, constant
band-like pain or pressure that lasts from 30 minutes to all day in
duration. Tension-type headaches usually begin gradually, and often occur
in the middle of the day.
The "severity" of a tension-type headache might increase
significantly with its frequency. Severe tension-type headaches occur
daily or almost daily, and the pain is usually described as a throbbing
pain affecting the front, top, or sides of the head. Although the
intensity of the pain might vary throughout the day, the pain is almost
always present. It is important to realize that although tension-type
headaches come and go over a prolonged period of time and might impair
your day-to-day function, they do not cause neurological symptoms, or
affect vision, balance, or strength.
What causes tension-type headaches?
There is no single cause for tension-type headaches. This type of
headache syndrome is not usually an inherited trait that runs in families.
In some people, tension-type headaches are thought to be caused by or
result in tightened muscles in the back of the neck and scalp. This muscle
tension might be caused by (1) inadequate rest, (2) poor posture, or (3)
emotional or mental stress, including depression. This stress might be
known (overt) or unknown (covert) to the patient and his or her parents.
The most common sources of stress in children and adolescents include
school, family, and friends or peers. Examples of stressors (not in any
particular order) include:
- Not getting enough sleep
- Being on the honor role or a straight-A student
- Having problems at home/difficult family life
- Going to a new school
- Having overly permissive or overly strict parents
- Having a substitute or strict teacher
- Having a new brother or sister
- Being a "teacher's pet"
- Having no close friends
- Preparing for school tests or exams
- Learning to drive
- Joining too many extra-curricular activities
- Starting a new part-time job
- Going on a field trip or vacation
- Being overweight
- Having other children make fun of you
- Competing in sports or other activities
- Learning difficulties
Having the adolescent seen by a headache specialist might be helpful,
particularly when the cause of tension-type headaches is difficult to
identify. Once the evaluation is completed, it is important to reassure
the patient that the headache pain they are experiencing is NOT likely to
be a brain tumor.
What are the symptoms of tension-type headaches?
Patients with tension-type headaches commonly report these symptoms:
- Constant or episodic, mild-to-moderate head pain
- Headache upon awakening
- General muscle aches
- Difficulty falling asleep and staying asleep
- Chronic fatigue
- Irritability
- Disturbed concentration
- Mild sensitivity to light or noise
- Occasional dizziness
- Occasional nausea
The presence of an aura (physical warning sign), significant
sensitivity to light or noise, nausea, and vomiting are not
symptoms associated with this type of headache syndrome. Often, the pain
associated with a tension-type headache is difficult for the patient to
describe. There are no associated neurological symptoms (for
example, balance or visual disturbances) in patients with tension-type
headaches.
How common are tension-type headaches?
Tension-type headaches affect 15 percent to 20 percent of adolescents
and a lower percentage of younger children. The percent of adults who
suffer with occasional tension-type headaches ranges from 30 percent to
about 80 percent. Women are twice as likely to suffer from tension-type
headaches as are men.
Most people with episodic tension-type headaches have them no more than
once or twice a month, but the headaches can occur more frequently.
Chronic tension-type headaches tend to be more common in females and in
students who are "high achievers." Many patients with chronic
tension-type headaches have already had the headaches for more than 60 to
90 days when evaluated, and many have missed an excessive amount of
school.
Nearly 60 percent of people with tension-type headaches report that
their daily activities are impaired because of the headaches.
Chronic tension-type headaches might co-exist in adolescents and
children who already have a history of migraines. These are called mixed
headaches.
How are tension-type headaches diagnosed?
The correct headache diagnosis is needed to develop an effective
treatment plan. The most important aspect of the headache evaluation is
the headache history, which should be obtained from both the child and his
or her parents.
The history includes asking patients to describe how they feel with the
headache, what happens when a headache occurs, the frequency and duration
of the headaches, and any associated symptoms experienced. A description
of previous and current medicines taken to treat the headaches is also an
important part of the headache evaluation. The results of any previously
conducted studies or tests should be brought with you to the headache
evaluation.
After completing the medical history part of the evaluation, your
doctor will perform physical and neurological examinations. Usually, the
results of these examinations are normal for people with tension-type
headaches.
An interview with a psychologist is commonly a part of the headache
evaluation. The psychologist usually meets with the child and the parents
together, and then with them separately for structured interviews. The
parents are typically asked to complete computerized questionnaires in
order to provide more in-depth information. Usually, no severe problems
are discovered, but stress factors are often identified.
After evaluating the results of the headache history, physical
examination, neurological and psychological examinations, your doctor
should be able to determine what type of headache you have, whether or not
a serious problem is present, and if additional tests are needed. Often,
no additional blood tests or X-rays are needed.
How are tension-type headaches treated?
