Relieve Pain – Pain Treatment

How to Treat Fioricet overdose

The treatment of Fioricet overdose is complicated by the presence of two substances which are highly toxic when taken in excessive amounts. Fioricet overdoses generally result in toxic amounts of both acetaminophen and butalbital being consumed at once, requiring both overdoses to be treated at once.

Fioricet overdose by anyone and/or any consumption by persons to whom it is not prescribed (particularly children) is always a medical emergency and medical attention must be sought immediately if an overdose or consumption by other persons is suspected.

Fioricet overdose is often fatal and symptoms may not present for hours following consumption, once initial overdose symptoms present they can progress rapidly and there may not be time to reach appropriate medical care after this point.

Acetaminophen over-exerts its toxicity through the production of a toxic metabolite which produces liver damage in doses of 3,000mg or more per day and acute liver failure in doses above that. The specific antidote to acetaminophen overdose is N-acetyl-cysteine. Kidney failure and stomach bleeding may also occur.

Butalbital overdoses exerts its toxicity through excessive sedation resulting in respiratory depression and ultimately death via hypoxia. Nonlethal overdoses may also result in coma and death. There is no specific antidote to butalbital overdose and treatment is supportive, common treatment regimens generally include the administration of intravenous administration of saline, naloxone, thiamine, glucose, NaHCO3 to alkalize the urine to increase rate of excretion, and activated charcoal via nasogastric tube. It is not uncommon for doctor to recommend observation of the patient in the Emergency Department for a number of hours or admission to the hospital for several days of observation if symptoms are severe and to counsel the patient on drug abuse and/or refer them for psychiatric evaluation.

Recommended dosages for this drug are based on someone’s age and weight and also the scheduled frequency of taking it.

Acetaminophen overdoses happen when someone:

Takes too much of the pain medication at one time
Re-doses too soon
Takes multiple medications at the same time that also contain acetaminophen

For a healthy adult weighing at least 150 pounds, the maximum daily dose of acetaminophen is 4,000 milligrams (mg). However, you can experience liver damage even if you stay at or below 4,000mg if you take this maximum dose for an extended period.

As such, doctors often recommend a maximum daily dose closer to 3,000 mg. Read the drug label carefully and know exactly how much acetaminophen is in each tablet, capsule or liquid dose.

The following table further details acetaminophen dosage recommendations:

	325mg	500mg	650mg (extended-release)
Take how many pills at a time?	1 or 2	1 or 2	1 or 2
Take how often?	Every 4 to 6 hours	Every 4 to 6 hours	Every 8 hours
Safest maximum daily dose for most adults	8 pills	6 pills	4 pills
Never take more than this in a 24-hour period	12 pills (3,900mg)	8 pills (4000mg)	6 pills (3,900mg)

For children, acetaminophen doses usually come in 80mg and 160mg, although many of the medications are delivered in liquids (syrups), not pills or chewable tablets.

Body weight plays more of a factor in dosing for kids than it does for adults. The smaller and younger a child is the more careful adults must be when giving the correct dosage. Get an updated weight on your child before administering acetaminophen or any medications that have acetaminophen in them.

Here are basic guidelines for children taking acetaminophen:

Child’s Weight	Syrup/Liquid (160mg)	Pills (80mg)
24 to 35 lbs	1 tsp	2 tablets
26 to 47 lbs	1.5 tsp	3 tablets
48 to 59 lbs	2 tsp	4 tablets
60 to 71 lbs	2.5 tsp	5 tablets
72 to 95 lbs	3 tsp	6 tablets
96 or more lbs	4 tsp	8 tablets

An important note: Children under the age of 6 should not take more than one medication at a time that has acetaminophen as an active ingredient.

If your child is younger than 2 years old, check with your pediatrician, an urgent-care physician or pharmacist before giving any medication that contains acetaminophen.

For adults and children, if the recommended dosages don’t relieve symptoms, consult with a doctor before making the decision to increase any dosages. Acetaminophen toxicity can lead to life-threatening acute liver failure.

How Often Can You Take Acetaminophen?

Dosing frequency is a crucial part of how much acetaminophen you can take at one time or during a one-day period. How long it takes acetaminophen to work, duration of its effects, and how long the medication stays in your body determine how often you should re-dose.

The recommended frequency is every four to six hours. After ingestion, it takes acetaminophen between 30 and 90 minutes to start working. Several factors, including formulation, other drug and alcohol intake influence the effects of acetaminophen.

