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Special warnings about this medication
Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine. Serious side effects can occur if y our medical doctor or dentist gives you certain medicines without knowing that you have taken butalbital.

Other medical problems
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For butalbital and acetaminophen combinat ions, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to butalbital or other barbiturates, or to acetaminophen, aspirin, r caffeine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Drug Interactions
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)—These 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)—The chance of side effects may be increased

Side Effects
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

What is this medicine
Some butalbital and acetaminophen combinations also contain caffeine (KAF-een) . Caffeine may help to relieve headaches. However, caffeine can also cause physical dependence when it is used for a long time. This may lead to withdrawal (rebound) headaches when you stop taking it.

Butalbital and acetaminophen combination may also be used for other kinds of headaches or other kinds of pain a s determined by your doctor.

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.

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