Smoking Cessation · Online Uk Pharmacy

OnlineUK Pharmacy

Smoking CessationConsultation

Before you begin: your answers are reviewed by a UK-registered prescriber and kept confidential. Please answer honestly and in full — it's what keeps your treatment safe. Do you understand and agree to answer honestly? Yes, I understand No

What is your sex registered at birth? Female Male

How old are you?

Varenicline is licensed for adults aged 18 and over.

Under 18 18 or over

Do you currently smoke? Yes No

How many cigarettes do you smoke a day? 10 or fewer 11 to 20 More than 20

How long have you been smoking? Less than a year 1 to 5 years More than 5 years

Do you have a quit date in mind?

Varenicline is usually started 1 to 2 weeks before your planned quit date.

Yes No

Have you tried to stop smoking before? Yes No

Have you taken varenicline (Champix) before? Yes No

Did you have any side effects with it? Yes No

Are you pregnant, breastfeeding, or trying to conceive? Yes No

Are you allergic to, or have you ever reacted badly to, varenicline? Yes Not sure No

Have you ever had depression, anxiety, bipolar disorder, schizophrenia, or another mental-health condition?

Varenicline can occasionally affect mood, so the prescriber needs to know your mental-health history.

Yes No

Are you currently having thoughts of harming yourself, or that life is not worth living? Yes No

Have you ever been diagnosed with any of the following? A heart attack or unstable heart condition in the last 2 months Severe kidney disease Epilepsy or seizures Heart attack, stroke, angina or other cardiovascular disease Diabetes None of these

Are you currently taking any medicines (prescription or over-the-counter), supplements, or recreational drugs? Yes No

Are you taking any of these?

When you stop smoking, the levels of some of these medicines in your body can change, so they may need monitoring.

Insulin or another diabetes medicine Theophylline Warfarin Clozapine or olanzapine A medicine for a mental-health condition Nicotine replacement therapy (patches, gum, lozenges, etc.) None of these

Which stop-smoking treatment are you interested in?

The prescriber confirms what's suitable for you.

Varenicline (Champix) Nicotine replacement therapy Bupropion (Zyban) Not sure — please advise

You understand varenicline can, in some people, cause changes in mood or behaviour — including low mood, agitation, or thoughts of self-harm — and that if this happens you (or someone close to you) should stop the medicine and seek medical help promptly. Do you understand? Yes No

Please confirm you understand this to continue.

You understand common side effects include nausea, vivid or unusual dreams, headache and difficulty sleeping, and that taking each dose with food and a full glass of water can help. Do you understand? Yes No

Please confirm you understand this to continue.

You understand that if you have a seizure while taking varenicline you should stop it and seek medical advice. Do you understand? Yes No

Please confirm you understand this to continue.

You understand stop-smoking medicine works best alongside behavioural support (for example your local Stop Smoking Service), and that combining the two gives you the best chance of quitting. Do you understand? Yes No

Please confirm you understand this to continue.

Is there anything else you'd like to tell the prescriber? Yes No

Please confirm all of the following: you will read the patient information leaflet supplied; the treatment is for your use only; you have answered every question truthfully and accurately; you will tell us and your GP if you get side effects, start new medicines, or your health changes; and you agree to our terms & conditions, privacy policy and acceptable-use policy. Yes, I confirm No

Please confirm to continue.

I understand that if this treatment is not suitable I will be refunded and signposted to appropriate care, and that the final prescribing decision always rests with the prescriber. Yes, I understand No

Please confirm you understand to continue.

Do you consent to us informing your NHS GP that you have started this treatment?

We think it’s safest to keep your regular GP in the loop about your care. If you don’t consent, we’re unable to continue with this treatment.

Yes, please inform my GP No, do not inform my GP

We can only provide this treatment if we’re able to inform your GP. If you have concerns about this, please speak to our pharmacist before continuing.

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