This is compulsory, a picture will help our healthcare team to make an appropriate decision about your treatment.
Acne continuing beyond or after this age may require further investigation.
Antibiotics are not a first line treatment for acne and should only be used when other treatment options have failed and been exhausted. Therefore if nothing is listed, your request may be rejected.
Acne presenting in other areas may require further investigation and needs to be treated by your own GP.
Lumps under the skin (nodules) or cysts (very large, pus-filled lumps that are similar to boils), need to be seen by your doctor as this acne may result in scarring and will need monitoring regularly.
Medicines to thin your blood e.g. warfarin.
Diuretics (used to treat kidney disease, heart disease or high blood pressure).
Other antibiotic medicines to treat acne.
Methoxyflurane (risk of fatal renal toxicity).
Any antacids for indigestion containing
aluminium, magnesium, calcium, zinc or
iron salts, as they may interfere with the
way oxytetracycline is absorbed in your body.
Ulcer healing drugs, e.g. ranitidine,
bismuth citrate, sucralfate and
tripotassium dicitrobismuthate.
Kaolin (to treat diarrhoea).
Quinapril (to control high blood pressure).
Atovaquone (to treat and prevent
infections such as malaria or pneumonia).
Other bactericidal drugs (e.g. penicillin).
Strontium ranelate (to treat osteoporosis).
Retinoids (to treat acne) e.g. tretinoin or
acitretin.
Cytotoxic drugs (to treat cancer) e.g.
methotrexate.
Ergot alkaloids (to treat migraines) e.g.
ergotamine or methysergide.
Oral contraceptives (birth control pill), as
this could cause contraceptive failure.
Corticosteroids.
Neuromuscular blocking agents.
Neostigmine or pyridostigmine.
History of inflammatory bowel disease or antibiotic-associated colitis.
You or any of your close family have had skin cancer.
You have had problems tolerating this or similar medicines in the past (you have found them too irritating for your skin).
Eczema.
Redness of the skin, broken blood vessels and tiny pimples usually in the centre of the face
(rosacea).
Redness and soreness around your mouth (perioral dermatitis).
Skin reactions in the sunlight.
Sun burn.
Kidney disease.
Liver disease.
Systemic lupus erythematosus (SLE).
Myasthenia Gravis.
Acute porphyria.
Suffer from thrush whilst being treated
with antibiotics.
Are suffering from syphilis.
Enter N/A if not applicable.
Enter N/A if not applicable.
This treatment is not suitable for use in pregnancy. Treatment should be discontinued for at least one cycle prior to pregnancy.
Usage during pregnancy can cause birth defects and effective contraception must be used. It is essential that you do not become pregnant while using this treatment.
Stop using your treatment immediately if you forget to use your contraception. If you think there is a possibility of pregnancy, discontinue treatment and speak to your GP immediately.
Protect your skin from the sun, by using a sunscreen product and wearing clothes to stop you getting sunburnt.
Avoid using sun beds (sun lamps) or spending a long time in the sun.
Very cold or windy weather may also irritate your skin.
That it can take 4-12 weeks of treatment before beneficial effects are seen and treatment should not exceed 12 weeks?
That most people will experience some skin redness and peeling during the first few weeks of treatment. If irritation persists, symptoms are severe or scarring occurs, then stop using the medication and seek medical advice.
You will read the patient information leaflet (provided with your medication or by following the relevant link).
The treatment is solely for your own use.
All the information you have provided is accurate. You understand our prescribers can only base decisions on the information provided and that incorrect information can be detrimental to your health.
We need to ensure that this medicine is suitable for the person it is intended for. Therefore may be required to contact you by phone/video call, If we are unable to speak to you when required your order may be delayed.
If necessary you consent to My Pharmacy contacting your GP surgery and/or accessing your Summary Care Records in regards to this treatment.
I consent to receive treatment from My Pharmacy, and confirm that I have the mental capacity to do so. The decision about the treatment is for both the patient and the prescriber to consider, however, the final decision will always rest with the prescriber and is subject to approval. If treatment is not suitable, you will be signposted to another point of care.
You will seek medical advice if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
You will inform your GP with regards to this prescription (It is best practice to inform your GP of any private treatment you receive. All treatment is completely confidential).