Privacy Notice

Please be advised that your Personally Identifiable Information will be used for the following: 1) to fulfill your request for materials 2) to evaluate the effectiveness of the program, if you check the box numbered 1 below and 3) to send you additional information, if you check the box numbered 2 below.Your Personal Information will be shared with Eisai Inc., PriCara®, Division of Ortho-McNeil-Janssen Pharmaceuticals Inc., their affiliates, and any third-party vendor who is involved with our fulfillment process.

  • Complete the form below and click on the Submit Form button
  • Or call 1-800-965-8229 and give us your information over the phone
  • Either way, you’ll receive your materials in the mail within 4 to 6 business days

Please complete the following information.

*Required fields are noted with an asterisk.
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Important Notice

The survey below is optional. By checking the box below, the personal information you provide will be shared with Eisai Inc., Ortho-McNeil-Janssen Pharmaceuticals, Inc., their affiliates, and companies working on their behalf, to evaluate the effectiveness of this program. However, your information will be de-identified so that no one will be able to identify you when they conduct the evaluation.

You can request that your information be removed from the mailing list and the evaluation at any time by calling 1-888-877-1201.

1. Yes, I consent to the use of my information to evaluate this program.

Are you:

Male Female

Have you been diagnosed with acid reflux disease by a healthcare professional?

 Yes  No

How are you currently treating your acid reflux symptoms?

 Over-the-counter medication
 Prescription medication
 Both over-the-counter medication and prescription medication
 Not taking medication

Are you currently taking prescription ACIPHEX®?

 Yes  No

For future communications, I prefer to receive information by:

E-mail Regular Mail Both

2. Yes, please send additional educational materials on ACIPHEX® and other related health information.

By clicking on the Submit Form button below, you agree that the information you submit will be governed by the Important Notice above and by our Privacy Policy.

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One ACIPHEX® 20 mg tablet daily is used for the treatment of persistent, frequent (2 or more days a week) heartburn and other symptoms associated with acid reflux disease.

ACIPHEX® is also used for the short-term (4 to 8 weeks) treatment in the healing and symptom relief of damaging (erosive) acid reflux disease (gastroesophageal reflux disease) and to maintain healing of damage (erosions) and relief of heartburn symptoms that happen with acid reflux disease. ACIPHEX® has not been studied for treatment lasting longer than 12 months (1 year).

Important Safety Information

ACIPHEX® has a well-established safety profile. The most common side effect possibly related to ACIPHEX® is headache. Symptom relief does not rule out other serious stomach conditions. Patients on warfarin (such as Coumadin®) may need to be monitored more closely by their doctors.

To learn more, talk to your doctor and see the Full Product Information.

Coumadin is a registered trademark of Bristol-Myers Squibb Company.

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ACIPHEX® is a registered trademark of Eisai Company, Ltd., Tokyo, Japan.
®2008 Eisai Inc. and Ortho-McNeil-Janssen Pharmaceuticals, Inc. 2007-2008. This site originates in the United States.

This information is intended for use by our customers, patients, healthcare professionals and interested parties in the United States only.
Eisai Inc. and PriCara® Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. recognize that the internet is a global communications medium;
however, laws, regulatory requirements and medical practices for pharmaceutical products vary from country to country.
The prescribing information included here is not appropriate for use outside the United States.

This site contains information about products that may have different product labeling in different countries.
This site is intended for adults 18 years and older.

This site is published by Eisai Inc. and PriCara® Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., which are solely responsible for its contents.

Coumadin is a registered trademark of Bristol-Myers Squibb Company.

This site was last modified on: March 25, 2008 at 5:30 EST

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