Weight Loss

Are you taking any medicines?

Are you taking any of the following medications? 

• Anticoagulant drugs (e.g warfarin)
• Ciclosporin
• Iodine salts and/or levothyroxine
• Amiodarone
• Medicines to treat HIV
• Acarbose (used to treat diabetes)
• Antiepileptic drugs
• Any other anti-obesity drug/treatment

Is your BMI over 30 OR Is your BMI between 28 and 30 and you also suffer from diabetes, coronary heart disease hypertension, sleep apnoea or hypercholesterolaemia?

Have you had previous problems when taking Alli or Orlistat 120mg capsules?

Have you been diagnosed with: 

• Cholestasis (a rare liver disorder usually associated with jaundice/yellowing of the skin)
• Malabsorption syndrome (a rare condition where nutrients are not absorbed normally)
• Kidney/renal disease (does not include occasional urinary infection)

Are you pregnant, breastfeeding, or intending to become pregnant while taking this medication?

Are you suffering from any eating disorders (anorexia nervosa/bulimia)?

Do you agree to the following:

• I need to follow a reduced calorie diet and exercise regularly
• Orlistat 120mg cannot be continued if I gain weight
• Orlistat 120mg must be stopped if my BMI goes below 28
• Orlistat/Alli/Xenical reduces the absorption of some fat soluble nutrients, and that I should take a multivitamin that contains vitamin E, vitamin K and beta carotene at night, at least 2 hours after Orlistat/Xenical/Alli
• Additional contraception is advised to prevent the possible failure of  oral contraception in the case of severe diarrhoea
• If I am taking high cholesterol or diabetes medication, I may need to adjust the dose of my medication and will seek further advice on this

I agree to the following:

• I will read the patient information leaflet supplied with my medication
• I will contact my GP or MyMedsUK if I experience any side effects
• The treatment is for my use only
• I have answered the assessment questions truthfully and accurately
• I agree to the Terms and Conditions and I confirm that I am over 18 years old
• I am aware that I may be contacted to give further information via phone or email and if I am not contactable this will lead to a delay in receipt of my prescription