If you have questions about acetaminophen and the right dose for you, speak with your doctor. Discuss other medications you may be taking and your overall health to determine the best plan for your needs.

How Long Does Acetaminophen Work For?

Acetaminophen typically lasts four hours for both pain relief and fever reduction. This is why the recommended dosing frequency is no more than every four to six hours.

The biological half-life of a drug plays an essential role in its effectiveness and safety. It is also an important factor for determining dosage recommendations.

How Long Does Acetaminophen Stay in Your System?

Scientists gauge the time it takes for your body to eliminate acetaminophen from the system by using the medication’s estimated half-life. A drug’s half-life is the time it takes for half a dose to be metabolized and eliminated from your bloodstream. Acetaminophen half-life elimination for therapeutic doses is between one and two-and-a-half (2.5) hours.

However, the expected half-life of acetaminophen can vary from person to person. Factors that affect its half-life include age, genetics, weight and overall health. Generally, a therapeutic dose of acetaminophen flushes fully from your system within 24 hours.

An acetaminophen overdose can extend the half-life of the drug to four and eight, meaning it may take up to three times longer for you to get the drug out of your body. If you re-dose too soon following even a small overdose period, it can lead to an acute case of severe acetaminophen toxicity.

How Much Acetaminophen Is Too Much?

Aside from determining how long acetaminophen works and how long it stays in your system, the drug’s half-life also determines how much is too much to take. The goal of medication is to achieve a steady state, at which point the amount of the drug you ingest and the amount that’s eliminated are equal.

Regardless of a drug’s half-life, it takes approximately four times longer for its concentration to reach a steady state in your body. Acetaminophen side effects often occur when you’re not in a steady state. A small amount of acetaminophen is metabolized into the compound NAPQI, which can cause liver toxicity in large amounts.

Taking too much acetaminophen can cause acute liver damage, which can be fatal. As such, you should not exceed the 4,000 mg maximum daily dose recommendation (you should ideally stay closer to 3,000 mg). Acetaminophen may also effect blood pressure. One 2022 clinical research study found that regular daily intake of 4 g acetaminophen increased systolic blood pressure in individuals with hypertension by about 5 mm Hg compared with a placebo.

Primary symptoms of acetaminophen overdose are:

Abdominal pain
Nausea
Vomiting
Diarrhea
Excessive sweating
Jaundice
Irritability
Seizures
Coma

In case you suspect someone took an overdose of acetaminophen or if you see someone exhibit the above symptoms, you should immediately call 911, emergency medical services, a poison control center or a doctor.

Emergency room treatment will depend on the presenting condition and other drugs that may have been taken. If you make it to the hospital just after taking an overdose, the doctor will attempt to empty your stomach.

Doctors like to prescribe a dose of activated charcoal within four hours of an overdose to bind drugs remaining in your gastro-intestinal tract. They also give N-Acetylcysteine, an antidote for acetaminophen toxicity, orally or intravenously within eight hours.

Emergency doctors recommend that anyone suspected to have taken an acetaminophen overdose get treatment as soon as possible, even before the symptoms occur. Early treatment of acetaminophen overdose can improve the outcome significantly.

Do I Need to Stay on the Same Brand of Gabapentin?

Gabapentin capsules, tablets, and oral solution are used along with other medications to help control certain types of seizures in people who have epilepsy.

Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles).

Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down).

Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.

Most people do not have to stay on the same brand of gabapentin as there’s very little difference between brands.

Talk to your doctor if you have been asked to switch to a different brand and are worried about that.

If your epilepsy has been hard to control in the past and the brand you’re now taking is working well for you, your doctor may recommend you stay on the same one.

Forms and strengths

Generic: Gabapentin

Form: oral capsule
Strengths: 100 mg, 300 mg, 400 mg

Brand: Neurontin

Form: oral capsule
Strengths: 100 mg, 300 mg, 400 mg

Dosage for postherpetic neuralgia

Adult dosage (ages 18–64 years)

Typical starting dosage: Day 1, 300 mg; day 2, 600 mg (300 mg two times per day, spaced evenly throughout the day); day 3, 900 mg (300 mg, three times per day, spaced evenly throughout the day). Your doctor may further increase your dosage after day 3.
Maximum dosage: 1,800 mg per day (600 mg, three times per day, spaced evenly throughout the day)

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years has not been established.

