Travel Sickness Assessment

Do not order medication for another patient or order multiple medications for different patients on a SINGLE order. Please register separate accounts for each patient as each account is treated as a medical record.

• Glaucoma (especially narrow angle glaucoma)
• Prostate problems
• Bladder problems/ urinary retention
• Myasthenia gravis
• Parkinson’s disease
• Epilepsy or seizures
• Porphyria
• Liver disease
• Kidney disease
• Heart conditions (especially fast heart rate/tachycardia)
• Ulcerative colitis or gastrointestinal conditions

• Antihistamines
• Amantadine
• Antipsychotics, for psychiatric disorders
• Antidepressants for depression, including a Monoamine Oxidase Inhibitor (MAOI) in previous 14 days
• Linezolid or other antibiotics
• Domperidone and metoclopramide, for nausea and vomiting
• Sublingual nitrates, for angina

Do not drink alcohol while taking travel sickness medications. Alcohol and these medications together can make you sleep very deeply, causing breathing impairment and can result in difficulty waking up.

I understand that:

• Travel sickness medications have small sedative effect can cause drowsiness and I should not drive or operate heavy machinery if I am affected.
• It is important to drink water and stay hydrated if I experience dry mouth.
• I will stop taking the medication if I experience confusion, visual disturbances or severe drowsiness and seek medical attention.
• Only one travel sickness medication should be used at once. I will not take any combination products.
• I should seek urgent medical attention if I experience sudden, severe abdominal pain, blood in my vomit, stiff neck or high fever, sudden severe headaches unlike anything I have had before and persistent symptoms that are worsening.
• I should not take these medications if I am pregnant or breastfeeding.

• You have read the information available on the treatments and medication web page and understand the side effects, effectiveness and alternatives available.
• You have answered the questions honestly and accurately and the treatment is solely for your personal use.
• You will read and understand the patient information leaflet supplied with your medication.
• You understand that although it is not compulsory it is important to inform your GP of this treatment so they can provide safe healthcare.
• You understand prescribing decisions will be based on the answers from your consultation and incorrect information can cause harm to your health. Orders may be rejected if not clinically suitable.
• You are aware The Family Chemist will undertake a soft check to validate your identity using LexisNexis. Note: This does not affect your credit rating.
• You have read and agree to our Terms and Conditions, Terms of Use and Privacy Policy.