acetaminophen + caffeine + butalbital + codeine

**Acetaminophen + caffeine + butalbital + codeine** is an oral fixed-dose combination pharmaceutical composed of acetaminophen, caffeine, butalbital, and codeine phosphate, marketed in the United States under brands including **Fioricet with Codeine** and **Phrenilin with Caffeine and Codeine**. It is indicated for the management or relief of the symptom complex of **tension headache** or **muscle contraction headache**, particularly when non-opioid and other alternative treatments are inadequate. Pharmacologically, the product combines a non-opioid analgesic and antipyretic (acetaminophen), a barbiturate central nervous system depressant with sedative and muscle-relaxant properties (butalbital), a methylxanthine central nervous system stimulant that can augment analgesic efficacy (caffeine), and an opioid agonist analgesic (codeine, acting primarily via mu-opioid receptors). The combination is a **small molecule** multi-ingredient analgesic product administered as an oral capsule, commonly in strengths such as 300 mg or 325 mg acetaminophen, 50 mg caffeine, 40 mg butalbital, and 30 mg codeine phosphate. Its clinical use is constrained by risks of addiction, abuse, misuse, medication-overuse headache, sedation, respiratory depression, and acetaminophen hepatotoxicity.

Brand names

Fioricet with CodeinePhrenilin with Caffeine and Codeine

Other names

butalbital + acetaminophen + caffeine + codeine phosphatebutalbital + acetaminophen + caffeine + codeinebutalbital, acetaminophen, caffeine, and codeine phosphate capsules