Senior dosage (ages 65 years and older)

Your kidney function may decrease with age. Your body may get rid of this drug more slowly. Your doctor may start you on a lower dose so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous. Your doctor may change your dose based on how well your kidneys are working.

Dosage for partial-onset seizures

Adult dosage (ages 18–64 years)

Typical starting dosage: 900 mg per day (300 mg, three times per day, spaced evenly throughout the day). Your doctor may increase your dose to 2,400–3,600 mg per day.

Child dosage (ages 12–17 years)

Typical starting dosage: 900 mg per day (300 mg, three times per day, spaced evenly throughout the day). The usual maintenance dose is 900–1,800 mg per day, divided into three doses daily. Your doctor may increase this dose to 2,400–3,600 mg per day.

Child dosage (ages 3–11 years)

Typical starting dosage: 10–15 mg/kg/day, divided into three doses, spaced evenly throughout the day. Your child’s doctor may increase the dosage to meet your child’s needs.

Child dosage (ages 0–2 years)

Dosage for people younger than 3 years has not been established.

Senior dosage (ages 65 years and older)

How and When to Take Gabapentin ?

Gabapentin is a prescription medicine. It’s important to take it as advised by your doctor.

Dosage and strength

Each capsule of gabapentin contains 100mg, 300mg or 400mg of gabapentin. Each tablet contains 600mg or 800mg of gabapentin.

If you’re taking gabapentin as a liquid, 2ml is usually the same as taking a 100mg tablet or capsule. Always check the label.

Dosage for epilepsy

The usual dose for:

- adults and older children (aged 12 and over) is 900mg to 3,600mg a day, split into 3 doses
- younger children (aged 6 to 12) – varies depending on their weight

Dosage for nerve pain

The usual dose to treat nerve pain in adults is 900mg to 3,600mg a day, split into 3 doses.

Changes to your dose

To prevent side effects, your doctor will prescribe a low dose to start with and then increase it over a few days. Once you find a dose that suits you, it will usually stay the same.

How to take Gabapentin ?

Swallow gabapentin capsules and tablets whole with a drink of water or juice. Do not chew them.

You can take gabapentin with or without food, but it’s best to do the same each day.

Try to space your doses evenly through the day. For example, you could take it first thing in the morning, early afternoon and at bedtime.

If you or your child are taking a liquid, it will come with a plastic syringe or spoon to measure your dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen spoon, as it will not measure the right amount.

How long to take it for

If you have epilepsy, it’s likely that once your condition is under control you’ll still need to take gabapentin for many years.

If you have nerve pain, once your pain has gone you’ll continue to take gabapentin for several months or longer to stop it coming back.

If you forget to take it

If you forget a dose, take it as soon as you remember. If it’s within 2 hours of the next dose, it’s better to leave out the missed dose and take your next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you have epilepsy, it’s important to take this medicine regularly. Missing doses may trigger a seizure.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking too much gabapentin can cause unpleasant side effects.

Urgent advice: Contact 111 for advice or go to A&E now if:

you take more than your prescribed dose of gabapentin and:

- you feel dizzy or sleepy
- you have double vision
- you start slurring your words
- you have diarrhoea
- you pass out (faint)

If you need to go to A&E, take the gabapentin packet or leaflet inside it, plus any remaining medicine, with you.

Stopping gabapentin

It’s important not to stop taking gabapentin suddenly, even if you feel fine. Stopping gabapentin suddenly can cause serious problems.

If you have epilepsy, stopping gabapentin suddenly can cause seizures that will not stop.

If you’re taking it for any reason and stop suddenly, you may have a severe withdrawal syndrome. This can have unpleasant symptoms, including:

- anxiety
- difficulty sleeping
- feeling sick
- pain
- sweating

It’s possible to prevent withdrawal seizures and other symptoms by gradually reducing the dose of gabapentin.

Do not stop taking gabapentin without talking to your doctor – you’ll need to reduce your dose gradually.

Gabapentin Interactions With Other Medications and Substances

Gabapentin can interact with other prescription and over-the-counter medications, vitamins, and herbal supplements.

People should be sure to give a doctor a full list of their current medications and supplements before taking gabapentin.

