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Risk Minimisation Materials

Thalidomide Prescription Authorisation form

Each prescription of Thalidomide must be accompanied by a newly completed Prescription Authorisation Form to confirm the patient has been counselled about the teratogenic risk of thalidomide and the requirement for the use of contraception and the continuous use of an effective contraception whilst taking thalidomide. Also, for woman of childbearing potential the confirmation of having a pregnancy test every 4-weeks, before each prescription to ensure they are not pregnancy. Completion of this information is mandatory for ALL patients.

For Healthcare Professionals