HealthRX.com · Printable symptom log
Adderall XR and caffeine intake and symptom log
Use this sheet to record your coffee, tea, soft drink and energy drink intake alongside your Adderall XR dose times, sleep, heart rate feelings and anxiety. Bring the completed log to your prescriber or pharmacist to discuss.
Your medicine and caffeine sources
Fill in before you start the log. Keep a copy at home.
Adderall XR product and strengthName on the pharmacy label
Usual time you take the capsuleWrite the time you usually swallow it on awakening
Usual coffee or tea and cup sizeBrand, size and how it is brewed
Energy drinks or caffeinated soft drinksName and can or bottle size
Daily caffeine and symptom record
Write each drink as it is taken. Note any feelings the same day.
| Date | Dose time | Caffeine drinks and times | Heart or anxiety notes | Sleep notes |
|---|---|---|---|---|
Before the visit
- Bring the completed log for the whole period
- Bring the Adderall XR pharmacy label and list of other medicines
- Note any over-the-counter products that contain caffeine
- Confirm the caffeine amount on the drink labels you recorded
- Write down any dose times that changed during the period
- Check with your pharmacist whether any other products you use are listed
Questions to ask your prescriber or pharmacist
- Is caffeine listed as an interaction for my Adderall XR?
- Should I check my blood pressure and pulse at home while on this medicine?
- Which of my logged symptoms should I report to you right away?
- Does the timing of my coffee relative to my dose matter for my sleep?
- Are energy drinks a concern for my situation or for a child in my care?
- Should my caffeine intake be discussed at my next routine visit?
- What should I bring to the next appointment to review this log?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.