Extreme Alka-Seltzer packaging in the Dominican Republic contains a blister strip of Alka-Seltzer tablets marketed under the "Extreme" label. Alka-Seltzer is an effervescent over-the-counter medicine used as an antacid and pain reliever, and this package appears to be a locally marketed variant of the brand.
Open Blister Pack of “Extreme” Alka-Seltzer Tablets