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Before Using This Medicine Breast-feeding—

- 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.

Possible Side Effect Check with your doctor immediately if any of the following side effects occur, especially if several of them occur together:

Bleeding or crusting sores on lips; chest pain; fever with or wi thout chills; hive-like swellings (large) on eyelids, face, lips, and/or tongue ; muscle cramps or pain; red, thickened, or scaly skin; shortness of breath, troubled breathing, tightness in chest, or wheezing; skin rash, itching, or hives; sores, ulcers, or white spots in mouth (painful); sore throat

Symptoms of overdose may include: Anxiety, confusion, excitement, irritability, nervousness, restlessness, or trouble in sleeping (severe, especially with products containing caffeine) ; convulsions (seizures) (for products containin g caffeine); diarrhea, especially if occurring together with increased sweating, loss of appetite, and stomach cramps or pain; dizziness, lightheadedness, drowsiness, or weakness, (severe) ; freque nt urination (for products containing caffeine) ; hallucinations (seeing, hearing, or feeling things that are not there); increased sensitivity to touch or pain (for products containing caffeine); muscle trembling or twitching (for products containing caffeine); nausea or vomiting, sometimes with blood;

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)—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

Description Esgic contains Acetaminophen / butalbital / caffeine. Acetaminophen is a pain reliever and fever reducer. Butalbital is in a class of drugs called barbiturates that slow down your central nervous syst em (brain and nerve impulses) causing relaxation. Caffeine is believed to constrict dilated blood vessels that may contribute to tension headaches. Together, acetaminophen, butalbital, and caffeine ar e used to relieve complex tension (muscle contraction) headaches although precisely how it works is unknown.

Cautions The butalbital in this medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressant s are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; other prescription pain medicine; narcotics; other barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Also, drinking large amounts of alcoholic beverages regularly while taking this medicine may increase the chance of live r damage, especially if you take more of this medicine than your doctor ordered or if you take it regularly for a long time.

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