Fiorinal/Fioricet

[aptekmies]

---

Members do not see this ad.

Just curious if anyone knows why Fiorinal is a CIII and Fioricet is not controlled? The pharmacists that I have asked have no idea. Is it just one of those things that slipped through the cracks?

I made a fool of myself today telling a pt. that if they transfered their Fioricet they could not transfer it anymore, (little did I know), the pt. had to tell me it wasn't controlled.

(Funny thing is that because the pt knew that much, it flagged their motive for transferring the script and started a whole other story but I'm sure most people could tell the rest of that all too common story. )

 

[twester]

I don't know the answer to the question. I searched around, but didn't really find anything. Maybe it has something to do with ASA being a more problematic drug in terms of allergy and drug-drug interactions than APAP?

But that logic doesn't hold with Percodan and Percocet which are both CII - maybe oxycodone overrides any safety differences btw ASA and APAP.

Maybe our panel of experts will chime in.

 

[dumbguy]

if i remember correctly, the only difference between fioricet and fiorinal is that fioricet has acetominophen instead of aspirin as in fiorinal. I don't understand why one would be control and the other would not, unless aspirin is more habit forming.



Disclaimer: Anything I say cannot be trusted as a reliable source. Remember, I'm just a dumb guy.

 

[aptekmies]

Well I've been googling it. I found an Alabama Pharmacy State Board Newsletter that gives somewhat of an explanation:

"In the past, there has been confusion over the controlled
status of Fioricet. Fioricet is not scheduled federally. In
1980, a federal panel set forth criteria to except certain compounds
if they were combined with butalbital and fell within
the proper ratio of acetaminophen and butalbital. Fioricet
met the criteria to be an excepted compound and was excepted
in 1980."​

It looks like it may be one of those times politics trumps science.👎

 

[greatdeals225]

I had actually asked that question to my pharmacist a few months back. She said that fioricet, the one with acetaminophen that's not controlled will not make you dependent. However, Fiorinal, the one with aspirin, will make someone dependent, therefore, it's a controlled substance. It might be the combo of aspirin with butalbital and caffeine....

 

[sdn1977]

Yep - this one goes waaaay back.

Fioricet or the acetaminophen containing product had more other "stuff" (excipients) which made the butalbital concentration per gm of final product fall below that which was required for controlled status.

Then....later - I can't tell you exactly when, the acetaminophen concentration was lowered, but they were able to keep it off the scheduled status since the concentration of butalbital per unit stayed the same.

Its one of those rare exceptions to the federal law which is not readily apparent. But, I think there are some states which can sell a certain amount of CV cough syrups otc as well.

In fact, over the years, I've seen some funny variations on this. You could buy more than one unit (I think 120ml of a codeine containing cough syrup) on any day EXCEPT Wednesday. What's with Wed???? Can't you have a bad cough on that day???😕

And here I thought the pseudoephedrine laws were ridiculous!😡

 

[aptekmies]

As far as Fioricet not causing dependency? I would definitely have to disagree on this one. My dad is a psychologist and deals with substance abuse daily and he has talked how Fioricet is hugely abused. I personally know someone that is very dependent on it, even taking way over the maximum dose (about 25 pills/day!!) So maybe in THEORY it should not cause dependency, I believe in reality the contrary is found.

I think that we should be aware that even though a drug may not be scheduled it does not mean that there will not be abuse. (Excuse the double negative)
Just take tramadol and Soma as examples (here in Nevada Soma is a CIV)

 

[sdn1977]

With butalbital/caffeine compounds there is a huge problem with rebound headaches. That's why most neurologists prefer to go to the triptans if they can.

 

[aptekmies]

Ya I forgot about that SDN'77

...the beloved caffeine rebound headaches. When I learned about this I remembered that my mom loves her Excedrin. She was becoming dependent on it for her daily tension headaches. I told her about this and asked her to just take 2 regular strength APAP and one ASA and see what happens. She had a hard time for a couple of weeks getting off the Excedrin but eventually it cut her headaches back from about once a day to once weekly.

 

[Farmercyst]

I had actually asked that question to my pharmacist a few months back. She said that fioricet, the one with acetaminophen that's not controlled will not make you dependent. However, Fiorinal, the one with aspirin, will make someone dependent, therefore, it's a controlled substance. It might be the combo of aspirin with butalbital and caffeine....

