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Esgic Plus, a pain reliever for treating tension headaches, is available as brand or generic (Zebutal). Below are the most frequently asked questions about Esgic Plus (Zebutal).
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:: What is Esgic Plus (Zebutal)?
Esgic Plus is the brand name of the combination drug containing Butalbital 50mg, Acetaminophen 500mg, and Caffeine 40mg.
Esgic Plus (Zebutal) is a FDA-approved pain-relief medication used for the treatment of tension headaches. It is manufactured by Forest Pharmaceuticals based in Cincinnati, Ohio, USA.
Generic Esgic Plus is made by various US manufacturers. Zebutal is the name of the generic preparation of Esgic Plus made by First Horizon Pharmaceuticals based in Alpharetta, Georgia, USA.
Esgic Plus, Zebutal, and Butalbital 50mg/Acetaminophen 500mg/Caffeine 40mg tablets and capsules all contain the same active ingredients.
You can buy brand Esgic Plus through our Esgic Plus price comparison page where you can select your preferred online US pharmacy with the lowest Esgic Plus prices, no prior prescription required.
Or if you prefer, you can buy generic Esgic Plus or Zebutal (Butalbital 50mg/Aceta-minophen 500mg/Caffeine 40mg) through our Zebutal price comparison page .
If this is the first time you are ordering Esgic Plus (Zebutal) online, see our beginner’s guide , where the process of obtaining a prescription online and ordering your medication is explained.
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:: Who should take Esgic Plus (Zebutal)?
Esgic Plus (Zebutal) should be used for patients who need effective relief of tension headaches.
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:: Who should not take Esgic Plus (Zebutal)?
You should not take Esgic Plus (Zebutal) if you:
- Have porphyria, a group of different genetic disorders caused by abnormalities in
the chemical production of heme. Heme is a substance in the blood and bone
marrow needed to carry oxygen. Porphyria disorders are grouped into two
categories, cutaneous (affecting the skin) or acute (affecting the nervous
system). Barbiturates such as butalbital can trigger attacks in people with
porphyria disorder leading to symptoms such as blisters, itching, and swelling of
skin; pain in the chest, abdomen, limbs, or back; muscle numbness, tingling, or
cramping; vomiting; constipation; and personality changes.
- Are allergic to Esgic Plus (Zebutal), Fioricet, butalbital, acetaminophen, caffeine,
or any other component of this product.
- Have severe liver disease.
It is important to let your doctor know, during either a physical or online consultation, about any prescription or over-the-counter medications you are taking especially sleeping pills, antihistamines, sedatives and tranquilizers, and if you have or have had other medical conditions especially liver problems, kidney problems or alcohol/drug dependence. Your doctor may need to adjust your dosage.
Esgic Plus (Zebutal) is not recommended for use in pregnant women unless the potential benefits outweigh the risks. There are no adequate and well-controlled studies in pregnant women. Esgic Plus (Zebutal) is secreted in human milk, which can lead to the potential for serious adverse reactions in nursing infants. Women should notify their doctor if they become pregnant or intend to become pregnant while taking Esgic Plus (Zebutal).
Only your healthcare provider can tell you for sure if you should or not take Esgic Plus (Zebutal). Inform your healthcare provider, during either a physical or online consultation, about all the medicines you are taking, prescription or over-the-counter, and about any medical conditions you have or have had, including allergies.
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:: What is a tension headache?
A tension headache is usually described as a condition involving dull pain or achy feeling in the head, scalp, or neck. Tension headaches are also often associated with muscle tightness in these areas. Tension headaches are one of the most common forms of headache.
Tension headaches are caused by muscle contractions of the neck and scalp muscles. These muscle contractions can be caused by various factors such as stress, anxiety, depression, holding your head in one position for a long time, sleeping in a cold room or sleeping with your neck in an uncomfortable position. Other causes include eye strain, fatique, overexertion; excessive use of alcohol, caffeine or smoking; colds, flu, sinus infection or congestion; excessive noise or bright light.
Symptoms of tension headaches can include: dull, pressure like pain, which can be either general or worse in the scalp, temples or back of the head. Pain is usually on both sides of the head and can feel like a vise or tight band around the head. Tension headaches can also lead to difficulty sleeping. Tension headaches can occur occassionaly or every day. If a headache occurs two or more times per week for several months or longer, the condition is considered chronic.