Tension-type headaches are treated using several drug and non-drug
strategies. Among the non-drug strategies are lifestyle changes (sleep,
dietary changes), physical therapy, stress management/relaxation training,
and counseling. Regardless of the treatment, tension-type headaches are
best treated before the headaches become more frequent and painful ?
that is, when the symptoms first begin and are mild.
Stress management/relaxation training and counseling
Both episodic and chronic tension-type headaches can be improved using
stress management and relaxation training. This is an essential part of
managing these types of headaches.
Recognizing and treating the underlying stress and tension that are
causing the headaches is very helpful. Often, however, patients forget
what stressful events initiated their headaches. Counseling helps patients
identify their headache triggers and learn useful coping methods.
Relaxation techniques include deep breathing exercises, progressive
muscle relaxation, mental imagery relaxation, or relaxation to music. Ask
your doctor for more information about these techniques.
Biofeedback is another method of learning how to manage stress. During
biofeedback, a series of sensors are connected to your body. The sensors
detect changes in physical functions, such as muscle tension, blood
pressure, heart rate, and skin temperature, and provide immediate feedback
through a tone displayed on a computer screen. Biofeedback helps you
recognize that your body is tense, identify the things that make it tense,
and learn ways to reduce the tension. Biofeedback usually requires several
sessions with a skilled biofeedback therapist.
If you miss more than five days of school per term, your counselor will
need to work with you and your parents to develop a plan so that you can
make up missed school work and ensure a smooth transition back to school.
Continued excessive school absence is an impediment to recovery.
Medicines
For occasional symptomatic relief of infrequent tension-type
headaches, over-the-counter (non-prescription) medicines are recommended.
Ask the advice of your doctor or pharmacist about the use of acetaminophen
(Tylenol), ibuprofen (Advil or Motrin), or naproxen sodium (Aleve). The
use of aspirin in children under age 14 is not recommended because of
aspirin's link with Reye's syndrome. Also, avoid compounds that contain
caffeine.
For relief of chronic tension-type headaches, daily preventive
medicines might be prescribed. These medicines which are aimed at
reducing both the frequency and severity of the headaches might
include antidepressants, such as amitriptyline hydrochloride (Elavil), and
non-steroidal anti-inflammatory medicines (NSAIDs), such as naproxen
sodium (Aleve). These medicines are not habit-forming.
Benzodiazepines, butalbital combinations, and narcotics (Codeine)
should be avoided because these medicines could become habit-forming or
addictive. Overuse of these medicines or the daily use of
pain-relieving medicines can cause analgesic rebound headaches, described
below.
Medicine overuse can increase headaches
An extremely important factor contributing to the development of
chronic daily headaches is the overuse of pain medicines. Medicine overuse
is most likely to occur in patients with chronic tension-type headaches.
Medicines associated with analgesic rebound headaches include
acetaminophen, ibuprofen, NSAIDs, triptans, ergotamine preparations,
butalbital combination analgesics, opiates, and combination analgesics
containing caffeine. Effective treatment of headaches associated with
medicine overuse requires withdrawal from the medicines causing the
rebound headaches. Rebound headaches might not go away for weeks after the
medicines are discontinued.
Treating tension-type headaches without medicines
Although medicines are helpful, it is important to learn other
headache treatment methods. Here are some suggestions:
- Apply an ice pack to the painful area of your head. Firmly
position it on your forehead, temples, or the back of your neck. (For
example, first place a thin cloth on your forehead, followed by the
ice pack, then finally secure it in place with a headband.)
- Take a warm bath or shower; take a nap; or take a walk.
- Ask someone to rub your neck and back, or treat yourself to a
massage.
- Apply gentle, steady rotating pressure to the painful area of your
head with your index finger and/or thumb. Maintain pressure for seven
to 15 seconds, then release. Repeat as needed.
- Rest, sit, or lie quietly in a low-lit room. Close your eyes and try
to release the tension in your back, neck, and shoulders.
- For patients who have excessive muscle contractions in the neck,
physical therapy exercises performed daily are often helpful.
How can I help reduce or prevent headaches?
- Follow your treatment plan Avoid taking medicines that
have not been ordered by your doctor. Do not overuse over-the-counter
medicines.
- Reduce emotional stress Take time to relax and take time
away from stressful situations. Learn relaxation skills, such as deep
breathing and progressive muscle relaxation.
- Reduce physical stress Proper rest and sleep will allow
you to deeply relax so you can face the stressors of the new day. When
sitting for prolonged periods, get up and stretch periodically. Relax
your jaw, neck, and shoulders.
- Exercise regularly Get at least 20 minutes of exercise
three times a week.
- Talk to a friend, family member, religious professional, or
health care professional This can help if your problems
are getting to you.
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