Fioricet Overdose Signs, Symptoms and Treatment

Fioricet Signs and Symptoms

Toxicity from barbiturate poisoning include drowsiness, confusion, and coma; respiratory depression; hypotension; and hypovolemic shock.

In acetaminophen overdosage: dose-dependent, potentially fatal hepatic necrosis is the most serious adverse effect. Renal tubular necroses, hypoglycemic coma, and thrombocytopenia may also occur. Early symptoms following a potentially hepatotoxic overdose may include: nausea, vomiting, diaphoresis, and general malaise. Clinical and laboratory evidence of hepatic toxicity may not be apparent until 48 to 72 hours post-ingestion. In adults hepatic toxicity has rarely been reported with acute overdoses of less than 10 grams, or fatalities with less than 15 grams.

Acute caffeine poisoning may cause insomnia, restlessness, tremor, and delirium, tachycardia and extrasystoles.

Fioricet overdose Treatment

A single or multiple overdose with this combination product is a potentially lethal polydrug overdose, and consultation with a regional poison control center is recommended.

Immediate treatment includes support of cardiorespiratory function and measures to reduce drug absorption. Vomiting should be induced mechanically, or with syrup of ipecac, if the patient is alert (adequate pharyngeal and laryngeal reflexes). Oral activated charcoal (1 g/kg) should follow gastric emptying. The first dose should be accompanied by an appropriate cathartic. If repeated doses are used, the cathartic might be included with alternate doses as required. Hypotension is usually hypovolemic and should respond to fluids. Pressors should be avoided. A cuffed endotracheal tube should be inserted before gastric lavage of the unconscious patient and when necessary, to provide assisted respiration. If renal function is normal, forced diuresis may aid in the elimination of the barbiturate. Alkalinization of the urine increases renal excretion of some barbiturates, especially phenobarbital.

Meticulous attention should be given to maintaining adequate pulmonary ventilation. In severe cases of intoxication, peritoneal dialysis, or preferably hemodialysis may be considered. If hypoprothrombinemia occurs due to acetaminophen overdose, vitamin K should be administered intravenously.

If the dose of acetaminophen may have exceeded 140 mg/kg, acetylcysteine should be administered as early as possible. Serum acetaminophen levels should be obtained, since levels four or more hours following ingestion help predict acetaminophen toxicity. Do not await acetaminophen assay results before initiating treatment. Hepatic enzymes should be obtained initially, and repeated at 24-hour intervals.

Methemoglobinemia over 30% should be treated with methylene blue by slow intravenous administration.

Toxic Doses (for adults)

 

Butalbital: toxic dose 1 g (20 tablets)
Acetaminophen: toxic dose 10 g (30 tablets)
Caffeine: toxic dose 1 g (25 tablets)

In all cases of suspected overdosage, call your Regional Poison Control Center to obtain the most up-to-date information about the treatment of overdosage. Telephone numbers of certified Regional Poison Control Centers are listed in the Physicians’ Desk Reference®*.

What is the max dosage of Butabital and why Fiorinal is a controlled substance ?

Butalbital (5-allyl-5-isobutylbarbituric acid), is a short to intermediate-acting barbiturate. It has the following structural formula:

butalbital
 

C11H16N2O3          Mol. wt. 224.26
Barbiturates may be habit-forming: Tolerance, psychological dependence, and physical dependence may occur especially following prolonged use of high doses of barbiturates.

The average daily dose for the barbiturate addict is usually about 1500 mg. That is 1500mg Butalbital will make you addictive to butalbital.

One tablet fioricet contains 325 mg acetaminophen. FDA attempt to cut down on incidences of potentially fatal liver damage associated with acetaminophen.  The max dosage of acetaminophen is 3000mg per day. But we recommend the max dosage of acetaminophen is 2000mg.  Especially for a patient who drink alcohol.

