To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.
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This could be prescription medication, over the counter or herbal remedies.
- Heart problems, such as heart failure or problems with the heart rhythm
- History of fainting
- Mania (symptoms include feeling over−excited, irritable or not being able to think clearly) or severe depression
- Moderate or severe liver problems.
- Medicines for depression called ‘monoamine oxidase inhibitors’ (MAOIs)
- Thioridazine used for schizophrenia
- Other medicines for depression (Nefazodone, St John’s wort)
- Lithium − a medicine for bipolar disorder
- Certain other antibiotics for treating infection (such as erythromycin, clarithromycin, telithromycin, Linezolid)
- Tryptophan − a medicine to help you sleep
- Tramadol − used to treat serious pain
- Medicines used to treat migraines (such as sumatriptan, rizatriptan and zolmitriptan)
- Certain medicines used to treat erectile dysfunction. (such as sildenafil, tadalafil or vardenafil)
- Certain other medicines for HIV (such as amprenavir and fosamprenavir, ritonavir, saquinavir, nelfinavir and atazanavir)
- Medicines to thin your blood (such as warfarin)
- Certain medicines used to treat high blood pressure and chest pain (angina) (such as verapamil and diltiazem, or enlarged prostate)
- Aprepitant − used to treat nausea.
- The treatment is solely for your own use.
- You have answered truthfully to all the questions and you are aware that any incorrect information you provided can present a potential danger to your health.
- You will read the patient information leaflet supplied with the medicine specifically the side effects and dosages.
- You will inform your doctor about any unusaul side effects.
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.
If you believe this to be an error or you would like to discuss this further, please contact us.
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