Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary.
When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
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- Riociguat
- Viloxazine
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Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
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- Alfentanil
- Alprazolam
- Amobarbital
- Anisindione
- Aprobarbital
- Butabarbital
- Calcium Oxybate
- Capmatinib
- Carisoprodol
- Chloral Hydrate
- Chlordiazepoxide
- Chlorzoxazone
- Clarithromycin
- Clonazepam
- Clorazepate
- Dantrolene
- Darunavir
- Diazepam
- Dicumarol
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Esketamine
- Estazolam
- Ethchlorvynol
- Etonogestrel
- Flunitrazepam
- Flurazepam
- Givosiran
- Halazepam
- Imatinib
- Iobenguane I 131
- Isoniazid
- Ketazolam
- Lorazepam
- Lormetazepam
- Magnesium Oxybate
- Medazepam
- Mephenesin
- Mephobarbital
- Meprobamate
- Metaxalone
- Methocarbamol
- Methohexital
- Midazolam
- Nifedipine
- Nitrazepam
- Oxazepam
- Peginterferon Alfa-2b
- Pentobarbital
- Phenindione
- Phenobarbital
- Phenprocoumon
- Piperaquine
- Pixantrone
- Pneumococcal 13-Valent Vaccine, Diphtheria Conjugate
- Potassium Oxybate
- Prazepam
- Primidone
- Quazepam
- Secobarbital
- Sodium Oxybate
- Temazepam
- Thiopental
- Trazodone
- Triazolam
- Ulipristal
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Other Interactions
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Using medicines in this class with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use your medicine, or give you special instructions about the use of food, alcohol, or tobacco.
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- Ethanol
- Tobacco
Other Medical Problems
The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:
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- Alcohol abuse (or history of) or
- Drug abuse or dependence (or history of)—Dependence on butalbital may develop. Also, acetaminophen may cause liver damage in people who abuse alcohol.
- Asthma (or history of), emphysema, or other chronic lung disease or
- Hepatitis or other liver disease or
- Hyperactivity (in children) or
- Kidney disease—The chance of serious side effects may be increased.
- Type 2 diabetes mellitus or
- Mental depression or
- Overactive thyroid or
- Porphyria (or history of)—Butalbital can make these conditions worse.
- Heart disease (severe)—The caffeine in some butalbital and acetaminophen combinations can make some kinds of heart disease worse.
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FIORICET (Brand for BUTALBITAL-ACETAMINOPHEN-CAFFE) Food Interactions
Alcohol
· Severity: Major
· Notes for Consumers: Do not drink alcohol while taking this medication. Drinking alcohol while taking this medication increases the risk of liver injury. Contact your care team right away if you experience right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, or unusual weakness or fatigue.
· Notes for Professionals: The risk of developing hepatotoxicity from acetaminophen appears to be increased in patients who regularly consume alcohol. Patients who drink more than 3 alcohol-containing drinks a day and take acetaminophen are at increased risk of developing hepatotoxicity. Acute or chronic alcohol use increases acetaminophen-induced hepatotoxicity by inducing CYP2E1 leading to increased formation of the hepatotoxic metabolite of acetaminophen. Also, chronic alcohol use can deplete liver glutathione stores. Administration of acetaminophen should be limited or avoided altogether in patients with alcoholism or patients who consume alcohol regularly.
Caffeine-containing Foods/Beverages
· Severity: Moderate
· Notes for Consumers: Caffeine may cause sleeplessness, so if you are taking a Barbiturate to help you sleep, you may wish to avoid taking caffeine and caffeine-containing foods like colas, coffee, teas, or chocolates within several hours prior to bedtime. Barbiturates may also decrease the actions of Caffeine; if you have a high intake of caffeinated foods or beverages you may experience a headache or irritability from decreased caffeine levels while taking these drugs until your body adjusts. If you take Caffeine for other purposes, notify your health care provider if you think Caffeine is not working as well for you.
· Notes for Professionals: Caffeine has been reported to increase the metabolism of barbiturates, and barbiturates increase caffeine elimination. Higher caffeine doses may be needed after barbiturate administration.
Cannabis
· Severity: Major
· Notes for Consumers: Discuss cannabis use with your care team. The effects of cannabis may be altered if used with your medication. Call emergency services right away if you experience slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, or trouble staying awake.
· Notes for Professionals: Advise patients to avoid cannabis use during barbiturate treatment due to the risk for additive CNS depression and other adverse reactions. Concomitant use may also decrease the concentration of some cannabinoids and alter their effects. The cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are CYP3A substrates and barbiturates are strong CYP3A inducers. Concomitant use of a cannabinoid product containing THC and CBD at an approximate 1:1 ratio with another strong CYP3A inducer decreased THC, 11-OH-THC, and CBD peak exposures by 36%, 87%, and 52% respectively.
Butalbital 50mg, Acetaminophen 300mg, Caffeine 40mg, Oral capsule
Grapefruit juice
· Severity: Mild
· Notes for Consumers: Do not significantly alter your grapefruit juice intake while taking medicines containing caffeine. Some reports suggest that intake of grapefruit juice can increase side effects from caffeine. Too much Caffeine can cause effects like nausea, tremor, nervousness, or sleeplessness. If these occur, consider ingesting less caffeine daily.
· Notes for Professionals: Data are limited and conflicting as to whether grapefruit juice significantly alters the serum concentrations and/or AUC of caffeine. Caffeine is primarily a CYP1A2 substrate, and grapefruit juice appears to have but a small effect on this enzyme in vivo. One report suggests that grapefruit juice decreases caffeine elimination by inhibition of flavin-containing monooxygenase, a P450 independent system. This interaction might increase caffeine levels and mildly potentiate the clinical effects and common side effects of caffeine. If side effects appear, patients may need to limit either caffeine or grapefruit juice intake.
Butalbital 50mg, Acetaminophen 300mg, Caffeine 40mg, Oral capsule
Tobacco
· Severity: Major
· Notes for Consumers: Do not smoke or use tobacco products while taking this medication. When used together, your medication may not work as well for you.
· Notes for Professionals: Advise patients who are taking caffeine to avoid smoking tobacco. Smoking tobacco has been observed to increase caffeine clearance by 50% to 70%. Caffeine is a CYP1A2 substrate and smoking tobacco induces CYP1A2.