INDICATIONS AND DOSAGE

ALLZITAL (butalbital 25mg and acetaminophen 325mg) tablets are indicated for the relief of the symptom complex of tension (or muscle contraction) headache.ALLZITAL (butalbital 25mg and acetaminophen 325mg) 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.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.

Take two tablets every four hours as needed, or as directed by your provider. Do not exceed 12 tablets per day. 

IMPORTANT SAFETY INFORMATION

Butalbital may be habit-forming. Patients should take the drug only for as long as it is prescribed, in the amounts prescribed, and no more frequently than prescribed.


Hepatotoxicity: Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4000 milligrams per day, and often involve more than one acetaminophen-containing product. The excessive intake of acetaminophen may be intentional to cause self-harm or unintentional as patients attempt to obtain more pain relief or unknowingly take other acetaminophen-containing products.



The risk of acute liver failure is higher in individuals with underlying liver disease and in individuals who ingest alcohol while taking acetaminophen.

Serious Skin Reactions: Rarely, acetaminophen may cause serious skin reactions such as acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. Patients should be informed about the signs of serious skin reactions, and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity.

Hypersensitivity/anaphylaxis: There have been post-marketing reports of hypersensitivity and anaphylaxis associated with use of acetaminophen. Clinical signs included swelling of the face, mouth, and throat, respiratory distress, urticaria, rash, pruritus, and vomiting. There were infrequent reports of life-threatening anaphylaxis requiring emergency medical attention. Instruct patients to discontinue ALLZITAL (butalbital and acetaminophen) tablets immediately and seek medical care if they experience these symptoms.

Do not take ALLZITAL (butalbital and acetaminophen) tablets if you are allergic to any of the ingredients.

See Full Prescribing Information. See Full Prescribing Information.

Patient Instructions

1. Get a valid prescription. Ask your doctor for a prescription for Allzital.
2. Confirm your eligibility. See eligibility information below.
3. Fill your prescription. Print or show this Savings Card to your pharmacist along with your prescription for Allzital.
 
Please consult accompanying Full Prescribing Information and Instructions for Use. *Individual out-of-pocket costs may vary. Program eligibility and restrictions apply. Please see below for eligibility details.

Pharmacist Instructions

1. Process this coupon using the numbers on the above co-pay card.
2. This coupon is acceptable for insured and cash paying patients.
3. Offer not available to patients insured by or reimbursed by any federal or state healthcare program.
4. Restore patient profile to Primary PBM after claim submission.

For Pharmacist

• This claim may be submitted electronically through SimpleSaveRx using the processing numbers on the front of this co-pay card or by mail.
• Process the patient’s insurance as the primary claim and this co-pay card as the secondary claim. Submit all electronic claims in NCPDP Standard D.O. Secondary processing should follow NCPDP standards for Co-Pay Only Billing (other coverage code 3 or 8) or by using Coordination of Benefits processing.
• Mail claims should go to SimpleSaveRx, 3350 N Arizona Ave, Ste. 2, Chandler, AZ 85225 along with the copy of the pharmacy prescription receipt (cash register receipts are not accepted), and the return address. Retain a copy of this co-pay card and file with the prescription for auditing purposes. For expedited processing, fax savings cards and Rx receipt to: 480.444.1449
• Call the SimpleSaveRx Help Desk at 1.844.SAVE4RX (844.728.3479) for processing questions.

By using this card, you and your pharmacist understand and agree to comply with these eligibility requirements and terms of use.This offer is not conditioned on any past, present or future purchase including refills. For more information about Allzital, see full prescribing information and discuss with your doctor.To report suspected adverse reactions, please contact Phlight Pharma at 228-365-6652, or contact FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 

ELIGIBILITY: Patients are eligible for this coupon savings if they present a valid prescription for Allzital and if they pay either through commercial insurance or cash. This coupon is not valid for prescriptions reimbursed under Medicare, Medicaid, TriCare or any other federal or state program, or where prohibited by law. Where third-party reimbursement covers a portion of your prescription, this coupon is valid only for the amount of your actual out-of-pocket expenses, up to the maximum benefit allowed per this program. This offer is not insurance and offer is valid only for prescriptions filled in the United States.

TERMS OF USE: Eligible patients with a valid prescription for Allzital who fill their prescription at participating pharmacies will receive up to a maximum benefit of $100 per 100 tablet or more prescription. Patient is responsible for any co-pay amount above the $100 maximum benefit. Offer has no limit on number of refills. Other restrictions may apply. Patient is responsible for applicable taxes, if any. Phlight Pharma reserves the right to rescind, revoke or amend this offer without notice. It is a violation of federal law to buy, sell, or counterfeit this certificate. Pharmacy Help Desk, Call 1-844-728-3479. Non-transferable, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. Pharmacists and prescribers are responsible for any reporting which may be required to be made to any reimbursement program. Phlight Pharma reserves the right to limit, terminate, or deny the benefit herein at any time, at its sole discretion.