Fioricet Overdose Signs and Symptoms, and Treatment

Fioricet is a combination medication that typically contains butalbital (a barbiturate), acetaminophen (a pain reliever), and caffeine (a stimulant). It is used to treat tension headaches but can be dangerous in the case of an overdose. Recognizing the signs of a Fioricet overdose is crucial for prompt medical intervention. Here are the signs and symptoms to look out for:

Signs and Symptoms of Fioricet Overdose

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.

Butalbital Overdose (Barbiturate Component)

1. Central Nervous System Depression:
   • Extreme drowsiness or lethargy
   • Confusion
   • Slurred speech
   • Stupor or coma
2. Respiratory Depression:
   • Slow or shallow breathing
   • Difficulty breathing or respiratory arrest
3. Cardiovascular Effects:
   • Hypotension (low blood pressure)
   • Bradycardia (slow heart rate)

Acetaminophen Overdose

1. Early Signs (within 24 hours):
   • Nausea and vomiting
   • Loss of appetite
   • Abdominal pain
   • Sweating
   • Pallor (pale skin)
2. Later Signs (24 to 72 hours):
   • Liver damage, which can manifest as:
     • Jaundice (yellowing of the skin and eyes)
     • Confusion or altered mental status due to liver failure
     • Coagulopathy (bleeding disorders)

Caffeine Overdose

1. Central Nervous System Effects:
   • Restlessness or agitation
   • Insomnia
   • Tremors
2. Cardiovascular Effects:
   • Tachycardia (rapid heart rate)
   • Palpitations
   • Hypertension (high blood pressure)
3. Gastrointestinal Effects:
   • Nausea and vomiting
   • Diarrhea

Immediate Actions to Take

If an overdose is suspected, it is crucial to seek emergency medical attention immediately. Here are some steps to take while waiting for help:

1. Call Emergency Services: Dial emergency services (e.g., 911 in the U.S.) immediately.
2. Do Not Induce Vomiting: Unless directed by a healthcare professional, do not attempt to induce vomiting.
3. Monitor Vital Signs: Keep track of the person’s breathing, heart rate, and level of consciousness.
4. Provide Information: Be prepared to provide the medical responders with information about the dosage and timing of Fioricet intake, as well as any other medications or substances taken.

Treatment of Overdose

A single or multiple overdose with Fioricet 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)

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®.