Weight Loss Injectables

• Acromegaly or any growth hormone problem
• Chronic Malabsorption Syndrome
• Cushings Syndrome
• Gallbladder, Bile duct or Pancreas disease
• Heart Failure
• Kidney Disease
• Liver Disease
• Multiple Endocrine Neoplasia
• Pancreatitis
• Personal or Family History of Thyroid Cancer

If yes please provide details of:

• Name of medicine
• Strength
• Date last dose taken

Please include:

• Name of medicine and strength.
• Length of treatment.
• When you took the last dose.
• Reason for stopping if no longer taken.

Please note: Changes to eating patterns can affect the absorption of these medications. You should continue to take these medications according to your usual routine whilst using Mounjaro or Wegovy.

Acarbose, Alogliptan, Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin, Fenfluramine, Glibenclamide, Gliclazide, Glimepiride, Glipizide, Insulin, Linagliptin, Orlistat, Pioglitazone, Repaglinide, Saxagliptin, Sitagliptin, Somatrogon, Tolbutamide, Vidagliptin.

This includes over the counter, prescription or recreational drugs?

• To Inform both us and your GP about any treatment-related side effects, the initiation of new medication, or changes in your medical conditions during the course of treatment.
• To read the patient information leaflet provided with your medication before using your new treatment. If you have any questions you can contact our support team or your GP.
• The prescribed treatment is intended exclusively for your personal use.
• You have provided accurate and truthful responses to all the preceding questions.
• You acknowledge that our prescribers rely on your responses as truthful and honest to make prescribing decisions and recognise that inaccurate information may result in serious health risks.