ESGIC (BUTALBITAL/ACETAMINOPHEN/CAFFEINE)

Moderate

• A-hydrocort

• A-methapred

• Abilify

• Abilify Discmelt

• Abilify Maintena

• acebutolol

• Activella

• Adasuve

• Adoxa

• Alora

• aminophylline

• Angeliq

• Anucort-hc

• Anusol-hc

• aripiprazole

• Aristospan Intra-articular

• Aristospan Intralesional

• Avidoxy

• betamethasone acet & sod phos

• betaxolol

• budesonide

• Celestone Soluspan

• Cenestin

• chlorpromazine

• Climara

• Climara Pro

• Colocort

• Combipatch

• Compazine

• Compro

• conj estrogens-bazedoxifene

• conjugated estrogens

• Cortef

• Cortenema

• Cortifoam

• cortisone

• Covaryx

• Covaryx H.s.

• Delestrogen

• Depo-estradiol

• Depo-medrol

• dexamethasone

• Dexamethasone Intensol

• dexamethasone sodium phos (PF)

• dexamethasone sodium phosphate

• Dexpak 10 Day

• Dexpak 13 Day

• Dexpak 6 Day

• dextromethorphan-quinidine

• Divigel

• Doryx

• Doxy-100

• doxycycline calcium

• doxycycline hyclate

• doxycycline monohydrate

• drospirenone-estradiol

• Duavee

• Dutoprol

• Eemt

• Eemt Hs

• Elestrin

• Elixophyllin

• Enjuvia

• Entocort Ec

• esterified estrogens

• Estrace

• estradiol

• estradiol acetate

• estradiol cypionate

• Estradiol Transdermal Patch

• estradiol valerate

• estradiol-levonorgestrel

• estradiol-norethindrone acet

• estradiol-norgestimate

• Estrasorb

• Estring

• Estrogel

• estrogens-methyltestosterone

• estropipate

• Evamist

• Ez Use Joint-tunnel-trigger

• felodipine

• Femhrt Low Dose

• Femring

• First-duke's

• First-mary's Mouthwash

• Flagyl

• Flagyl Er

• Flo-pred

• fludrocortisone

• fluphenazine decanoate

• fluphenazine HCl

• fluvoxamine

• Grx Hicort 25

• Haldol

• Haldol Decanoate

• haloperidol

• haloperidol decanoate

• haloperidol lactate

• Hemril-30

• hydrocortisone

• hydrocortisone acetate

• hydrocortisone sod succ (PF)

• hydrocortisone sod succinate

• Inderal La

• Inderal Xl

• Innopran Xl

• isoniazid

• isoniazid-rifamp-pyrazinamide

• Jinteli

• Kenalog

• lithium carbonate

• lithium citrate

• Lithobid

• Lopressor

• Lopressor Hct

• loxapine

• loxapine succinate

• Loxitane

• Luvox Cr

• Medrol

• Medrol (pak)

• Menest

• Menostar

• methylprednisolone

• methylprednisolone acetate

• methylprednisolone sod suc(PF)

• methylprednisolone sodium succ

• methylprednisolone-bupivacaine

• metoprolol su-hydrochlorothiaz

• metoprolol succinate

• metoprolol ta-hydrochlorothiaz

• metoprolol tartrate

• Metro I.v.

• Metrogel Vaginal

• metronidazole

• metronidazole in NaCl (iso-os)

• Millipred

• Millipred Dp

• Mimvey

• Minivelle

• Monodox

• Morgidox

• Nuedexta

• nystatin-hydrocortisone-diphen

• nystatin-TCN-HC-diphenhydramin

• Ogen 2.5

• Oracea

• Orapred

• Orapred Odt

• Pediapred

• perphenazine

• perphenazine-amitriptyline

• Phenadoz

• Phenergan

• Physicians Ez Use M-pred

• prednisolone

• prednisolone acetate

• prednisolone sodium phosphate

• prednisone

• Prednisone Intensol

• Prefest

• Premarin

• prochlorperazine

• prochlorperazine Edisylate

• prochlorperazine maleate

• Proctocort

• promethazine

• Promethazine Vc

• Promethazine Vc-codeine

• promethazine-codeine

• promethazine-DM

• promethazine-phenyleph-codeine

• promethazine-phenylephrine

• Promethegan

• propranolol

• propranolol-hydrochlorothiazid

• quinidine gluconate

• quinidine sulfate

• Rayos

• Rectacort-hc

• Rifamate

• rifampin-isoniazid

• Rifater

• Risperdal

• Risperdal Consta

• Risperdal M-tab

• risperidone

• risperidone microspheres

• Sectral

• Seroquel

• Solu-cortef

• Solu-cortef (pf)