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:: How does Esgic Plus (Zebutal) work?
The exact mechanism of action and the role each component plays in relieving the symptoms of tension headaches are not completely understood.
Butalbital is a barbiturate, which slows down your central nervous system (brain and nerve impulses) causing anti-anxiety and muscle relaxant effects.
Acetaminophen is a pain reliever and fever reducer which inhibits the production of compounds in your nervous system that make pain receptors more sensitive to stimulation.
Dilated blood vessels are thought to be a factor in causing tension headaches. Caffeine is believed to constrict dilated blood vessels thereby relieving pain; it also may help acetaminophen work faster or better.
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:: How well does Esgic Plus (Zebutal) work?
A study comparing the effects of Fioricet , a butalbital/acetaminophen/caffeine combination similar to Esgic Plus, with sugar pill found Fioricet to be significantly better for decreasing pain intensity and complete pain relief at 2 and 4 hours.
Fioricet lead to complete pain relief at 2 hours in 27% of patients versus 12% taking sugar pill, and at four hours in 56% of patients versus 39% taking sugar pill. This same study also found that patients taking Fioricet did not have more side effects than patients taking sugar pill.
Another study compared the effects of Fioricet with the combination acetaminophen/codeine (Tylenol with Codeine No. 3), and found that although there was no difference with complete pain relief at 2 hours, Fioricet was significantly better at four hours.
More patients, 56%, had complete pain relief with Fioricet at four hours versus 39% of patients taking acetaminophen with codeine. This study also reported that there was no difference in the intensity or amount of side effects in patients taking Fioricet versus acetaminophen with codeine.
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:: How safe is Esgic Plus (Zebutal)?
Esgic Plus has been used since 1996 but Fioricet a similar combination medication has been used since 1984. Its safety and efficacy profile have been maintained by real-world experience as well as clinical trials.
Esgic Plus (Zebutal) has been approved by the FDA to successfully and safely treat tension headaches. However, Esgic Plus (Zebutal) may not be for everyone. Make sure to read about Who should not take Esgic Plus? .
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:: What does Esgic Plus (Zebutal) look like?
Esgic Plus is available as brand or generic.
Brand Esgic Plus
Forest Pharmaceuticals based in Cincinnati, Ohio, USA, manufacture:
Esgic Plus 50mg butalbital, 500mg acetaminophen, and 40mg caffeine combination tablet, white, oblong, with the imprint FOREST on one side, and 678 to the right of the score line on the other side.
Esgic Plus 50mg butalbital, 500mg acetaminophen, and 40mg caffeine combination capsule, red, opaque, with FOREST 0372 printed in white on the cap, and Esgic Plus printed in white on the body.
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Generic Esgic Plus - Zebutal is made by various companies including the following:
Zebutal, 50mg butalbital, 500mg acetaminophen, and 40mg caffeine combination, is the name of the generic form of the Esgic Plus capsule, and is made by First Horizon Pharmaceuticals, based in Alpharetta, Georgia, USA. Zebutal capsules are red, opaque, with HPC printed in white on the body, and 170 printed in white on the cap.
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50mg butalbital, 500mg acetaminophen, and
40mg caffeine combination tablets, manufactured
by Able Laboratories, based in South Plainfield, New Jersey, USA, are white, oblong, with the imprint A235 on one side, and scored on the other side.
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50mg butalbital, 500mg acetaminophen, and
40mg caffeine combination tablets, manufactured
by Inwood Laboratories, a subsidiary of Forest Labs., based in Commack, New York, USA, are white, oblong, with the imprints of the Inwood Labs IL logo and 3657 separated by the score line on one side, and nothing on the other side.
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50mg butalbital, 500mg acetaminophen, and
40mg caffeine combination tablets, manufactured
by West Ward Pharmaceuticals, based in Eatontown, New Jersey, USA, are white, oblong, with the imprints WW and 115 separated by the score line on one side, and nothing on the other side.
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Your pills may look different, consult your physician or pharmacist if you have any questions.
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:: How do I take Esgic Plus (Zebutal)?
