HealthRX.com · Printable medication review sheet
Sildenafil (Generic) older adult medication review sheet
Use this sheet to list your sildenafil products, nitrates, blood pressure medicines and health conditions, then bring it to your prescriber or pharmacist. It also tracks symptoms after each use, especially if you are an older adult or take interacting medicines.
Sildenafil products and current medicines
Write what is on each bottle label exactly as printed.
Sildenafil product name on labelViagra, Revatio or generic sildenafil
Prescriber name and phone
Pharmacy name and phone
Nitrate medicines, including nitroglycerinName, form and how often
Alpha-blocker medicine and how long taken
Other blood pressure medicines
Antibiotics, antifungals or HIV medicinesInclude erythromycin, ketoconazole, itraconazole or ritonavir if listed
Supplements and over-the-counter products
Gather before the visit
Bring this sheet and the items below.
- Bring every sildenafil bottle and its prescription label.
- Write down all prescription, over-the-counter and herbal products you take.
- List any heart, blood pressure, liver or kidney conditions your prescriber knows about.
- Note any recent heart attack, stroke, fainting or chest pain and when it happened.
- Check with your pharmacist whether any new medicine interacts with sildenafil.
- Confirm which sildenafil product you have, since Viagra and Revatio differ.
- Note any nitrate prescription and when you last used it.
- Bring the names of any eye, hearing or erection problems you have noticed.
Questions to ask at the visit
- Is sildenafil still appropriate for my heart and blood pressure history?
- Which of my current medicines could change how sildenafil affects my blood pressure?
- Should my sildenafil starting amount be adjusted for my age, kidney or liver function?
- If I need nitrates in an emergency, what waiting period, if any, should I follow?
- Which symptoms should make me stop sildenafil and seek care right away?
- Should I have my testosterone checked before we decide on treatment?
- Can my pharmacist check for interactions whenever a new medicine is added?
Symptoms after each sildenafil use
Record the product, what you noticed and when. Share this log at each visit.
| Date and time | Product taken | Symptoms noticed | Dizziness or fainting? | Vision or hearing change? |
|---|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.