HealthRX.com · Printable medication review sheet
Liraglutide and SSRI (sertraline or escitalopram) medicine review
Use this sheet before a visit with your prescriber or pharmacist about taking Saxenda or Victoza together with sertraline (Zoloft) or escitalopram. Fill it in by hand, bring it along, and keep it at home for later visits.
Medicines I take now
Write each name exactly as it appears on the pharmacy label.
Liraglutide productSaxenda or Victoza, as labelled
Liraglutide dose and how oftenCopy from the label
SSRI nameSertraline (Zoloft) or escitalopram
SSRI dose and how oftenCopy from the label
Diabetes medicinesInsulin or sulfonylurea names, if any
Other medicines and supplementsInclude St John's wort, contraceptives, pain relievers
Before the visit
- Bring every pen, tablet and capsule box you use, including over the counter products.
- List every prescriber and pharmacy you use.
- Note whether you use insulin or a sulfonylurea.
- Write down when each medicine was last changed and who changed it.
- Confirm which label version of each medicine your pharmacy is using.
- Check with your pharmacist whether any of your medicines are missing from this list.
Questions to ask
- Does the Saxenda or Victoza label list any interaction with my SSRI?
- Could liraglutide change how my SSRI or contraceptive is absorbed?
- Which serotonin syndrome signs should I report to you straight away?
- Should my insulin or sulfonylurea dose be checked when liraglutide starts or changes?
- How will you check my blood sugar readings while I take both medicines?
- What mood or suicidal thought changes should I report, and to whom?
- Does my age or weight change which of these medicines is suitable?
- What should I do if I miss a dose of either medicine?
Symptoms and readings to track
Record new or unusual changes after any dose change. Bring this page to your next visit.
| Date | Symptom or reading | Medicine taken | Reported to |
|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.