Home Drug Guide Butalbital; Acetaminophen; Caffeine; Codeine Phosphate

Drug Guide

Generic Name

Butalbital; Acetaminophen; Caffeine; Codeine Phosphate

Brand Names Fioricet with Codeine

Classification

Therapeutic: Analgesic, sedative, and antipyretic combination

Pharmacological: Barbiturate (butalbital), opioid (codeine), analgesic (acetaminophen), stimulant (caffeine)

FDA Approved Indications

  • Moderate to severe pain management

Mechanism of Action

Butalbital depresses sensory cortex, alters spinal reflexes, and produces generalized CNS depression; Acetaminophen inhibits prostaglandin synthesis; Caffeine blocks adenosine receptors, leading to CNS stimulation; Codeine binds to opioid receptors, inhibiting ascending pain pathways.

Dosage and Administration

Adult: As prescribed, typically one tablet every 4 hours as needed, not exceeding 6 tablets per day.

Pediatric: Not recommended for children under 12 due to risk of respiratory depression and metabolic issues.

Geriatric: Use with caution; start at lower end of dosing range due to increased sensitivity and risk of side effects.

Renal Impairment: Adjust dose accordingly; use with caution to avoid accumulation of toxic metabolites.

Hepatic Impairment: Use with caution; may require dose adjustments due to metabolism.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, crosses blood-brain barrier.

Metabolism: Metabolized in liver; codeine via CYP2D6 to morphine, acetaminophen via conjugation.

Excretion: Renal excretion of metabolites.

Half Life: Butalbital ~4-6 hours; codeine ~3 hours; acetaminophen ~2-3 hours; caffeine ~3-7 hours.

Contraindications

  • Hypersensitivity to components
  • Respiratory depression
  • Porphyria

Precautions

  • Use with caution in patients with hepatic impairment, respiratory depression, or a history of substance abuse; monitor for potential dependence and abuse.

Adverse Reactions - Common

  • Drowsiness (Common)
  • Dizziness (Common)
  • Nausea (Common)

Adverse Reactions - Serious

  • Respiratory depression (Rare)
  • Hypersensitivity reactions (Rare)
  • Severe allergic reactions (Rare)
  • Addiction, dependence (Potential)

Drug-Drug Interactions

  • Other CNS depressants, alcohol, MAO inhibitors, CYP2D6 inhibitors

Drug-Food Interactions

  • Alcohol enhances CNS depression.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess pain characteristics and response; monitor for signs of CNS depression, respiratory depression, and allergic reactions.

Diagnoses:

  • Pain, acute
  • Risk for respiratory depression
  • Risk for dependency

Implementation: Administer with food if gastrointestinal upset occurs; monitor vital signs; avoid alcohol and other CNS depressants.

Evaluation: Evaluate pain relief and monitor for adverse effects.

Patient/Family Teaching

  • Take exactly as prescribed; do not increase dose.
  • Avoid alcohol and sedatives.
  • Report signs of allergic reactions or respiratory difficulty.
  • Caution against operating machinery or driving until response is known.

Special Considerations

Black Box Warnings:

  • Addiction potential, respiratory depression, hepatotoxicity (from acetaminophen in overdose).

Genetic Factors: CYP2D6 polymorphisms can affect codeine metabolism, influencing efficacy and safety.

Lab Test Interference: May alter liver function tests; monitor as indicated.

Overdose Management

Signs/Symptoms: Respiratory depression, somnolence, cyanosis, hypotension, coma.

Treatment: Provide airway support, administer narcotic antagonists like naloxone, manage symptoms supportively, induce vomiting or gastric lavage if early and appropriate.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable for 2-3 years under proper storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.