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Medical Assessment for Jet Lag Relief

Complete this short online consultation so our medical team can show you suitable treatments.

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Tell us about yourself
Are you between 18 and 75 years of age?
Are you requesting melatonin to help manage short-term symptoms of jet lag following travel across time zones?
Are you seeking melatonin solely for jet lag, rather than for long-term sleep problems or insomnia?
Do you understand that melatonin for jet lag is intended for short-term use only?
Your Health Information
Are you currently pregnant, breastfeeding, or think you may be pregnant at this time?
Have you ever had an allergic reaction or intolerance to melatonin, lactose, or similar medicines, as this could affect whether treatment is suitable for you?
Do you have any existing medical conditions or past health problems from the list below? (This information helps ensure your treatment is safe and suitable for you.)

Alcohol dependence or problematic alcohol use
This can affect how medicines work and may increase the risk of side effects or unsafe use.

Autoimmune conditions (such as rheumatoid arthritis or Graves’ disease)
Some medicines may not be suitable or may require extra monitoring in autoimmune conditions.

Depression requiring treatment with medication
Certain treatments can affect mood or interact with antidepressant medicines.

Epilepsy or a history of seizures
Some medicines can lower the seizure threshold or interfere with seizure control.

Galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption
Some medicines contain lactose or related sugars and may not be suitable in these conditions.

Heart disease or other significant heart conditions
Certain treatments can affect heart rate, rhythm, or blood pressure.

Kidney disease or reduced kidney function
Impaired kidney function can affect how medicines are cleared from the body.

Liver disease or ongoing liver problems
The liver plays a key role in processing medicines, and liver problems may increase the risk of harm.

Schizophrenia or bipolar disorder
Some treatments may worsen symptoms or interact with psychiatric medicines.

 

Your Current Medication
Do you take any current medication, including prescription treatments, over-the-counter products, or any recreational drugs?
Melatonin can increase drowsiness and may lower blood pressure, particularly when taken with certain other medicines. The medications listed below may increase these effects. Do you understand that if you experience symptoms such as dizziness, light-headedness, excessive sleepiness while taking melatonin, you must stop taking it immediately?

Alcohol and sedating medicines
(Can increase drowsiness, slowed reactions, and excessive sleepiness)
Alcohol; opioid painkillers; antihistamines; antipsychotic medicines; tricyclic antidepressants; mirtazapine; phenobarbital; primidone; muscle relaxants such as baclofen or tizanidine.

Blood pressure–lowering medicines
(May increase the risk of dizziness, light-headedness, or fainting)
Alpha-blockers (e.g. doxazosin, alfuzosin, tamsulosin, prazosin); beta-blockers; calcium-channel blockers; diuretics (water tablets); nitrates; vasodilators such as hydralazine, minoxidil, or sodium nitroprusside.

Centrally acting blood pressure medicines
(Act on the brain and may increase sedation or low blood pressure)
Clonidine; guanfacine; lofexidine; methyldopa; moxonidine; diazoxide.

Medicines affecting melatonin levels or blood cells
(May increase side effects or alter how melatonin is processed)
Ritonavir; myelosuppressive medicines.

Patient Declaration & Consent
Do you agree to the following? Please read each statement carefully before confirming. This ensures you understand how your treatment will be supplied and used safely.

 

☑️ I will read the Patient Information Leaflet provided with my medication before use.

☑️ I will contact ifeelshy and inform my GP immediately if I experience any side effects, start a new medication, or if my medical conditions change during treatment.

☑️ I understand that the treatment is for my personal use only and will not be shared with anyone else.

☑️ I confirm that I have answered all questions accurately and truthfully to the best of my knowledge.

☑️ I understand that the prescriber relies on my answers in good faith, and that providing incorrect or incomplete information could affect my health.

☑️ I understand that while treatment decisions are made jointly between myself and the prescriber, the final decision to issue a prescription rests with the prescriber.

Are you aware that melatonin may make you feel drowsy, and that you must not drive or use heavy machinery for at least eight hours after taking a dose?
Do you understand that melatonin should be taken once a day at bedtime in your new time zone, only between 8 pm and 4 am, as this helps reset your body clock, and that it should not be used for more than five days? (Melatonin helps reset your body clock after travel. Taking it at bedtime in your new time zone helps it work properly, while using it at other times or for too long can interfere with your sleep.)
Do you understand that some studies suggest melatonin may be linked to an increased risk of falls, accidents, memory problems, and possible dependence or withdrawal (mainly with long-term or inappropriate use)?
Are you aware that melatonin should not be taken with alcohol, as this can increase drowsiness and side effects?