Treatment Questions | Pharma Aesthetics

Answer medical questions to order

Have you read the medical information for weight loss?

Yes No

Do you have obesity or overweight, with a BMI of 28 or over?

Yes No

Use this BMI calculator to find out your BMI

Is your BMI between 28 and 30?

Yes No

Are you aware orlistat should only be taken with a nutritionally-balanced, calorie-controlled diet?

Yes No

You should eat three roughly equal meals a day. Your diet should be varied and include at least 5 items of fruit or vegetables (to avoid vitamin depletion). Just under a third (30%) of your total calories should be from fat.

Are you pregnant or breastfeeding or intending to become pregnant whilst taking orlistat?

Yes No

If you have already been taking orlistat for over 12 weeks, have you lost the required amount of weight in the first 12 weeks?

Yes No

Orlistat 120mg (Xenical) - 5% of your body weight should be lost after 12 weeks. Orlistat 60mg (alli, Orlos) - there should be some significant weight loss after 12 weeks. Orlistat is unlikely to work if these targets are not met in the first 12 weeks. NOTE: If you have not yet been taking orlistat for 12 weeks answer 'Yes'.

Are you aware you should miss a dose of orlistat if you:

Yes No

Have a very fatty meal. Miss a meal. Have a zero fat meal. The combination of orlistat and highly fatty food can produce greasy diarrhoea. A fatty meal is one like fish and chips or a meal with cream, or cake. Missing a meal or taking a zero fat meal, means that there is no need for orlistat.

Are you taking any of the following?

Yes No

The following medicines interact with orlistat: Contraceptive or period delay pills (e.g. The Pill, combined oral contraceptive, progestogen-only pill, minipill, emergency contraceptive pills, norethisterone, Provera). Anticoagulant drugs especially warfarin. Ciclosporin. Levothyroxine. Amiodarone. Acarbose. HIV medication. Antiepileptic medication. Diabetic medication. Antidepressants. Antipsychotic medication. Anti-anxiety medication.

Do you have any of the following?

Yes No

Allergy to orlistat or other capsule ingredients Malabsorption conditions - unable to fully absorb food from the gut Cholestasis - a liver and bile duct disorder Kidney disease Thyroid disease

Have you ever suffered from anorexia or bulimia or another eating disorder?

Yes No

If taking orlistat 60mg (alli, Orlos) for longer than 6 months, do you agree to Pharma Aesthetics supplying this to you 'off label'?

Yes No

If a medicine is prescribed for an 'off label' (unlicensed) use the manufacturer is not liable in case of adverse events. Doctors take the responsibility for the prescribing. NOTE: If ordering orlistat 120mg (Xenical) - or orlistat 60mg (alli) with under 6 months use - please answer 'Yes'.

Do you have any further medical information or questions?

Yes No

Is there anything you do not understand or do you need further help?

Do the following apply to you?

Yes No

The medication is for my own use and I will not share with anyone else I will read the patient information leaflet supplied with the medicine pack I am over 18 and I agree to identity verification checks I understand my GP will be informed about the supply of medicine I have completed this questionnaire myself and fully understand all the information My responses are honest and accurate, and I understand that this is necessary for a safe medical assessment I agree to the terms & conditions, privacy policy, data sharing policy & consent to cookies

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Weight loss

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