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Compare Fioricet vs. Topamax

What is Fioricet?

Fioricet (butalbital / acetaminophen / caffeine) works well for tension headaches, but isn’t typically recommeneded as a first-line treatment due to the ability to overuse it and have withdrawal symptoms.  Fioricet capsules contain a combination of acetaminophen, butalbital, and caffeine. Acetaminophen is a pain reliever and fever reducer. Butalbital is in a group of drugs called barbiturates. It relaxes muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

Fioricet is used to treat tension headaches that are caused by muscle contractions.

Extended and repeated use of Fioricet is not recommended because of the potential for physical dependence.

  • Fioricet (butalbital / acetaminophen / caffeine) works better and faster in treating tension headaches than the combination of acetaminophen and codeine.
  • Fioricet (butalbital / acetaminophen / caffeine) has a cheaper, generic version.
  • Fioricet (butalbital / acetaminophen / caffeine) does not require dosage adjustments if you have kidney and liver problems.

What is Fioricet used for ?

  • Tension headache
  • Muscle contraction headache

What is the disadvantages of Fioricet ?

  • Fioricet (butalbital / acetaminophen / caffeine) isn’t the first choice medication for treating tension headaches.
  • Fioricet (butalbital / acetaminophen / caffeine) is not a good medication for long-term use.
  • Overuse of Fioricet (butalbital / acetaminophen / caffeine) can lead to chronic tension headaches.
  • Fioricet (butalbital / acetaminophen / caffeine) can cause dangerous withdrawal symptoms, intoxication, and dependence.
  • Taking Fioricet (butalbital / acetaminophen / caffeine) can decrease your ability to drive a car, or operate machinery.

Fioricet Dosage forms

  • Pill
  • Solution

Fioricet Side Effects

The Fioricet (butalbital / acetaminophen / caffeine) FDA package insert doesn’t have numbers about how common side effects are.

Risks and risk factors of Fioricet

  • Liver toxicity
    • Drinking more than 2 alcoholic beverages a day
    • Taking Fioricet (butalbital / acetaminophen / caffeine) with other acetaminophen-containing medicines
    • History of liver disease
  • Potential for habit-forming, abuse, and misuse
    • Personal or family history of substance abuse
    • History of mental illness
  • Hypersensitivity (allergic) reactions
    • Allergy to Fioricet (butalbital / acetaminophen / caffeine)

Topamax (topiramate)


TOPAMAX® is indicated for:


Adults and adolescents 12 years of age and older for the prophylaxis of migraine headache. The usefulness of TOPAMAX® in the acute treatment of migraine headache has not been studied.

Monotherapy Epilepsy

Initial monotherapy in patients 2 years of age and older with partial onset or primary generalized tonic-clonic seizures. Safety and effectiveness in patients who were converted to monotherapy from a previous regimen of other anticonvulsant drugs have not been established in controlled trials.

Adjunctive Epilepsy

Adjunctive therapy for adults and pediatric patients ages 2 to 16 years with partial onset seizures or primary generalized tonic-clonic seizures, and in patients 2 years of age and older with seizures associated with Lennox-Gastaut syndrome.

What is Topamax used for ?

  • Seizures
  • Migraine prevention
  • Alcoholism
  • Essential tremors
  • Eating disorder

Prevents seizures and migraine headaches.

Topamax (topiramate) is very effective at preventing many types of seizures and migraines, but it can cause several severe side effects that can lead to stopping the medication.

  • Can lower your number of seizures and also prevent migraine headaches. This medicine can be used on its own or with other antiepileptic medicines to lower the frequency of seizures.
  • Doesn’t need routine blood tests like similar medications.
  • Available in short-acting and long-acting forms.
  • Comes as a generic, so it’s relatively cheap.

What is the disadvantages of Topamax ?

  • Can cause many severe side effects. People starting Topamax (topiramate) need to be monitored for these effects as soon as they start treatment.
  • This medicine can take 4 to 6 weeks for the full effects of this medication to kick in, especially for people taking it for migraines.
  • Children taking Topamax (topiramate) for long periods of time need to have their dose adjusted by their pediatrician as they grow.
  • At higher doses (ie. 400 mg/day), children may experience difficulty with concentration/attention, fever, flushing, and confusion.