Personally it sounds like they were just quoting the definitions of scheduled and unscheduled. Essentially that's what they taught in my Pharmacology for technicians class. Scheduled have higher propensity for dependency/abuse/addiction vs unscheduled which don't. It appears every rule still has an exception. (Except the one about rules having exceptions😀 )

 

[golf299]

Any medication that is used for the acute relief of headache can cause rebound if it is overused, so switching to a triptan is not void of risk. While Excedrin Migraine is the #1 cause, others will do it as well.

 

[LowGPAHighPCAT]

Just curious if anyone knows why Fiorinal is a CIII and Fioricet is not controlled? The pharmacists that I have asked have no idea. Is it just one of those things that slipped through the cracks?

I made a fool of myself today telling a pt. that if they transfered their Fioricet they could not transfer it anymore, (little did I know), the pt. had to tell me it wasn't controlled.

(Funny thing is that because the pt knew that much, it flagged their motive for transferring the script and started a whole other story but I'm sure most people could tell the rest of that all too common story. )

Fiorinal is a much older drug than Fioricet and was released at a time when all butalbital-containing drugs were listed as Schedule-III. Butalbital was later removed from that listing but brand name Fiorinal was never taken off of the list. Fioricet came along after butalbital was removed from the list and it therefore carries no control status. However, butalbital does still carry some danger of dependence and there is no difference in the dependence levels between butalbital with aspirin and butalbital with acetaminophen.

At least, that's what I was told by a pharmacist that I worked with.

 

[Julianne]

Well I've been googling it. I found an Alabama Pharmacy State Board Newsletter that gives somewhat of an explanation:

"In the past, there has been confusion over the controlled
status of Fioricet. Fioricet is not scheduled federally. In
1980, a federal panel set forth criteria to except certain compounds
if they were combined with butalbital and fell within
the proper ratio of acetaminophen and butalbital. Fioricet
met the criteria to be an excepted compound and was excepted
in 1980."​

Kinda interesting...This article is from 2002 but just last week I heard some talk about Alabama pushing for legislation (is that the right word?) to have all products that contain butalbital or tramadol reclassified as controls.

Along this same line, I'm curious as to which states out there consider carisoprodol a control and which do not (I was going to be good and google it, but didn't feel like wading through a gazillion "Buy Soma Here with no Rx!!" sites)...

 

[aptekmies]

I found a site* that posts some states where Soma is controlled but I know it is incomplete because Nevada is not on it;

* Georgia (Schedule IV)
* Hawaii (Schedule IV)
* Kentucky (Schedule IV)
* Massachusetts (Schedule VI)
* New Mexico (Schedule IV)
* Oklahoma (Schedule IV)​

*I noticed that this page was last updated in 1997 and it is the LA police Department so I guess it may not be that reliable.

 

[ForgetMeNot]

Kinda interesting...This article is from 2002 but just last week I heard some talk about Alabama pushing for legislation (is that the right word?) to have all products that contain butalbital or tramadol reclassified as controls.

Along this same line, I'm curious as to which states out there consider carisoprodol a control and which do not (I was going to be good and google it, but didn't feel like wading through a gazillion "Buy Soma Here with no Rx!!" sites)...

Arizona calls soma a control.

 

[sdn1977]

Soma's not controlled in CA.

 

[Julianne]

Arizona calls soma a control.

As does Alabama...

 

[dumbguy]

is there a website that tells you what is control for each state?

 

[DrugDealer]

Just curious if anyone knows why Fiorinal is a CIII and Fioricet is not controlled?

I thought that ASA (or at least it's salicylic acid metabolite) was rather highly protein-bound and was able to more readily displace butalbital from plasma proteins than APAP can. Thus, you have more free butalbital in the plasma, which then translates into more butalbital in the tissues and brain, where it can exert its benzo-like effect.

 

[Emory25]

A pharmacist I once worked with told me that Fiorinal's aspirin (ASA) component increases the absorption of the butalbital. Butalbital, combined with APAP or ASA, is the habit forming component used to induce sleep. Since ASA tends to also be a GI irritant, you may have some absorption of Butalbital directly into the bloodstream bypassing the liver, whereas APAP does not cause GI upset and must pass through the liver first...just a thought.