Check with your doctor:

• If the medicine stops working as well as it did when you first started using it. This may mean that you are in danger of becoming dependent on the medicine. Do not try to get better pain relief by increasing the dose.
• If you are having headaches more often than you did before you started taking BUTALBITAL. This is especially important if a new headache occurs within 1 day after you took your last dose of BUTALBITAL, headaches begin to occur every day, or a headache continues for several days in a row. This may mean that you are dependent on the medicine. Continuing to take BUTALBITAL will cause even more headaches later on. Your doctor can give you advice on how to relieve the headaches.

Check the labels of all nonprescription (over-the-counter [OTC]) or prescription medicines you now take. If any contain a barbiturate or acetaminophen, check with your health care professional. Taking them together with BUTALBITAL may cause an overdose.

The butalbital in BUTALBITAL 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 depressants 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 BUTALBITAL may increase the chance of liver damage, especially if you take more of BUTALBITAL than your doctor ordered or if you take it regularly for a long time. Therefore, do not drink alcoholic beverages, and check with your doctor before taking any of the medicines listed above, while you are using BUTALBITAL.

BUTALBITAL may cause some people to become drowsy, dizzy, or lightheaded. Make sure you know how you react to BUTALBITAL before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert and clearheaded.

Before you have any medical tests, tell the person in charge that you are taking BUTALBITAL. Caffeine (present in some butalbital and acetaminophen combinations) interferes with the results of certain tests that use dipyridamole (e.g., Persantine) to help show how well blood is flowing to your heart. Caffeine should not be taken for 8 to 12 hours before the test. The results of other tests may also be affected by butalbital and acetaminophen combinations.

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

If you have been taking large amounts of BUTALBITAL, or if you have been taking it regularly for several weeks or more, do not suddenly stop taking it without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are taking before stopping completely in order to lessen the chance of withdrawal side effects.

If you think you or anyone else may have taken an overdose of BUTALBITAL, get emergency help at once. Taking an overdose of BUTALBITAL or taking alcohol or CNS depressants with BUTALBITAL may lead to unconsciousness or possibly death. Signs of butalbital overdose include severe drowsiness, confusion, severe weakness, shortness of breath or unusually slow or troubled breathing, slurred speech, staggering, and unusually slow heartbeat. Signs of severe acetaminophen poisoning may not occur until 2 to 4 days after the overdose is taken, but treatment to prevent liver damage or death must be started within 24 hours or less after the overdose is taken.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

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

• Rare
  • Bleeding or crusting sores on lips;  chest pain;  fever with or without 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
  • Anxiety, confusion, excitement, irritability, nervousness, restlessness, or trouble in sleeping (severe, especially with products containing caffeine) ;  convulsions (seizures) (for products containing caffeine);  diarrhea, especially if occurring together with increased sweating, loss of appetite, and stomach cramps or pain;  dizziness, lightheadedness, drowsiness, or weakness, (severe) ;  frequent 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;  ringing or other sounds in ears (for products containing caffeine);  seeing flashes of ``zig-zag'' lights (for products containing caffeine);  shortness of breath or unusually slow or troubled breathing;  slow, fast, or irregular heartbeat;  slurred speech;  staggering;  swelling, pain, or tenderness in the upper abdomen or stomach area;  unusual movements of the eyes 
  
  

Also, check with your doctor as soon as possible if any of the following side effects occur:

• Less common
  • Confusion (mild);  mental depression ;  unusual excitement (mild) 
  
  

• Rare
  • Bloody or black, tarry stools;  bloody urine;  pinpoint red spots on skin;  swollen or painful glands;  unusual bleeding or bruising ;  unusual tiredness or weakness (mild) 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Bloated or ``gassy'' feeling;  dizziness or lightheadedness (mild);  drowsiness (mild);  nausea, vomiting, or stomach pain (occurring without other symptoms of overdose) 
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.