Fiorinal with Codeine

Fiorinal with Codeine is a prescription-only analgesic combination indicated for the relief of the symptom complex associated with tension (or muscle contraction) headache when alternative treatments have been inadequate. It combines four active agents — a barbiturate, a nonsteroidal analgesic, a mild stimulant, and an opioid — to address headache pain through complementary mechanisms.

Active Ingredients & Strengths (per capsule):

• Butalbital 50 mg – a barbiturate that provides CNS depressant effects to relax muscle tension.

• Aspirin 325 mg – nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation and pain.

• Caffeine 40 mg – a central nervous system stimulant that can potentiate analgesic effects.

• Codeine Phosphate ~30 mg – an opioid analgesic that binds to CNS receptors to relieve pain.

Primary Indication:

• Management of tension-type headache pain when non-opioid analgesics alone are insufficient.

Mechanism of Action:

• Butalbital helps relax muscle contractions and reduce anxiety-related tension.

• Aspirin provides anti-inflammatory and pain reduction.

• Caffeine enhances pain relief and counters sedation.

• Codeine acts as a mild opioid analgesic to decrease pain perception.

Typical Dosage:

• Patients may be prescribed 1–2 capsules every 4 hours, not exceeding 6 capsules in 24 hours. Dosing must be individualized based on clinical response and risk.

Important Safety & Precautions:

• Prescription Only / Controlled Substance: Fiorinal with Codeine is a Schedule III controlled medication due to the opioid component.

• Risk of Addiction, Abuse, Dependence, and Overdose: Use only as directed; misuse can lead to serious breathing problems, addiction, or death.

• Avoid in Children: Not for use in children <12 years or those <18 years after tonsil/adenoid surgery due to risk of respiratory depression.

• Contraindications: Severe asthma, significant respiratory disease, known NSAID or barbiturate hypersensitivity, hemophilia, or concurrent MAOI use.

• Pregnancy & Breastfeeding: Codeine and aspirin components pose risks; consult a clinician before use.

• Interactions: May interact dangerously with alcohol, benzodiazepines, sedatives, and other CNS depressants.

Common Side Effects:

• Drowsiness, dizziness, nausea, vomiting, constipation, light-headedness.

• Serious respiratory depression or central nervous system depression at high doses.

Patient Counseling Points:

• Take exactly as prescribed; do not exceed recommended dosing.

• Store securely to prevent misuse.

• Do not share medication with others.

• Seek medical help if experiencing signs of overdose or severe side effects.