Esgic Plus (Zebutal) tablets/capsules come in one dosage combination of butalbital 50mg, acetaminophen 500mg and caffeine 40mg only. Esgic Plus (Zebutal) may be taken with or without food. Take it with food if it upsets your stomach.
Do not take more than 2 tablets/capsules in a four-hour period or more than 6 tablets/capsules per day.
You should take Esgic Plus (Zebutal) as directed by your doctor. Do not take more medication than prescribed.
Usual Adult Dose
Oral dosage form (Tablets/Capsules) - One or two tablets/capsules as needed to relieve tension headaches every 4 hours, a maximum of 6 tablets/capsules per day.
Patients with kidney or liver problems and elderly patients may require lower doses.
Your doctor may have a plan that varies from above, always follow your doctor’s recommendations.
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:: What if I miss a dose of Esgic Plus (Zebutal)?
Esgic Plus (Zebutal) is usually taken on an as-needed basis therefore missing a dose is not a problem. Take your dose as you need it and do not take another dose for the amount of time prescribed. Do not take more doses, or doses more frequently, than your doctor prescribed as this may result in serious side effects.
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:: How should I store Esgic Plus (Zebutal)?
Keep Esgic Plus (Zebutal) and all medications out of children's reach.
Store Esgic Plus (Zebutal) at room temperature in a tight container. Store away from moisture, heat and direct light. Do not keep medicine past the expiration date, dispose of properly.
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:: What is the difference between Esgic and Esgic Plus?
The difference is in the quantity of the acetaminophen component. Esgic contains butalbital 50mg/acetaminophen 325mg/caffeine 40mg while Esgic Plus contains butalbital 50mg/acetaminophen 500mg/caffeine 40mg. Esgic is equivalent to Fioricet .
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:: What is the difference between Esgic Plus (Zebutal) and Fioricet?
The difference is in the acetaminophen component.
Fioricet and generic preparations of Fioricet contain the same dose of butalbital and caffeine as Esgic Plus and generic Esgic Plus (e.g. Zebutal), but the Fioricet tablets have 325mg of acetaminophen, while Esgic Plus tablets have 500mg of acetaminophen. This difference of 500mg versus 325mg of acetaminophen may make Esgic Plus and its generic preparations slightly more effective than Fioricet.
Esgic Plus = butalbital 50mg/acetaminophen 500mg/caffeine 40mg = Zebutal
Fioricet = butalbital 50mg/acetaminophen 325mg/caffeine 40mg = Esgic
To learn more about Fioricet, see our Fioricet FAQ .
For prices, see our Fioricet price comparison page and select your preferred online US pharmacy with the lowest Fioricet prices, no prior prescription needed.
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:: What else can I do to help relieve my tension headaches?
In addition to taking your headache medication, simple changes to your daily activities and environment can help keep your headache under control.
Daily Activities:
1. Always take your medication properly as prescribed by your doctor
2. Get at least 8 hours of sleep nightly
3. Start a simple exercise program*
4. Practice mental and physical relaxation therapy
5. Get massages
6. Use hot or cold packs on your head or neck
7. Take a hot or cold shower or bath to help relieve your headache
8. Take breaks frequently to stretch muscles especially if your work requires you to
keep you head in one position for a long time such as at a computer, microscope
or with craftwork.
* Exercising regularly, including proper warm-up, stretching, and cool-down, can greatly help you avoid or reduce tension headaches. For many exercising guidelines, see What kind of activities can I do? and Sample exercise plans ,
in our extensive Weight Loss FAQ .
Changes to your environment:
1. Insure your mattress and pillow are comfortable.
2. Set your thermostat to a comfortable temperature if your headaches are
associated with cold.
3. Wear clothing that keeps your head and neck warm if your headaches are
associated with cold.
4. Use appropriate lighting such as dimmers, low watt light bulbs, light shades if
your headaches as associated with bright lights.
5. Insure your workplace environment is comfortable. If you work at a desk or
computer, your chair should support your back, your feet should touch the
ground or have a foot rest, your monitor should be at eye-level and may need a
glare filter, and your keyboard should be at elbow level to reduce strain on your
body.
Be sure to ask your doctor about these and other types of non-drug pain management techniques that might be right for you. You can also ask for referrals to specific providers of these services.
