Why Fiorinal is Controlled but Fioricet is Not Controlled

Fiorinal and Fioricet are medicines for tension-type headaches. Fiorinal contains aspirin and Fioricet contains acetaminophen. They both contain butalbital and caffeine. Codeine is sometimes also added to this combination. Butalbital, a barbiturate sedative, is habit-forming.

These medications should not be used on a daily basis because dependency on them can develop. Regular use, more than 2 days per week, can cause rebound headache, which may not respond to usually effective acute and preventive treatments.

Some patients are wondering why fioricet is not controlled but fiorinal is controlled. The reasons is that Fiorinal contains aspirin but fioricet only contains non-aspirin pain killer and barbiturate butalbital. The potential for abuse is decreased if a sufficient amount of a non-controlled substance (e.g., aspirin or acetaminophenn) is added.

The ratio required for exemption is 70 mg of acetaminophen to 15 mg of butalbital. In contrast, the ratio of aspirin to butalbital is 188 mg to 15 mg. The acetaminophen to butalbital ratio is approximately 97 mg to 15 mg in Fioricet, thus it is exempt from being controlled. Another reasons is that drug abusers can easily perform an “acid wash” to remove the aspirin (acetylsalicylic acid) component in Fiorinal but It is much more difficult to remove the acetaminophen component in Fioricet. F