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Before Using This Medicine
Breast-feedingˇX

- For butalbital: Barbiturates such as butalbital pass into the breast milk and may cause drowsiness, unusually slow heartbeat, shortness of breath, or troubled breathing in nursing babies.
- For acetaminophen: Although acetaminophen has not been shown to cause problems in nursing babies, it passes into the breast milk in small amounts.
- For caffeine: Caffeine (present in some butalbital and acetaminophen combinations) passes into the breast milk in small amounts. Studies have shown that nursing babies may appear jittery and have trouble in sleeping when th eir mothers drink large amounts of caffeine-containing beverages.

Why is this drug prescribed?
Butalbital and acetaminophen (byoo-TAL-bi-tal and a-seat-a-MIN-oh-fen) combination is a pain reliever and relaxant. It is used to treat tension headaches. Butalbital belongs to the group of medicines called barbiturates (bar-BI-tyoo-rates) . Barbiturates act in the central nervous system (CNS) to produce their effects.

When you take butalbital for a long time, your body may get used to i t so that larger amounts are needed to produce the same effects. This is called tolerance to the medicine. Also, butalbital may become habit-forming (causing mental or physical dependence) when it is used for a long time or in large doses. Physical dependence may lead to withdrawal side effects when you stop taking the medicine.

Missed Dose
Take the missed dose as soon as you remember. Do not takedouble dose of Esgic . Wait the prescribed amount of time before taking your next dose.

What side effects may occur?
Although side effects from acetaminophen, butalbital, and caffeine are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

- drowsiness
- upset stomach
- vomiting
- stomach pain
- depression
- lightheadedness
- confusion

If you experience any of the following symptoms, call your doctor immediately:
- skin rash
- itching
- difficulty breathing

Symptoms of overdose
Seek emergency medical attention. Symptoms of an acetamino phenbutalbita lcaffeine - Esgic overdose include insomnia, restlessness, tremor, nausea, vomiting, diarrhea, abdominal pain, sweating, seizur es, drowsiness, decreased breathing,

Other Medicines
It is especially important that your health care professional know if you are taking any of the following:

- Antidepressants, tricyclic (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendi n], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [ e.g., Surmontil]) or
- Central nervous system (CNS) depressants (medicines that often cause drowsiness)ˇXThese medicines may add to the effects of butalbital and increase the chance of drowsiness or other side effects
- Divalproex (e.g., Depakote) or
- Valproic acid (e.g., Depakene)ˇXThe chance of side effects may be increased




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