The results of another 2017 review suggest that the following are some of the main substances that interact with the drug:

- caffeine, which is present in tea, coffee, and cola
- ethacrynic acid, which is a diuretic
- losartan, which is a medication for high blood pressure
- magnesium oxide, which is a mineral supplement and antacid
- mefloquine, which is an antimalarial drug
- morphine, which is an opioid pain medication
- phenytoin, which is an anti-seizure medication

If gabapentin causes sleepiness, a person should speak with a doctor before taking other medications that can also cause drowsiness, including:

- antianxiety medications
- antidepressants
- antihistamines
- cold and flu medications
- muscle relaxers
- narcotics, which are pain medications
- sleeping pills

Presence of other health conditions

To ensure that gabapentin is safe to take, a person should tell a doctor if they also currently have or have ever had:

- diabetes
- dialysis treatment
- drug or alcohol misuse issues
- heart disease
- kidney disease
- liver disease
- seizures (if taking gabapentin for conditions unrelated to seizures)

Gabapentin oral capsule can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Below is a list of medications that can interact with gabapentin. This list does not contain all drugs that may interact with gabapentin.

Before taking gabapentin, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Opioids

When used with gabapentin, opioids can cause dangerous effects in the body. Some examples of these drugs include morphine, hydrocodone, and oxycodone.

Taking gabapentin with an opioid increases your risk for severe sleepiness, respiratory depression, coma, and even death.

Stomach acid drugs

When used with gabapentin, certain drugs used to treat stomach acid problems can reduce the amount of gabapentin in your body. This can make it less effective. Taking gabapentin 2 hours after taking these drugs can help prevent this problem. Examples of these drugs include:

aluminum hydroxide
magnesium hydroxide

The gabapentin dosage your doctor prescribes will depend on several factors. These include:

the type and severity of the condition you’re using gabapentin to treat
your age
the form of gabapentin you take
other medical conditions you may have

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

What is the Maximum Daily Dosage of Gabapentin?

I’m taking 800mg three times a day for anxiety. It works great. The max recommended dose is 3600mg daily, but I’ve read where some people take up to 4800mg a day. I guess it depends on the person and how they metabolize it.

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

This medicine comes with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have any questions.

If you are using Gralise® tablets:

These should be taken with the evening meal.
Swallow the tablet whole. Do not crush, break, or chew it.

For patients with epilepsy who take gabapentin three times per day, do not allow more than 12 hours to pass between any 2 doses. The medicine works best if a constant amount is in the blood.

Neurontin® capsules, tablets, and solution may be taken with or without food.

You may break the scored Neurontin® tablets into two pieces, but make sure you use the second half of the tablet as the next dose. Do not use the half-tablet if the whole tablet has been cut or broken after 28 days. Ask your doctor or pharmacist if you have any questions.

Swallow the capsule whole with plenty of water. Do not open, crush, or chew it.

Measure the oral liquid using a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

If you take an antacid that contains aluminum or magnesium, wait at least 2 hours before taking gabapentin. Some examples of these antacids are Di-Gel®, Gaviscon®, Gelusil®, Maalox® and Mylanta®.

Only use the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage forms (capsules, liquid, and tablets):
- For epilepsy:
  - Adults and children 12 years of age and older—At first, 300 milligrams (mg) three times per day. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 1800 mg per day (600 mg three times per day).
  - Children 3 to 11 years of age—Dose is based on body weight and must be determined by your doctor. The starting dose is 10 to 15 milligrams (mg) per kilogram (kg) of body weight per day and divided in 3 doses. Your doctor may adjust your dose as needed and tolerated.
  - Children younger than 3 years of age—Use and dose must be determined by your doctor.
- For postherpetic neuralgia:
  - Adults— At first, 300 milligrams (mg) as a single dose in the evening. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 1800 mg per day.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

You should store the Neurontin® oral liquid in the refrigerator. Do not freeze.

Although the FDA says 3600mg/day in most places, they have a more extensive doc about gabapentin/neurontin usage and bioavailability. First, your body can only process a certain amount taken and the rest is excreted, so large doses over their bioavailablity chart don’t give larger effects.

Lyrica and other meds have different bioavailability, so use smaller dosages. Since your kidneys do much of the work with gaba/neurontin, you want to make sure you do not have any kidney problems.

A person may need lower doses or not use it due to that. Second, calcium channel meds like gabapentin are nonlinear, so side effects and benefits vary from person to person.

What works or doesn’t work for one, may be the opposite for another. That is why dosage benefits and side effects vary so much from person to person. Even a small dose might make you sleep, but not to another person.

