Fiorinal with codeine is useful for controlling headache pain in people who have tried and struggled with other treatment options.

Fiorinal with codeine is a combination tablet that contains four different medications. The active ingredients and their mechanism are:

  • Aspirin: Non-steroidal pain medication that can treat pain and fever, available over-the-counter.
  • Butalbital: Barbiturate with sedative and hypnotic properties. Can be used to help with sleep, pain or seizure disorders.
  • Caffeine: Stimulant that also causes vasoconstriction (tightens blood vessels).
  • Codeine: Opioid medication that reduces the sensation of pain.

Fiorinal with codeine is a Schedule III medication as classified by the Drug Enforcement Administration, meaning it has medical use but a high potential for abuse and addiction.

By themselves, codeine and butalbital are controlled medications, so Fiorinal with codeine contains two addictive substances. While this does not increase the overall addictive potential of the drug, it can increase the health risks when it is abused with other substances like alcohol.

What Is Fiorinal With Codeine Used For?

Fiorinal with codeine is indicated to treat tension or muscle contraction headaches. There are no accepted off-label uses for Fiorinal with codeine.

A similar combination tablet called Fioricet with Codeine is available to treat headaches, but contains acetaminophen (Tylenol) instead of aspirin. Both medications are used to treat headaches.

Fiorinal with codeine is a better choice for people with liver problems because acetaminophen can cause or worsen liver damage in some people.

Fiorinal with Codeine Addiction

Fiorinal with codeine contains two substances with addictive potential: butalbital and codeine. Therefore addiction treatment is more complex for people addicted to this combination. Fiorinal with codeine withdrawal symptoms can be any combination of opioid and barbiturate withdrawal symptoms. Withdrawal with the combination is more harmful than either drug by itself.

Symptoms of Codeine Addiction (By Itself) Include:

  • Diarrhea
  • Dilated pupils
  • Goosebumps
  • Irritability
  • Muscle pain
  • Nausea and vomiting
  • Racing thoughts
  • Stomach aches
  • Sweating
  • Trouble sleeping

Learn more about codeine abuse and its symptoms.

Symptoms of Barbiturate Addiction (By Itself) Include:

Barbiturates are considered to be central nervous system depressants. A person who is abusing barbiturates may seem to be:

  • Very relaxed, sleepy or sedated
  • Loss of inhibitions
  • Problems walking
  • Slurred speech

Symptoms of barbiturate abuse can seem similar to those of being drunk from alcohol.

Learn more about barbiturate abuse symptoms.

Symptoms of Withdrawal Include:

Withdrawal from opioids like codeine is uncomfortable, but generally not life-threatening. Barbiturates like butalbital can cause life-threatening withdrawal symptoms such as:

  • Agitation
  • Difficulty sleeping
  • Hallucinations
  • High temperature
  • Seizures
  • Tremors or shaking

Seizures and high body temperature are both medical emergency which can lead to harm or death.

Polysubstance Abuse & Risk of Overdose

Fiorinal with codeine should never be mixed with alcohol or other depressants. Abusing multiple depressants at once can cause seizures, loss of consciousness, slowed breathing, coma and death. When someone overdoses on depressants, their breathing slows and less oxygen reaches the brain. Having low levels of oxygen in the brain is called hypoxia and can cause permanent cognitive impairment and long-term damage. The chances of overdose increase dramatically with polysubstance abuse.

Other depressants to avoid while taking this medication are benzodiazepines, sleeping medication and other opioids or barbiturates.

Key Points: Using Fiorinal with Codeine

Keep the following key points in mind when using Fiorinal with codeine:

  • Fiorinal with codeine contains: aspirin, butalbital, caffeine and codeine
  • Fiorinal with codeine is a controlled substance with addictive potential
  • Two of the active ingredients in Fiorinal with codeine are controlled substances themselves
  • Someone addicted to Fiorinal with codeine who stops taking it may feel withdrawal symptoms from both codeine and butalbital
  • Butalbital withdrawal can be fatal and should happen under the care of a medical professional

Thomas Christiansen
Editor – Thomas Christiansen
With over a decade of content experience, Tom produces and edits research articles, news and blog posts produced for Advanced Recovery Systems. Read more
Conor Sheehy
Medically Reviewed By – Dr. Conor Sheehy, PharmD, BCPS, CACP
Dr. Sheehy completed his BS in Molecular Biology at the University of Idaho and went on to complete his Doctor of Pharmacy (PharmD) at the University of Washington in Seattle. Read more

Food and Drug Administration. “Fiorinal with Codeine: Highlights of […]bing Information.” 1990. Accessed July 22, 2019.

MedlinePlus. “Opiate and Opioid Withdrawal: Medline[…]cal Encyclopedia.” 2016. Accessed July 22, 2019.

National Institute on Drug Abuse. “Prescription CNS Depressants.” 2018. Accessed July 22, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.