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Consultation

Alli

A prescriber reads every answer. Answer honestly: a wrong answer here is not a shortcut, it is the thing that makes a medicine unsafe for you.

  1. 1About your health
  2. 2About this treatment
  3. 3About you

Allergies

Do you have any allergies to medicines? *
Which medicines, and what happened? *

Current Medications

List any medicines you take, including anything you buy without a prescription. *

Medical History

Are you being treated for any long-term condition? *
Which conditions? *

Current Medications

Have you previously taken any of the following medicines? *
Please provide more information including all medications that you take for this condition. *
Do you take any of the following medicines?AmiodaroneCarbamazepineCiclosporinClozapineDigoxinFenfluramineLithiumMethotrexate Oral TabletsMycophenolate mofetilPhenytoinSomapacitanSomatrogonTacrolimusTheophyllineWarfarin *
In the last 3 months, have your depression symptoms got worse, or has your depression treatment changed, such as an increased dose or any new medicine added? *
Can you confirm you understand the following essential safety advice for Orlistat?• Take orlistat only with meals containing fat and do not take a dose if a meal is missed or contains no fat.• Keep to a reduced-calorie, lower-fat diet to reduce oily stools, urgency, wind and leakage.• Take a multivitamin containing fat-soluble vitamins A, D, E and K at bedtime or at least 2 hours away from orlistat if advised.• Seek advice if you develop severe abdominal pain, rectal bleeding, signs of liver problems such as yellowing skin/eyes or dark urine, or persistent diarrhoea.• Orlistat can interact with medicines such as warfarin, ciclosporin, levothyroxine and epilepsy medicines; tell the prescriber about all medicines you take. *
Please provide more information including all medications that you take *
Do you take any of the following medicines?AmiodaroneCarbamazepineCiclosporinClozapineDigoxinFenfluramineLithiumMethotrexate Oral TabletsMycophenolate mofetilPhenytoinSomapacitanSomatrogonTacrolimusTheophyllineWarfarinInsulinLevothyroxine *
Do you agree to discuss the dosage of any medicines you take with your doctor as your weight decreases? *

Medical History

Have you ever suffered with an eating disorder? *
Which best describes your ethnicity? *
Do you have any upcoming surgery or procedure planned that involves deep sedation, sedation, or general anaesthesia? *
Do you know the date of the procedure? *
Have you been diagnosed with Diabetes (with or without treatment)? *
Is there anything else you would like to let the prescriber know such as any medical conditions or surgery not previously mentioned in this form? *
Last dose (strength) taken? *
Any side effects experienced? *
Most recent administration date? *
Have you ever suffered from an eating disorder such as Bulimia or Anorexia Nervosa? *
Are you experiencing rectal bleeding? *
Have you taken orlistat before and suffered serious side effects? *
Are you aware if you skip a meal, or consume one with no fat content, you do not need to take a dose: *
Are you aware you should take a multivitamin supplement containing vitamins A, D, E & K before bedtime: *
Are you aged 18-74? *
Last dose (strength) taken *
Have you ever suffered from an eating disorder? *
Do you take orlistat (also known as Xenical or Alli)? *
Do you have problems absorbing food (chronic malabsorption syndrome) diagnosed by a doctor? *
Have you taken Orlistat and suffered serious side effects before? *
Do you suffer with thyroid problems? *
Have you been diagnosed with cholestasis? *
Are you aware you should limit your fat consumption to less than 15g per meal to avoid side effects: *

Lifestyle

Have you previously tried to lose weight by diet and exercise alone? *
Are you aware you need to commit to a calorie-controlled healthy diet combined with exercise for best results: *
Are you aware that, while taking orlistat, you should follow a reduced-fat diet and aim to keep each main meal to no more than around 15 g of fat, as higher-fat meals can increase side effects such as oily stools, diarrhoea, wind, urgency and abdominal discomfort? *

Allergies

Are you allergic to orlistat (also known as Xenical or Alli)? *

Your answers are seen by the prescriber reviewing your order and the dispensing pharmacist. They are not used for marketing.