Medical Assessment - Duac 5% Gel

About You
Have you previously been diagnosed with mild to moderate acne by a medical doctor?
Your Health
Are you allergic to any of the following?
  • Clindamycin
  • Lincomycin
  • Benzoyl peroxide
Do any of the following apply to you:
  • I take neostigmine or pyridostigmine (used for conditions such as Myasthenia Gravis)
  • I am likely to have an operation whilst I am on Duac
  • I was hoping to get Oral Typhoid vaccine whilst on Duac
Are you pregnant, planning on becoming pregnant, or breastfeeding?
  • This treatment is not suitable for use in pregnancy. Treatment should be discontinued for at least one cycle prior to pregnancy.
Do you have acute porphyria?
  • a rare hereditary disease affecting haemoglobin
Do you currently have sunburn?
Your Medication
Are you currently taking any medication (including over the counter, prescription or recreational drugs)?
Agreement
Do you understand that it can take 4-8 weeks of treatment before beneficial effects are seen?
Do you understand that treatment with Duac should not exceed 12 weeks?
Do you understand that you should use Duac at most once a day, after washing your face with a mild cleanser and fully drying?
Do you understand if your acne gets worse or starts to cause scarring, you must see your GP?
Do you understand that if severe erythema (severe redness), dryness, itching or burning of the affected area occurs, Duac gel should be discontinued?
Do you understand that this medication can make your skin more sensitive to sunlight (photosensitivity)? You should avoid sunlight and sunlamps while using this gel and take care to use sunscreen and cover in protective clothing if sunlight exposure is necessary.
Do you understand that if prolonged or significant diarrhoea occurs, that treatment should be stopped immediately?
Do you understand that this medicine must not come in contact with eyes, mouth, mucus membranes, or eczematous/ broken/ sunburned skin, and that if it does by accident you should seek medical advice?
Do you agree to the following?
  • You will read the patient information leaflet supplied with your medication
  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.


Complete our 2 minute questionnaire
We’re almost done!
Dr Oliver Large
To make sure this treatment is safe for you to take, we just need you to answer a few questions.
Dr Oliver Large
Confidential & Secure
  • Our prescribers will review your details in complete confidence
  • Your medication will be delivered in plain unlabelled packaging
  • Appears on your statement as “Mexpress”
  • All data is securely encrypted with 128bit SSL
Need help? If you need help with this medical assessment, contact our helpline:
0208 123 0508
or email us: help@medexpress.co.uk