Treatment Questions | Pharma Aesthetics

Answer medical questions to order

Have you read the medical information on cold sores and aciclovir?

Yes No

Are you planning to use aciclovir whilst pregnant or breastfeeding?

Yes No

Have you been diagnosed with reduced immunity from any cause?

Yes No

For instance you have: Had a bone marrow transplant or low white blood cell count. Been diagnosed with a neurological abnormality or any condition leading to permanently low oxygen levels. Note: most people who are troubled with cold sores have normal immune systems.

Have you been diagnosed with severe liver or kidney disease?

Yes No

Includes conditions which could reduce kidney function - does not include occasional urinary infections. Kidney disease can be part of the ageing process and people over 65 should check with their GP.

Are you taking any of the following?

Yes No

The following medicines interact with aciclovir: Probenecid (used to treat gout). Cimetidine (used to treat stomach ulcers). Mycophenolate mofetil (used to stop your body rejecting transplanted organs). Ciclosporin or tacrolimus (immunosuppressive drugs). Theophylline or aminophylline (used in asthma and other breathing problems). Zidovudine (used in HIV infection).

Are you aware aciclovir cream is not for internal use or for use in or around the eye?

Yes No

Not for use in the vagina, anus, or inside the mouth.

Are you aware you should seek medical advice if sores are getting worse or are not healing after 10 days?

Yes No

Confirm you understand the treatment dose with aciclovir tablets?

Yes No

Single outbreak: one aciclovir 200mg tablet five times daily for five days. Suppressive therapy: One aciclovir 400mg tablet twice daily for up to 12 months. Note: The prescribed dose written on the label affixed to the packet may differ from the patient information leaflet supplied with the tablets. Please follow the instruction on the label affixed to the packet supplied.

Have you had an outbreak when taking suppressive treatment (aciclovir 400mg twice daily)?

Yes No

If this is your first time ordering OR if you are ordering treatment for a single outbreak, answer 'No'.

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 information leaflet supplied with the medication I am over 18 and I agree to identity verification checks 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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Cold sores

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