• Solu-medrol

• Solu-medrol (pf)

• synthetic conj estrogens A

• synthetic conj estrogens B

• Theo-24

• Theochron

• theophylline

• theophylline in dextrose 5 %

• thioridazine

• Toprol Xl

• triamcinolone acetonide

• triamcinolone hexacetonide

• triamcinolone-lidocaine

• trifluoperazine

• Uceris

• Vagifem

• Vandazole

• Veripred 20

• Vibramycin

• Vivelle-dot

Moderate

• Anemia

• Cardiac arrhythmia

• Complex sleep behavior

• Disease of liver

• Hyperkinesis

• Hypertension

• Insomnia

• Kidney disease with reduction in GFR

• Neutropenic disorder

• Renal disease with moderate to severe impairment

• Seizure disorder

• Severe hepatic disease

• Thrombocytopenic disorder

Acetaminophen

• Severity Level:

  2

• Additional Notes: Available data suggest no known risk; otc product, no fda pregnancy warnings

Butalbital

• Severity Level:

  C

• Additional Notes: Case report of neonatal withdrawal seizures with butalbital combo product

Caffeine

• Severity Level:

  C

• Additional Notes: Reports of miscarriage,poor fetal growth possibly assoc w/high doses of caffeine

Contraindicated

None

General	Excretion Potential	Effect on Infant	Notes
			None

Precaution Exists

Butalbital

Possibility of central nervous system depression in nursing infant.

High doses may cause hyperactivity and wakefulness in infant.

General	Excretion Potential	Effect on Infant	Notes
Evaluate use carefully	Excreted	Drug shown to have adverse effect	Possibility of central nervous system depression in nursing infant.

Caffeine

Possibility of central nervous system depression in nursing infant.

High doses may cause hyperactivity and wakefulness in infant.

General	Excretion Potential	Effect on Infant	Notes
Evaluate use carefully	Excreted	Drug shown to have adverse effect	High doses may cause hyperactivity and wakefulness in infant.

No Known Risk

Acetaminophen

Low levels excreted with low risk for adverse effects in infant

General	Excretion Potential	Effect on Infant	Notes
No known risks; does not adversely affect lactation	Excreted	No adverse effect	Low levels excreted with low risk for adverse effects in infant

Contraindicated

None

Precaution Exists

Acetaminophen (oral,rectal)

Hepatic-Elderly may be more susceptible to hepatotoxicity. Strict adherence to a maximum daily dose is recommended, and the maximum dose recommendation varies between 3000-3800 mg depending on strength used and source of the recommendation.

General-Not recommended in the elderly due to sedation which may predispose to falls. May exacerbate depression. Renal-Renal excretion may increase adverse events with renal impairment. Monitor renal function.

Organ / System	HEP	REN	CARD	ENDO	NEURO / PSYCH	PULM
Increased Risk / Adverse Effects	N	Y	N	N	N	N

BEERS: N     HEDIS: N     STOPP: N

Butalbital

Hepatic-Elderly may be more susceptible to hepatotoxicity. Strict adherence to a maximum daily dose is recommended, and the maximum dose recommendation varies between 3000-3800 mg depending on strength used and source of the recommendation.

General-Not recommended in the elderly due to sedation which may predispose to falls. May exacerbate depression. Renal-Renal excretion may increase adverse events with renal impairment. Monitor renal function.

Organ / System	HEP	REN	CARD	ENDO	NEURO / PSYCH	PULM
Increased Risk / Adverse Effects	Y	Y	N	Y	N	N

BEERS: Y     HEDIS: Y     STOPP: Y

No Known Risk

None

0-9	A-Z
G44.2	Tension-type headache
G44.20	Tension-type headache, unspecified
G44.201	Tension-type headache, unspecified, intractable
G44.209	Tension-type headache, unspecified, not intractable
G44.21	Episodic tension-type headache
G44.211	Episodic tension-type headache, intractable
G44.219	Episodic tension-type headache, not intractable
G44.22	Chronic tension-type headache
G44.221	Chronic tension-type headache, intractable
G44.229	Chronic tension-type headache, not intractable