Chlorphenamine 4mg Tablets Brands May Vary (28 Tablets)

Due to the nature of this product, we’ll just need to ask some simple questions so we can ensure our duty of care. We’ll never share any information here with a third party without your prior consent, and only every use it for processing your order effectively.

GPcH No: 9011211

Who will be using the item?

Myself Someone else

Is the intended user taking this for any of the following conditions?

Hay fever or allergies
Nettle rash
Skin rash
Hives or prickly heat
Insect bites or stings
Itchy rash

Yes No

Have you been diagnosed with any of the following conditions?

Very high blood pressure
Heart disease
Epilepsy
Glaucoma
Enlarged prostate
Kidney disease
Liver disease

Yes No

Is the intended user pregnant or breastfeeding?

Yes No

Please confirm the intended user:
- Is over 6 years old.
- Has never had an allergic reaction to antihistamines and is not currently taking any other antihistamines.
- Understands this medication can cause drowsiness and agrees not to drive or operate machinery if affected and not to drink alcohol while using it.
- Has not taken Monoamine Oxidase Inhibitors (MAOIs) for depression in the last 2 weeks
-Understands this product should be used with caution when taking other medicines that cause drowsiness (e.g., sleeping tablets).
- Agrees to inform their GP if they are being treated for high blood pressure, heart disease, epilepsy (especially Phenytoin), glaucoma, enlarged prostate, liver or kidney disease, bronchitis/asthma or bronchiectasis, anxiety, or insomnia.

Yes No

Are they taking any other medicines?

Yes No

Chlorphenamine 4mg Tablets Brands May Vary (28 Tablets)

Chlorphenamine 4mg Tablets Brands May Vary (28 Tablets)

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