Generic Name: CODEINE/BUTALBITAL/ASPIRIN/CAFFEINE - ORAL
Pronounced: (KO-deen/AS-pir-in/KAF-een/byou-TAL-bih-tall)

Butalbital Compound-Codeine Oral Interactions

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.

This drug should not be used with the following medications because very serious interactions may occur:

• ketorolac
• mifepristone
• naltrexone
• sodium oxybate

If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting this product.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of:

• acetazolamide
• adenosine
• antacids
• anticholinergic medications (e.g., scopolamine)
• beta agonists (e.g., albuterol)
• "blood thinners" (e.g., warfarin, heparin, ticlopidine)
• certain drugs used to treat gout (e.g., uricosuric drugs such as probenecid, sulfinpyrazone)
• certain antibiotics (e.g., penicillin, sulfonamides such as sulfamethoxazole)
• diabetes drugs (e.g., insulin, sulfonylureas such as glyburide)
• drugs affecting liver enzymes that remove this medication from your body (such as macrolide antibiotics including erythromycin, cimetidine, disulfiram, valproic acid)
• drugs that lower blood pressure (e.g., "water pills"/diuretics such as hydrochlorothiazide, furosemide, ACE inhibitors such as lisinopril, enalapril)
• ginkgo biloba
• lepirudin
• lithium
• MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine)
• 6-mercaptopurine
• methotrexate
• methoxyflurane
• other medications for pain (e.g., pentazocine, nalbuphine, morphine)
• pemetrexed
• phenytoin
• salicylates (e.g., salsalate)
• certain antidepressants (SSRIs such as fluoxetine, fluvoxamine)

This drug can speed up the removal of other drugs from your body by affecting certain liver enzymes. These affected drugs include cyclosporine, corticosteroids such as prednisone, estrogen, felodipine, metronidazole, quinidine, certain beta blockers (such as metoprolol), theophylline, doxycycline.

Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), medicine for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem), muscle relaxants, psychiatric medicines (e.g., chlorpromazine, risperidone, amitriptyline, trazodone).

Check the labels on all your medicines (e.g., cough-and-cold products, other headache medications) because they may contain aspirin, caffeine, or drowsiness-causing ingredients. Also keep in mind that certain beverages (e.g., coffee, colas, tea) contain caffeine. Ask your pharmacist about using those products safely.

Also, check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (NSAIDs such as ibuprofen or naproxen) that are similar to this drug and may increase your risk for side effects if taken together with this medication.

---