Are you allergic to lactose?

Do you have any of the following?

• Kidney problems
• Liver problems
• Heart problems
• Any Autoimmune condition (e.g. rheumatoid arthritis, Graves’ disease)
• Galactose intolerance, LAPP lactase deficiency or glucose-galactose malabsorption
• Alcohol dependency
• Depression requiring treatment with medication
• Schizophrenia or Bipolar Disorder
• Epilepsy (or ever suffered a seizure)

Are you pregnant or breastfeeding?

Are you taking any of the following medications?

• Benzodiazepines (e.g. diazepam, temazepam, lorazepam)
• Zopiclone or Zolpidem (or any other sleeping tablets)
• Fluvoxamine
• Alcohol
• Cimetidine
• Oestrogen containing medication (e.g. HRT or combinec contraceptive pill)
• Warfarin or any other blood thinning medication
• carbamazepine
• rifampicin
• quinolones or fluoroquinolones (e.g. ciprofloxacin)
• pipemidic acid
• teriflunomide
• leflunomide
• axitinib

Circadin, as a medication that helps you sleep, can enhance the effects of sleepiness or low blood pressure with a number of medications. Below is a list of medications whose side effects could be enhanced by circadin. Do you understand that if you are on these medications and have any symptoms of light headedness, muzziness or excessive sleepiness you should immediately stop your Circadin?

• Alcohol
• Alpha-blockers (e.g. Doxazocin, Alfuzosin, Tamsulosin, Prazocin)
• Antidepressants, Tricyclic
• Antihistamines
• Antipsychotics
• Myelosuppressive drugs
• Baclofen
• Beta-blockers
• Calcium-channel Blockers
• Clonidine
• Diazoxide
• Diuretics
• Guanfacine
• Hydralazine
• Lofexidine
• Methyldopa
• Minoxidil
• Mirtazapine
• Moxonidine
• Nitrates
• Opioid Analgesics
• Phenobarbital
• Primidone
• Ritonavir
• Sodium Nitroprusside
• Tizanidine

Do you understand that although many studies show Circadin (melatonin) helps with jet lag and is safe to use, it is not specifically licensed for this use in the UK? Nevertheless, it benefits many people who regularly cross time zones. Our prescribers have given this consideration, and will prescribe this for you if you acknowledge and understand this statement, and confirm you have visited and read this website.

Do you understand that Circadin should be taken daily, 1-2 hours before your intended bedtime in your new time zone?

Do you understand that should not take Circadin with alcohol?

Do you understand that Circadin can cause drowsiness, so you should not drive or operate heavy machinery for at least 8 hours after taking Circadin?

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.