butalbital and acetaminophen

INDICATIONS AND USAGE Butalbital and acetaminophen tablets are indicated for the relief of the symptom complex of tension (or muscle contraction) headache. Evidence supporting the efficacy and safety of this combination product in the treatment of multiple recurrent headaches is unavailable. Caution in this regard is required because butalbital is habit-forming and potentially abusable.

DOSAGE AND ADMINISTRATION 25 mg/325 mg: Two tablets every four hours. Total daily dosage should not exceed 12 tablets. 50 mg/325 mg: One to two tablets every four hours as needed. Total daily dosage should not exceed six tablets. 50 mg/300 mg: One or two tablets every four hours. Total daily dosage should not exceed six tablets. Extended and repeated use of these products is not recommended because of the potential for physical dependence.

CONTRAINDICATIONS This product is contraindicated under the following conditions: • Hypersensitivity or intolerance to any component of this product. • Patients with porphyria.

ADVERSE REACTIONS Frequently Observed The most frequently reported adverse reactions are drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, abdominal pain, and intoxicated feeling. Infrequently Observed All adverse events tabulated below are classified as infrequent. Central Nervous: headache, shaky feeling, tingling, agitation, fainting, fatigue, heavy eyelids, high energy, hot spells, numbness, sluggishness, seizure. Mental confusion, excitement or depression can also occur due to intolerance, particularly in elderly or debilitated patients, or due to overdosage of butalbital. Autonomic Nervous System: dry mouth, hyperhidrosis. Gastrointestinal: difficulty swallowing, heartburn, flatulence, constipation. Cardiovascular: tachycardia. Musculoskeletal: leg pain, muscle fatigue. Genitourinary: diuresis. Miscellaneous: pruritus, fever, earache, nasal congestion, tinnitus, euphoria, allergic reactions. Several cases of dermatological reactions, including toxic epidermal necrolysis and erythema multiforme, have been reported. The following adverse drug events may be borne in mind as potential effects of the components of this product. Potential effects of high dosage are listed in the OVERDOSAGE section. A cetaminophen: allergic reactions, rash, thrombocytopenia, agranulocytosis. To report SUSPECTED ADVERSE REACTIONS , contact Quagen Pharmaceuticals LLC at 1-888-344-9603 or www.quagenpharma.com, or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Drug interactions The CNS effects of butalbital may be enhanced by monoamine oxidase (MAO) inhibitors. Butalbital and acetaminophen may enhance the effects of: other narcotic analgesics, alcohol, general anesthetics, tranquilizers such as chlordiazepoxide, sedative-hypnotics, or other CNS depressants, causing increased CNS depression.

DESCRIPTION Each Butalbital and acetaminophen tablets, 25 mg/325 mg for oral administration contains: *Butalbital, USP ............. 25 mg Acetaminophen, USP ................ 325 mg Each Butalbital and acetaminophen tablets, 50 mg/325 mg for oral administration contains: *Butalbital, USP ............. 50 mg Acetaminophen, USP ................ 325 mg Each Butalbital and acetaminophen tablets, 50 mg/300 mg for oral administration contains: *Butalbital, USP ............. 50 mg Acetaminophen, USP ................ 300 mg * Habit forming ingredient In addition, each tablet contains the following inactive ingredients: Colloidal Silicon Dioxide, Croscarmellose Sodium, Crospovidone, Magnesium Stearate, Microcrystalline Cellulose, Povidone, Pregelatinized Starch, Silicified Microcrystalline Cellulose, and Stearic Acid. Butalbital (5-allyl-5-isobutylbarbituric acid), a slightly bitter, white, odorless, crystalline powder, is a short to intermediate-acting barbiturate. It has the following structural formula: Acetaminophen (4'-hydroxyacetanilide), a slightly bitter, white, odorless, crystalline powder, is a non- opiate, non-salicylate analgesic and antipyretic. It has the following structural formula: butalbital structure acetaminophen structure

OVERDOSAGE Following an acute overdosage of butalbital and acetaminophen, toxicity may result from the barbiturate or the acetaminophen. Signs and Symptoms: Toxicity from barbiturate poisoning includes drowsiness, confusion, and coma; respiratory depression; hypotension; and hypovolemic shock. In acetaminophen overdosage: dose-dependent, potentially fatal hepatic necrosis is the most serious adverse effect. Renal tubular necrosis, hypoglycemic coma and coagulation defects may also occur. Early symptoms following a potentially hepatotoxic overdose may include: nausea, vomiting, diaphoresis and general malaise. Clinical and laboratory evidence of hepatic toxicity may not be apparent until 48 to 72 hours post-ingestion. Treatment: A single or multiple drug overdose with these combination products 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.

HOW SUPPLIED Butalbital and Acetaminophen tablets, 25 mg/325 mg: White to off-white, capsule shaped, bi-convex tablets, debossed “A33” on one side and plain on the other side, in bottles of 100 tablets with child-resistance closure (NDC 69292-303-01). Butalbital and Acetaminophen tablets, 50 mg/325 mg: White to off-white, Capsule shaped, bi-convex tablets, debossed “A34” on one side and plain on the other side, in bottles of 100 tablets with child-resistance closure (NDC 69292-302-01). Butalbital and Acetaminophen tablets, 50 mg/300 mg: White to off-white, round bi-convex tablets, debossed “A32” on one side and plain on the other side, in bottles of 100 tablets with child-resistance closure (NDC 69292-301-01). Storage: Protect from light and moisture. Store butalbital and acetaminophen tablets at 25°C (77°F), excursions permitted to 15°C-30°C (59°F-86°F). Dispense in a tight, light-resistant container with a child-resistant closure. Rx only Distributed by: Amici Pharma, Inc. Melville, NY 11747 Code: L7232/00 Rev: 02/2026