I have heard from some people their doc may prescribe smaller doses during the day and a larger dose at the time of day more problems appear such as at night.

Gaba/neurontin has a short half life so needs doses spread out during the day. One challenging thing is that people that are on gaba are also on other meds too, so there is going to be confusion about what caused what and if there are interactions.

After a couple years, I was only on gaba. For me on maximum dose, I did sleep more, plus several other side effects. It all comes down to finding the most benefit with the least negatives including cost or as docs say, benefits outweigh the risks. Suggest reading more of this forum for a patient viewpoint.

Does Gabapentin Cause Constipation?

Gabapentin may cause constipation, but it is not a common side effect. In clinical trials of adults taking gabapentin for nerve pain, only about 4% of people reported constipation.

Gabapentin belongs to a class of drugs called anticonvulsants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

It’s not fully understood how gabapentin works. For postherpetic neuralgia, it seems to prevent the increase in sensitivity to pain that occurs. For seizures, it may alter the effect of calcium (low levels of calcium may cause seizures).

Who may not be able to take gabapentin

Gabapentin is not suitable for some people.

To make sure it’s safe for you, tell your doctor if you:

- have ever had an allergic reaction to gabapentin or any other medicine
- have ever misused or been addicted to a medicine
- are trying to get pregnant or are already pregnant
- are on a controlled sodium or potassium diet, or your kidneys do not work well (gabapentin liquid contains sodium and potassium, so speak to your doctor before taking it)

Some people in these trials took an inactive medicine (placebo). About 2% of people taking a placebo also reported constipation, so the actual percentage of people with constipation while taking gabapentin is probably less than 4%.

In clinical trials of people aged 12 and over taking gabapentin for seizure disorder, about 2% reported constipation as a side effect. Out of people taking a placebo, 1% also reported constipation.

In the clinical trials of gabapentin to treat nerve pain in adults, the most common side effects were:

Dizziness
Sleepiness
Swelling in the hands or feet (peripheral edema)

In clinical trials of people older than 12 taking gabapentin to treat a seizure disorder, the most common side effects were sleepiness and clumsiness (ataxia).

Thoughts of death or suicide is another rare but important side effect of gabapentin, occurring in about 1 in 500 people. These thoughts can happen within one week of starting gabapentin. Call your doctor right away if you have any unusual changes in mood or behavior, or any of these symptoms:

Thoughts about suicide or dying
Suicide attempt
Depression, new or worsening
Anxiety, new or worsening
Panic attacks

In 2019, the U.S. Food and Drug Administration (FDA) added another important warning about gabapentin: When this drug is taken with opioid pain medication or used by a person with chronic lung disease like chronic obstructive pulmonary disease (COPD), it may cause severe and possibly fatal difficulty breathing (respiratory depression). Before starting gabapentin, let your doctor know if you are taking any opioid drug, or if you have been diagnosed with a lung disease.

Even if you have side effects from gabapentin, it is important not to stop taking it suddenly on your own. This medication must be reduced over time (tapered) by your doctor. Stopping suddenly can lead to withdrawal symptoms such as:

Anxiety
Insomnia
Nausea
Pain

If you are taking gabapentin to control seizures, stopping suddenly may increase your risk of a seizure.

Does Gabapentin Help you Sleep?

Gabapentin is a prescription medication that may help you sleep. That may be why it has been prescribed for people with insomnia, even though it is not approved for that use.

Gabapentin is an anti-convulsant medication that inhibits the release of excitatory neurotransmitters, allowing for its use against pathologic neurotransmission such as that seen in neuropathic pain and seizure disorders. It has a wide therapeutic index, with doses in excess of 8000 mg/kg failing to cause a fatal reaction in rats.

Gabapentin is ineffective in absence seizures and should be used in caution in patients with mixed seizure disorders involving absence seizures. Gabapentin has been associated with drug reaction with eosinophilia and systemic symptoms (DRESS), otherwise known as multi-organ hypersensitivity. This reaction can prove fatal and early symptoms such as fever, lymphadenopathy, and rash should be promptly investigated.

Gabapentin is available on prescription. It comes as tablets, capsules and a liquid that you swallow.

