Question about Fioricet

[Dys0rdeR]

Hey all I've got a question about Fioricet (50 mg Butalbital, 40 mg caffeine, 325 mg apap). My question is this: Could the Butalbital (since it's a barb) possibly prevent a seizure or make one less likely? I've wondered about this for a long time actually and if anyone knows or has some kind of answer I'd greatly appreciate it. One of the reasons I ask is because at times, if I can't get my hands on anything else, I will take a bit more than 400 mg of Tramadol at once. Like maybe 500 mg. Since Fioricet is commonly available to me, I was curious if it could possibly negate (or somewhat lessen) the seizure threshold lowering effects of the Tramadol. I combine Tram and Fioricet fairly regularly (about 400-500 mg Tramadol and about 150-200 mg Butalbital from the Fioricet). I know a better way to prevent a seizure would be a benzo like Clonazepam, or Clorazepate, but I can rarely obtain these.
Thanks for any responses guys!

 

[Jekyl Anhydride]

I believe Phenobarbital was the gold standard for seizure prevention with or without an adjuvant thrown in like Phenytoin (Dilantin). Hard to say if Butalbital would have a comparable efficacy as you would probably lose any benefits part way through the first half life whereas phenobarbital saturates your system with its crazy long half life. Tramadol induced seizures seem particularly scary as they can be unpredictable and severe. Also I think the ceiling effect begins at around 400mg so the reaped rewards would be nil and most likely not worth the risk. Might need to switch to a full agonist opiate rather than risk seizures.

 

[Keif' Richards]

I would expect Butalbital (Fioricet, Firoinal) to be effective at controlling seizures. Like Jekyl said, Phenobaribtal has been something of a gold standard for controlling Status Epilepticus-type stuff for quite a while. In fact, it's pretty much the first truly effective medication developed for the purpose, although other, less effective medications were definitely in use for the purpose prior to its introduction. Something you probably want to be aware of, as it's pretty counterproductive in terms of your needs, is that the Barbiturate family in general is known to induce Cytochrome P450. Butalbital isn't known to cause as extreme of a shift in terms of enzyme activity as Phenobarbital or Secobarbital (Seconal) but the effect will still be present.

If I'm not mistaken, as Tramadol is metabolized by Cyctochrome P450 into O-Desmethyltramadol, taking the two in conjuction could be weakening the general effects of the Tramdol, leading you to need more. I just think the combination as you're using it could be a little counterproductive. Other than that, you're not going to find a lot of medication more effective at controlling seizures. A lot like Benzodiazepines, some are better suited for better purposes, but as a general rule, if someone is having a seizure and you give them a good dose of any Benzodiazepine or any Barbiturate, it will arrest the symptoms.

 

[Dys0rdeR]

Okay. Thanks a lot guys! That's exactly what I needed to know.