We will access your consultation upon receipt to determine the outcome
Date Format: MM slash DD slash YYYY
Topical acne treatments such as Panoxyl, Skinoren, Differin, Isotrex, Epiduo, Dalacin or Duac. Antibiotic are not a first line treatment for acne and should only be used when other treatment options have failed and been exhausted.
Acne continuing beyond or after this age may require further investigation.
Oxytetracycline , tetracycline, doxycycline or minocycline),
or any of the components of oxytetracycline such as lactose
any antacids for indigestion containing aluminium, magnesium, calcium, zinc or iron salts, as they may interfere with the way the oxytetracycline is absorbed in your body
ulcer healing drugs, e.g. ranitidine, bismuth citrate; sucralfate and tripotassium dicitrobismuthate
kaolin (to treat diarrhoea)
quinapril (to control high blood pressure)
atovaquone (to treat and prevent infections such as malaria or pneumonia)
other bactericidal drugs (e.g. penicillin)
anticoagulants (to prevent blood clots) e.g. warfarin
strontium ranelate (to treat osteoporosis)
retinoids (to treat acne) e.g. tretinoin or acitretin
cytotoxic drugs (to treat cancer) e.g. methotrexate
ergot alkaloids (to treat migraines) e.g. ergotamine or methysergide
oral contraceptives (birth control pill), as this could cause contraceptive failure.
systemic lupus erythematosus (SLE)
are sensitive to sunlight or are exposed to ultraviolet light or direct sunlight
suffer from thrush whilst being treated with antibiotics
are suffering from syphilis.
This treatment is not suitable for use in pregnancy. Treatment should be discontinued for at least one cycle prior to pregnancy.
All treatment is completely confidential, however for certain medication we must share this information with your GP.
accessing your NHS Summary Care Record ensures that any prescribed treatment is safe and that your consultation details agree with your NHS record
You will read the patient information leaflet (provided with your medication or by following the relavent link)
The treatment is solely for your own use
All the information you have provided is accurate. You understand our prescribers can only base descions on the information provided and that incorrect information can be detrimental to your health.
We need to ensure that this medicine is suitable for the person it is intended for. Therefore may be required to contact you by phone/video call, If we are unable to speak to you when required your order may be delayed.
You will seek medical advice if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
You will inform your GP with regards to this prescription (It is best practice to inform your GP of any private treatment you receive).
I confirm that I give permission for My Pharmacy 365 to inform my doctor of the treatment I have received if the prescriber feels it is clinically necessary