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:: What are the possible side effects of Esgic Plus (Zebutal)?
The most common side effects are drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, constipation, dry mouth, abdominal pain and intoxicated feeling.
Side effects other than those listed here may also occur. Talk to your doctor about any side effects that seem unusual or that are especially bothersome.
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:: What other precautions should I take when taking Esgic Plus
(Zebutal)?
In addition to the above possible side effects of Esgic Plus (Zebutal), please be aware of the following as they apply to you.
Driving and Hazardous Work:
Esgic Plus (Zebutal) may make you dizzy or sleepy. Use caution before driving a car or engaging in hazardous work until you know how the medicine affects you.
Dependence:
Butalbital may be habit-forming. Take it as prescribed, in the amount prescribed, only as often as prescribed and only for as long as it is prescribed. See Can I become dependent on Esgic Plus (Zebutal)?
Consumption of Alcohol:
Do not drink alcoholic beverages while taking Esgic Plus (Zebutal). It can result in liver damage and can increase side effects.
Medication Interactions:
Before you start taking Esgic Plus (Zebutal), inform your healthcare provider, during either a physical or online consultation, about all the medicines you use, and do not start taking any prescription or over-the-counter medications without asking your doctor first. Some medications can increase side effects such as drowsiness, and are best avoided while taking Esgic Plus (Zebutal). See What are the possible drug interactions of Esgic Plus (Zebutal)?
Pregnancy and Breast Feeding:
Esgic Plus (Zebutal) is not recommended for use in pregnant women unless the potential benefits outweigh the risks. There are no adequate and well-controlled studies in pregnant women. Esgic Plus (Zebutal) is secreted in human milk, which can lead to the potential for serious adverse reactions in nursing infants. Women should notify their doctor if they become pregnant or intend to become pregnant while taking Esgic Plus (Zebutal).
Kidney and Liver Disease:
The side effects may be more likely due to potential for higher blood levels of Esgic Plus (Zebutal). Depending on the severity of your condition, your doctor may need to adjust your dosage.
Adults over 65 years old:
Dosing should be more conservative as drug effects may be more pronounced due to medical conditions and other multiple drug therapy.
Do NOT share your Esgic Plus (Zebutal) prescription with others, this can be a very dangerous practice.
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:: What are the possible drug interactions of Esgic Plus (Zebutal)?
Inform your doctor, during either a physical or online consultation, about all the medicines you use, prescription and non-prescription. Certain medicines should never be used together. Some medicines may be used together even if an interaction might occur. In these cases, your doctor may change the dose, monitor the effects or take other precautions.
When you are taking Esgic Plus (Zebutal), it is especially important that you inform your doctor if you are taking any of the following:
- Monoamine Oxidase (MAO) inhibitors: Furoxone (furazolidone), Nardil (phenelzine),
Eldepryl (selegiline), Marplan (isocarboxazid), Matulane (procarbazine), Parnate
(tranylcypromine)- increased risk of side effects.
- Any antidepressants, antihistamines, sedative hypnotics to help you sleep, other
pain relievers, anxiety medications, muscle relaxers and alcohol- risk of increased
side effects especially drowsiness and reduced breathing rate.
- Other medications containing acetaminophen (Tylenol) such as over-the-counter
cold, pain or allergy preparations.
Drugs other than those listed here may also interact with Esgic Plus (Zebutal).
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:: Can I take Esgic Plus if I drink alcohol (Zebutal)?
Do not drink alcoholic beverages while taking Esgic Plus (Zebutal). It can result in serious side effects. back to top
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:: Can I become dependent on Esgic Plus (Zebutal)?
Barbiturates such as Butalbital can cause dependence or a need to continue taking medication. Dependence or addiction is more common when a medication is used at high doses or for a long period of time. Although anyone can become dependent it is more likely if you have been dependent on alcohol or other drugs in the past.
Stopping Esgic Plus (Zebutal) abruptly may lead to an adjustment period for your body and you may experience withdrawal side effects. The length of time this takes depends on the amount of medicine you were using and how long you used it. If you have been taking Esgic Plus (Zebutal) in large doses or for a long period of time, you should consult your doctor before stopping therapy. Your doctor may decide it is best to gradually reduce the dose to help minimize withdrawal side effects. Withdrawal symptoms may include anxiety, sweating, insomnia, pain, tremors, nausea, diarrhea, and rarely convulsions and delirium.