  • Alcohol consumption substantially increases the risk of acute liver failure from acetaminophen overdose.
  • Liver damage may occur with consumption of only 2,600 mg of acetaminophen in the course of a day in people who have consumed varying amounts of alcohol.

acetaminophen

Acetaminophen effectively lowers fever and relieves minor aches and pains without stomach discomfort and heart issues associated with ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs).

It is strongly recommended that people who consume alcohol on a regular basis limit acetaminophen intake to a maximum of 1,000 to 2,000 mg per day. The preference is to stay at the lower end of that range.

If you do not want to hurt yourself, the max dosage of fioricet is six pills per day. We donot suggest a drunk man to take fioricet.

One tablet fioricet contains 50mg butalbital. The average daily dose for the barbiturate addict is usually about 1500 mg (30 Fioricet tablets).  That is five times of acetaminophen max dosage. At this dosage,  you will kill yourself by acetaminophen.

It is very hard to separate butalbital from fioricet or generic fioricet, so fioricet is not controlled substance.

Fiorinal contains a combination of aspirin, butalbital, and caffeine. Aspirin is a pain reliever, as well as an anti-inflammatory and a fever reducer. Butalbital is a barbiturate. It relaxes muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

Fiorinal is used to treat tension headaches. This medicine is not for treating headaches that come and go.

It is easy to separate butalbital from Fiorinal, That is why Fiorinal is a controlled substance.

 

 

 

How to treat Fioricet overdose

The treatment of Fioricet overdose is complicated by the presence of two substances which are highly toxic when taken in excessive amounts. Fioricet overdoses generally result in toxic amounts of both acetaminophen and butalbital being consumed at once, requiring both overdoses to be treated at once.

Fioricet overdose by anyone and/or any consumption by persons to whom it is not prescribed (particularly children) is always a medical emergency and medical attention must be sought immediately if an overdose or consumption by other persons is suspected.fioricet

Fioricet overdose is often fatal and symptoms may not present for hours following consumption, once initial overdose symptoms present they can progress rapidly and there may not be time to reach appropriate medical care after this point.

Acetaminophen over-exerts its toxicity through the production of a toxic metabolite which produces liver damage in doses of 3,000mg or more per day and acute liver failure in doses above that. The specific antidote to acetaminophen overdose is N-acetyl-cysteine. Kidney failure and stomach bleeding may also occur.

Butalbital overdoses exerts its toxicity through excessive sedation resulting in respiratory depression and ultimately death via hypoxia. Nonlethal overdoses may also result in coma and death. There is no specific antidote to butalbital overdose and treatment is supportive, common treatment regimens generally include the administration of intravenous administration of saline, naloxone, thiamine, glucose, NaHCO3 to alkalize the urine to increase rate of excretion, and activated charcoal via nasogastric tube. It is not uncommon for doctor to recommend observation of the patient in the Emergency Department for a number of hours or admission to the hospital for several days of observation if symptoms are severe and to counsel the patient on drug abuse and/or refer them for psychiatric evaluation.

What is the max dosage of acetaminophen ?

Acetaminophen, which is also known as paracetamol, is a commonly used OTC (over-the-counter) pain reliever (analgesic) and fever reducer (antipyretic). People use it for headaches, and minor aches and pain. Liver injury from acetaminophen overdose remains a serious public health problem despite ongoing regulatory and educational efforts over the past several years to improve the safe use of medicines that contain acetaminophen.

Fioricet contains acetaminophen 325 mg per tablet. The max dosage of an adult for acetaminophen goes down from 4000mg to 3000mg per day (http://www.medicalnewstoday.com/articles/231915.php). So only acetaminophen, you should not take more than eight tablet fioricet per day. IF you take more than eight fioricet tablet per day, you will hurt your liver.

acetaminophen

From tylenol website, they lowered the maximum daily dose for single-ingredient Extra Strength TYLENOL® (acetaminophen) products sold in the U.S. from 8 pills per day (4,000 mg) to 6 pills per day (3,000 mg). The dosing interval has also changed from 2 pills every 4 – 6 hours to 2 pills every 6 hours.