Acid Reflux Treatment & Heartburn Relief

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If you are suffering from any symptoms that you wouldn't expect with indigestion, like breathlessness, chest pain or jaundice, or feel generally unwell, contact your GP urgently for help and advice. Please tick to confirm you do not have any of these symptoms at the moment.

Why are you requesting treatment for indigestion today?

I have symptoms of indigestion
My doctor has recommended it after having tests done (e.g. an endoscopy)
My doctor has recommended it to protect my stomach from a regular medication I take
Some other reason

Please select all that apply

What symptoms of indigestion do you have?

Heartburn
Acid reflux
Bloating or fullness in your stomach
Feeling sick or vomiting, especially after eating
Belching or burping more than usual
Pain or discomfort in your upper abdomen
Other

What other symptom(s) do you have?

Have you had an endoscopy?

An endoscopy is when you have a thin long tube with a camera on the end of it passed down into your stomach to have a look at what might be causing your symptoms.

Some long-term medications can increase your risk of gastrointestinal bleeding. Have you been advised to take antacid medication because you are on any of these medications?

Anticoagulant (like warfarin, apixaban or rivaroxaban)
Aspirin
Bisphosphonate (like alendronate or risedronate)
Calcium channel blocker (like amlodipine, felodipine, verapamil or diltiazem)
Non-steroidal anti-inflammatory drug (like ibuprofen, diclofenac or naproxen
Selective serotonin re-uptake inhibitor or SSRI (like citalopram, sertraline or fluoxetine)
Steroid (like prednisolone)
Theophylline (a.k.a. Uniphyllin)
Other

Please give us more information about why you are requesting indigestion medication today

Please tell us which medication you are currently taking that needs a PPI or H2RA alongside it.

PPIs are proton pump inhibitors like Lansoprazole, Omeprazole, Pantoprazole and Esomeprazole. H2RAs are histamine-2 receptor antagonists like Ranitidine or Cimetidine.

Do you suffer from any of the following symptoms?

Unintentional weight loss (that is disproportionate to any lifestyle behaviours like dieting or exercise)
Vomiting with visible blood
Vomiting that is brown or looks like ground coffee
Black stools that are thick and sticky (like tar), which can have a very strong, unpleasant smell
A lump, growth or mass in your upper abdomen
Pain, discomfort or difficulty when you swallow
A change in bowel habits (either unusual constipation or persistent/recurring diarrhoea)
None of the above

Vomitting

You have indicated that you’re suffering from a symptom which could suggest a serious underlying issue and I would advise you to get in contact with your doctor urgently today, or go to A&E if you are acutely unwell. Please tick to confirm that you understand this.

Have you been experiencing any of the following symptoms recently?

Unusual shortness of breath, especially after exertion (like exercise or walking up stairs)
Chest pain or tightness
Palpitations or irregular heart beats
Jaundice (a yellow tinge to your skin or whites of your eyes)
Dark coloured urine
Diarrhoea, especially with oily or floating stools
Unusually itchy skin
Regular or unusual loss of appetite
None of the above

Do you have any of these rare hereditary conditions: fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency?

Do you suffer from any liver diseases?

Please provide more details about your liver condition.

Do you have any other medical conditions?

Please list all your medical conditions.

Are you currently taking any other medication, or have you recently finished a course of medication?

Please list the names and doses of all these medications.

What condition(s) do you take these medications for?

Are you allergic to any medications or other substances?

For example, penicillin or lactose.

Are you allergic to any of the following?

PPIs (like lansoprazole, omeprazole, pantoprazole or esomeprazole)
Penicillin
Peanuts or soya
Lactose
Other medications
Other substances

P & S

Our pharmacists source medication from a wide range of approved manufacturers to ensure we have a good supply available. Some manufacturers produce medication that isn’t suitable for people who suffer with peanut or soya allergies. Before starting your medication, it’s important to check the enclosed manufacturer’s leaflet to make sure the medication you’ve received is suitable for people with peanut or soya allergies. We also recommend checking with your local pharmacist.Please tick if you’d still like to proceed with your order.

Are you able to take pills containing lactose?

Please provide more details about your other allergies.

Are you pregnant or breastfeeding?

No
I'm pregnant
I might be pregnant, I’m not sure
I'm breastfeeding

preg

Simple over the counter antacids and alginates are recommended as first-line treatments in pregnancy, if symptoms are not improved by lifestyle changes (e.g diet).If you've tried these and still have symptoms, then the drug we offer is omeprazole. The manufacturer of omeprazole advises that it can be used in pregnancy, and is widely used in practice. But there is a lack of good quality evidence regarding safety, with some possible concerns about a small increased risk of congenital malformations, and a possible association with childhood asthma and allergy.If you're happy to proceed, we can offer this for you to use for the shortest time necessary. Please tick to confirm you understand.

Are you currently registered with a UK GP practice?

Yes
No
I don't know

Can you tell us why you are not currently registered with a GP, or why you're unsure?

I've only recently moved to the UK
I've been removed from my practice list and not had a chance to register elsewhere
Other

Please remember that you must make sure to provide GP details next time, otherwise we might not be able to accept your order request.

Please provide more details.

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Please tick to confirm that you: fully understand the questions in this questionnaire and have answered honestly and truthfully fully understand the side effects of the treatment options, their effectiveness and alternative options, and are happy to continue with your requestconfirm and agree that any treatment prescribed for you is for your personal use only *
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674 Coventry Road, Small Heath, Birmingham, B10 0UU
105 Barton Street , Gloucester, GL1 4HR
267 Dewsbury Road, Leeds, LS11 5HZ
41 Caldmore Green, Walsall, West Midlands, Walsall, WS1 3RW

Nationwide Delivery

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