Topamax Dosage Form

  • Pill
  • Extended release capsule

Topamax Side Effects

  • Sleepiness                                        26%
  • Loss of appetite                               24%
  • Fatigue                                             16%
  • Injury                                                14%
  • Nervousness                                     14%
  • Personality disorder (behavior problems)  11%
  • Difficulty with concentration/attention      10%
  • Weight loss                                       9%
  • Aggressive reaction                          9%
  • Abnormal gait                                   8%
  • Purpura                                             8%
  • Difficulty sleeping                             8%
  • Viral infection                                    7%
  • Impaired coordination                      6%
  • Nausea                                              6%
  • Increased saliva                                 6%
  • Muscle spasm                                    5%
  • Constipation                                      5%
  • Difficulty with memory                      5%
  • Pneumonia                                        5%
  • Dizziness                                            4%
  • Speech disorders/ related speech problems      4%
  • Nose bleed                                         4%
  • Confusion                                           4%
  • Urinary incontinence                          4%
  • Stomach flu                                         3%
  • Psychomotor slowing                         3%
  • Skin disorder                                      3%
  • Allergic reaction                                 2%
  • Abnormal reflexes                              2%
  • Thirst                                                  2%
  • Pussing                                               2%
  • Hair loss                                              2%
  • Dermatitis                                            2%
  • Increased hair growth                         2%
  • Red skin rash                                      2%
  • Eye abnormality                                 2%
  • Abnormal vision                                 2%
  • Leukopenia                                        2%

Risks and risk factors of Topamax

  • Suicidal thoughts or behavior
    • History of depression
  • Fever and inability to sweat
    • Children
  • Mental and cognitive changes
    • History of metabolic disorders
    • People also taking Depakote
  • Kidney stones
    • Low-carb diet
    • Dehydration
    • Drug interactions
  • Vision problems
  • Withdrawal seizures
    • Stopping Topamax (topiramate) suddenly

How Long Can You Stay On Topamax?

Generally, it can take 2 to 3 months for Topamax to fully work. Once your condition is under control, you’ll usually need to keep taking Topamax for many years. Is it safe to take long term? Yes, many people take Topamax safely for many months or years.

What drugs can interact with Topamax?

Topamax can cause drug interactions with other medicines and cause side effects. There may be certain medications you should avoid while taking Topamax. Do not start a new prescription or over-the-counter medicine without talking with your healthcare provider first.

Tell your healthcare provider if you take:

  • Valproic acid (brand name examples: Depakote). Taking Topamax when you are also taking valproic acid can cause a drop in your body temperature to less than 95 degrees F (35 degrees C), or can cause tiredness, confusion, or coma. Taking these medicines may also cause raised levels of ammonia in your blood.
  • Zonisamide (brand name example: Zonegran). Using zonisamide with Topamax can cause metabolic acidosis, a condition that causes high levels of acid in your blood. Combining these medicines may increase the risk and severity of this side effect.
  • Glaucoma medications, including eye drops.
  • Birth control pills. Topamax may make your birth control pills less effective. Tell your doctor if you experience any breakthrough bleeding (menstrual bleeding changes) if you are taking birth control pills and Topamax. Ask your doctor about using a non-hormonal birth control (condom, diaphragm, cervical cap, or contraceptive sponge) to prevent pregnancy.
  • Medicines that impair or decrease your thinking, concentration, or muscle coordination.

Not all possible drug interactions are listed above. This list is not complete and other medicines can affect Topamax. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter (OTC) medicines, vitamins, and herbal supplements.

Take a list of your medicines to your appointments so your doctor can review for any possible drug interactions. You can also take your medicine bottles (including OTC medications) with you and show them to your doctor if that is easier.

Frequently Asked Questions About Topamax

Can I take vitamin C with Topamax?

No interactions were found between Topamax and Vitamin C.

When should you not take Topamax?

People with chronic kidney disease conditions should avoid taking this medication as long-term side effects of Topamax are more common among people with kidney conditions.

Can you take vitamin D with Topamax?

No interactions were found between Topamax and Vitamin D3. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

What does Topamax do to your brain?

Topamax works by reducing the spread of seizure activity in the brain and restoring the normal balance of nerve activity. For epilepsy – brain cells normally “talk” to each other using electrical signals and chemicals. Seizures can happen when the brain cells are not working properly or working faster than normal.

What painkillers can I take with Topamax?

Paracetamol and most other over-the-counter medicines can be safely taken with Topamax. Over-the-counter medicines are those that can be bought without a prescription.

Why is Topamax considered a hazardous drug?

Topamax can increase the level of acid in your blood (metabolic acidosis). This can weaken your bones, cause kidney stones, cause growth problems in children, or harm an unborn baby.

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