Key facts

You’ll usually take gabapentin 3 times a day. You can take it with or without food.
Most people who take gabapentin do not get any side effects. But some people may feel sleepy, tired and dizzy. Common side effects are usually mild and go away by themselves.
It takes at least a few weeks for gabapentin to work.
Most people do not have to stay on the same brand of gabapentin as there’s very little difference between brands.
Some people can become addicted to gabapentin after taking it for a long time. When stopping gabapentin you’ll need to reduce your dose gradually to avoid withdrawal symptoms.
If you have epilepsy, you are entitled to free prescriptions for all the medicines you take, not just your epilepsy ones. You can get an application form from your doctor’s surgery.

However, gabapentin enacarbil (Horizant) has been approved by the Food and Drug Administration (FDA) to treat a sleep disorder called restless legs syndrome (RLS).

One of the most common side effects of gabapentin is drowsiness.
In people taking gabapentin for its approved conditions (certain epileptic seizures and postherpetic neuralgia), 19% of patients older than 12 years of age with epilepsy and 21% of patients with postherpetic neuralgia reported drowsiness as a side effect.

Gabapentin and sleep

Most studies show that gabapentin improves slow wave sleep (“deep sleep”) and total sleep time.

Two small studies showed that gabapentin may help people with primary insomnia and occasional sleep disturbance improve total sleep time and wakefulness in the morning.
In other studies, it appears that gabapentin may improve sleep in people with other medical conditions that make it more difficult to sleep, such as alcohol dependence, hot flashes and bipolar disorder.

In a large review of 26 studies on gabapentin and sleep in patients with other medical conditions, the average dose taken daily was about 1,800 mg. Although positive sleep outcomes were reported, the researchers noted that gabapentin was not tolerated as well as placebo and some patients stopped taking it. Misuse and abuse of the drug has also been reported.

It takes about 2 to 3 hours for immediate-release gabapentin to reach its fullest effect, and it’s typically taken 3 times per day.

RLS treatment

Gabapentin may also be used to treat RLS, a disorder that makes it hard to fall asleep or stay asleep. RLS causes an uncontrollable and uncomfortable urge to move your legs, which is worse at night.

The FDA has approved gabapentin enacarbil (Horizant) — a long-acting gabapentin — as a treatment for RLS.

Side effects of gabapentin

The most common side effects with gabapentin include:

Clumsiness
Viral infection
Drowsiness
Nausea and vomiting
Speaking difficulties
Tremor
Swelling, usually involving the legs and feet
Fatigue
Fever
Movements that are jerky
Coordination difficulties
Double vision
Unusual eye movement
Serious reactions can include:
Difficulty breathing
Allergic reactions with swelling of the throat or face

Acetaminophen Mechanism of Action

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.

Acetaminophen, butalbital, and caffeine is a combination medicine used to treat tension headaches that are caused by muscle contractions.

Paracetamol (acetaminophen) is generally considered to be a weak inhibitor of the synthesis of prostaglandins (PGs). However, the in vivo effects of paracetamol are similar to those of the selective cyclooxygenase-2 (COX-2) inhibitors. Paracetamol also decreases PG concentrations in vivo, but, unlike the selective COX-2 inhibitors, paracetamol does not suppress the inflammation of rheumatoid arthritis.

It does, however, decrease swelling after oral surgery in humans and suppresses inflammation in rats and mice. Paracetamol is a weak inhibitor of PG synthesis of COX-1 and COX-2 in broken cell systems, but, by contrast, therapeutic concentrations of paracetamol inhibit PG synthesis in intact cells in vitro when the levels of the substrate arachidonic acid are low (less than about 5 mumol/L).

When the levels of arachidonic acid are low, PGs are synthesized largely by COX-2 in cells that contain both COX-1 and COX-2. Thus, the apparent selectivity of paracetamol may be due to inhibition of COX-2-dependent pathways that are proceeding at low rates.

This hypothesis is consistent with the similar pharmacological effects of paracetamol and the selective COX-2 inhibitors. COX-3, a splice variant of COX-1, has been suggested to be the site of action of paracetamol, but genomic and kinetic analysis indicates that this selective interaction is unlikely to be clinically relevant.

There is considerable evidence that the analgesic effect of paracetamol is central and is due to activation of descending serotonergic pathways, but its primary site of action may still be inhibition of PG synthesis.

The action of paracetamol at a molecular level is unclear but could be related to the production of reactive metabolites by the peroxidase function of COX-2, which could deplete glutathione, a cofactor of enzymes such as PGE synthase.

Important Acetaminophen Warning from FDA

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.

