What is Butalbital APAP Caffeine? Uses, warnings & side effects

Updated Sep 2, 2025  •  Published Dec 30, 2020

The combination drug, butalbital-acetaminophen-caffeine, is a generic prescription pain reliever for tension headaches. While acetaminophen (or “APAP”) is a familiar analgesic, most people don’t know that caffeine also relieves pain, particularly when combined with another pain reliever. Butalbital is a barbiturate that slows down nerves, also dulling pain. Doses are taken by mouth every four hours for as long as pain relief is needed, but this medicine should be used only for a short time.

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Butalbital APAP Caffeine overview

BRAND NAMES:

  • Fioricet

Generic Names:

  • Butalbital-acetaminophen-caffeine

Uses:

  • Treats tension headaches

Therapeutic Classes:

  • Analgesic

Forms:

  • Capsule, tablet, oral solution (liquid)

How it’s taken:

  • By mouth

What is Butalbital APAP Caffeine used for?

Butalbital-acetaminophen-caffeine relieves acute pain due to tension headaches, also called muscle contraction headaches. Doctors may prescribe it off-label to treat acute migraine headaches.

What form(s) does Butalbital APAP Caffeine come in?

  • Tablet

    • 50 mg butalbital-325 mg acetaminophen-40 mg caffeine

  • Capsule

    • 50-300-40 mg

    • 50-325-40 mg

  • Oral solution

    • 50-325-40 mg/15 mL

What are common Butalbital APAP Caffeine dosages?

  • For tension headache in adults: 1–2 capsules or tablets or 15–30 mL oral solution every four hours

Butalbital APAP Caffeine images - What does Butalbital APAP Caffeine look like?

  • Butalbital-APAP-Caffeine
    50-300-40mg capsule

  • Butalbital-APAP-Caffeine
    50-325-40mg capsule

  • Butalbital-APAP-Caffeine
    50-325-40mg tablet

How to take Butalbital APAP Caffeine

  • Take this medication as directed. Do not use more medicine, take it more often, or take it for longer than instructed. 

  • Take doses at the start of a headache.

  • Doses can be taken with or without food.

  • Swallow tablets and capsules whole with a drink of water.

  • Measure the oral liquid medicine with a calibrated oral syringe or medicine cup provided with the medicine or by a pharmacist.

  • Store butalbital-APAP-caffeine at room temperature in the original light-resistant container.

What to do if you miss a dose of Butalbital APAP Caffeine

  • Ask the prescriber how to handle missed doses.

  • If a missed dose is taken, do not take the next dose until four hours later.

  • Do not take extra medicine to make up for a missed dose.

Butalbital APAP Caffeine contraindications - Who shouldn't take Butalbital APAP Caffeine?

  • This medicine is not right for everyone. 

  • Do not use it if you have:

    • Porphyria

    • Known allergies to acetaminophen, butalbital, or caffeine

Butalbital APAP Caffeine warnings

  • Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.

  • Keep all appointments with the prescriber.

  • This medicine is habit-forming. Misuse can cause overdose and death.

    • Only use this medicine for a short time to treat the pain from a tension headache.

    • Call the prescriber if the medicine is not working.

  • Before starting butalbital-APAP-caffeine, tell your doctor if you are pregnant, breastfeeding, or have:

    • Kidney problems

    • Liver problems

    • Acute abdominal conditions

    • A history of drug or alcohol abuse

  • Butalbital-APAP-caffeine can cause serious problems, including liver damage or severe skin reactions.

  • This medicine contains acetaminophen, a drug that can be toxic or fatal when too much is taken. 

    • Do not use more than your prescribed dose.

    • Always take doses four hours apart.

    • Read the labels of all other medicines you are using to see if they also contain acetaminophen (or APAP), or ask your doctor or pharmacist. 

    • Do not take more than 4 grams (4,000 milligrams) of acetaminophen in one day.

  • This medicine may make you dizzy or drowsy. Do not drive or do anything that could be dangerous until you know how this medicine affects you.

  • Keep all medicine in a tightly closed, childproof container out of the reach of children.

Butalbital APAP Caffeine interactions & what to avoid when taking Butalbital APAP Caffeine

  • To avoid possible drug interactions, tell the prescriber about all the prescription drugs, over-the-counter medications, and supplements regularly used, particularly:

  • Do not drink alcohol while you are using this medicine. Acetaminophen can damage your liver, and alcohol can increase this risk.

  • Tell other healthcare providers you are taking butalbital-APAP-caffeine before they prescribe new medications.

Butalbital APAP Caffeine side effects - How does Butalbital APAP Caffeine make you feel?

Serious side effects

Talk to a doctor if you notice any signs or symptoms of a possible serious side effect, including:

  • Dark urine or pale stools, nausea, vomiting, loss of appetite, stomach pain, yellow skin or eyes

  • Extreme dizziness or weakness, trouble breathing, slow heartbeat, and cold, clammy skin

  • Seizures

  • Blistering, peeling, red skin rash

  • Allergic reaction: Itching, skin rash, hives, swelling in your face, lips, mouth, or throat, chest tightness, trouble breathing, trouble swallowing

Less serious side effects

  • Drowsiness

  • Lightheadedness

  • Dizziness

  • Sedation

  • Shortness of breath

  • Nausea

  • Vomiting

  • Abdominal pain

Sources:

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