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:: What are symptoms of a possible Esgic Plus (Zebutal) overdose?
Symptoms of overdose may include reduced breathing rate, severe drowsiness, nausea, vomiting, confusion, low blood pressure and coma. If overdose is suspected, call your doctor, emergency medical services (EMS) 911, or the poison control center immediately.
National Poison Control Center telephone number: 800-222-1222
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:: Is Esgic Plus (Zebutal) available over the counter?
No. Esgic Plus (Zebutal) is currently available by prescription only.
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:: How can I get an Esgic Plus (Zebutal) prescription online?
Go to our Esgic Plus price comparison page where you can select your preferred online US pharmacy with the lowest Esgic Plus prices, no prior prescription required.
Or if you prefer generic, you can buy Zebutal (generic Esgic Plus) by going to our Zebutal price comparison page .
Our featured US-based online pharmacies work with US-licensed doctors and pharmacists to provide you with your prescriptions through an online consultation.
If this is your first time ordering Esgic Plus online, see our beginner’s guide , where the process of obtaining a prescription online and ordering your medication is explained.
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:: How much does Esgic Plus (Zebutal) cost?
Some companies charge less per pill but charge you separately for their consultation and pharmacy dispensing fees. Others include these fees into their final pricing.
RxPriceCheck's featured pharmacies give you a free online medical consultation with your order.
There is brand Esgic Plus and generic Esgic Plus (Zebutal) available. Be sure to compare Esgic Plus prices and Zebutal prices before buying.
Usually, the more pills you buy, the cheaper the price per pill.
Generic Esgic Plus is usually cheaper than brand especially as quantities increase. Brand or generic is really up to your preference.
Go to our Esgic Plus price comparison page where you can select your preferred online US pharmacy with the lowest Esgic Plus prices, no prior prescription required.
Or if you prefer generic, you can buy Zebutal (generic Esgic Plus) by going to our Zebutal price comparison page .
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:: What is generic Esgic Plus and is it available?
The generic name of Esgic Plus is butalbital 50mg/acetaminophen 500mg/caffeine 40mg. Various manufacturers make generic Esgic Plus. One such generic preparation is called Zebutal. Brand Esgic Plus and generic butalbital/acetaminophen/caffeine are available as capsules or tablets.
See What does Esgic Plus (Zebutal) look like? for pictures.
Generic is usually cheaper than brand. Brand or generic is really up to your preference.
Go to our Zebutal price comparison page where you can select your preferred online US pharmacy with the lowest Zebutal prices, no prior prescription required.
Compare with Esgic Plus prices
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:: Is it safe to order Esgic Plus (Zebutal) or other medications
from non-US pharmacies?
Purchasing Esgic Plus or Zebutal from non-US pharmacies can be potentially dangerous. The FDA (Food and Drug Administration) does not recommend ordering medications online from pharmacies located outside the U.S. because it cannot guarantee the origin, quality or safety of the medication or regulate the manufacturers. Therefore, it may be filled with other ingredients that may harm you, or it may be fake, sold as Esgic Plus, but not contain the active ingredients Butalbital, Acetaminophen, and caffeine.
RxPriceCheck.com only affiliates with online US pharmacies that work with US licensed physicians and pharmacists, and sell brand Esgic Plus approved by the FDA and manufactured by Forest Pharmaceuticals, or generic Esgic Plus (Zebutal) approved by the FDA and made in the US. You can therefore choose from our list of online US pharmacies with confidence.
See our Esgic Plus price comparison page where you can select your preferred online US pharmacy with lowest Esgic Plus prices, no prior prescription needed.
Or if you prefer generic, you can buy Zebutal (generic Esgic Plus) by going to our Zebutal price comparison page .
If this is your first time ordering Esgic Plus online, see our beginner’s guide , where the process of obtaining a prescription online and ordering your medication is explained.
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* The information contained in RxPriceCheck.com is for educational purposes only and is not intended as medical advice. Consult your healthcare provider regarding your medical condition. All product names are trademarks or registered trademarks of their respective holders. View our terms of use .
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