Taking too much acetaminophen can cause liver damage, sometimes serious enough to require liver transplantation or cause death. You might accidentally take too much acetaminophen if you do not follow the directions on the prescription or package label carefully, or if you take more than one product that contains acetaminophen.

To be sure that you take acetaminophen safely, you should

not take more than one product that contains acetaminophen at a time. Read the labels of all the prescription and nonprescription medications you are taking to see if they contain acetaminophen. Be aware that abbreviations such as APAP, AC, Acetaminophen, Acetaminoph, Acetaminop, Acetamin, or Acetam. may be written on the label in place of the word acetaminophen. Ask your doctor or pharmacist if you don’t know if a medication that you are taking contains acetaminophen.
take acetaminophen exactly as directed on the prescription or package label. Do not take more acetaminophen or take it more often than directed, even if you still have fever or pain. Ask your doctor or pharmacist if you do not know how much medication to take or how often to take your medication. Call your doctor if you still have pain or fever after taking your medication as directed.
be aware that you should not take more than 4000 mg of acetaminophen per day. If you need to take more than one product that contains acetaminophen, it may be difficult for you to calculate the total amount of acetaminophen you are taking. Ask your doctor or pharmacist to help you.
tell your doctor if you have or have ever had liver disease.
not take acetaminophen if you drink three or more alcoholic drinks every day. Talk to your doctor about the safe use of alcohol while you are taking acetaminophen.
stop taking your medication and call your doctor right away if you think you have taken too much acetaminophen, even if you feel well.

Talk to your pharmacist or doctor if you have questions about the safe use of acetaminophen or acetaminophen-containing products.

Fioricet Dosing Information and Fioricet Overdose Treatment

Usual Adult Dose of Fioricet for Headache:

Acetaminophen 300 mg, butalbital 50 mg, and caffeine 40 mg:
1 or 2 capsule(s) orally every 4 hours as needed. Maximum daily dose: 6 doses.

Acetaminophen 325 mg, butalbital 50 mg, and caffeine 40 mg:
1 or 2 tablet(s), capsule(s), or tablespoonful(s) orally every 4 hours.
Maximum daily dose: 6 doses

Acetaminophen 500 mg, butalbital 50 mg, and caffeine 40 mg:
1 tablet or capsule orally every 4 hours.
Maximum daily dose: 6 doses

Acetaminophen 750 mg, butalbital 50 mg, and caffeine 40 mg:
1 tablet orally every 4 hours.
Maximum daily dose: 5 tablets

Usual Pediatric Dose of Fioricet for Headache:

12 years and older:
Acetaminophen 300 mg, butalbital 50 mg, and caffeine 40 mg:
1 or 2 capsule(s) orally every 4 hours as needed. Maximum daily dose: 6 doses.

Fioricet Overdose Treatment

The first signs of an acetaminophen overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in your upper stomach, dark urine, and yellowing of your skin or the whites of your eyes.

Overdose symptoms may also include insomnia, restlessness, tremor, diarrhea, increased shallow breathing, uneven heartbeats, seizure (convulsions), or fainting.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of Fioricet can be fatal.

Overdose symptoms may also include insomnia, restlessness, tremor, diarrhea, increased shallow breathing, uneven heartbeats, seizure (convulsions), or fainting.

A single or multiple drug overdose with this combination product is a potentially lethal polydrug overdose, and consultation with a regional poison control center is recommended. Immediate treatment includes support of cardiorespiratory function and measures to reduce drug absorption.

Oxygen, intravenous fluids, vasopressors, and other supportive measures should be employed as indicated. Assisted or controlled ventilation should also be considered.

Gastric decontamination with activated charcoal should be administered just prior to N-acetylcysteine (NAC) to decrease systemic absorption if acetaminophen ingestion is known or suspected to have occurred within a few hours of presentation.

Serum acetaminophen levels should be obtained immediately if the patient presents 4 hours or more after ingestion to assess potential risk of hepatotoxicity; acetaminophen levels drawn less than 4 hours post-ingestion may be misleading.

To obtain the best possible outcome, NAC should be administered as soon as possible where impending or evolving liver injury is suspected. Intravenous NAC may be administered when circumstances preclude oral administration.

Vigorous supportive therapy is required in severe intoxication. Procedures to limit the continuing absorption of the drug must be readily performed since the hepatic injury is dose dependent and occurs early in the course of intoxication.