HealthRX.com · Printable medication review sheet
Metformin and rosuvastatin medication review sheet
Use this sheet before a visit to review metformin and rosuvastatin together. Fill in your medicines and kidney results, gather what to bring, note questions, and track muscle and blood sugar symptoms between visits.
Medicines and kidney results
Copy these from your bottles, lab reports and prescription labels.
Metformin form on the bottleImmediate-release or extended-release, as printed
Rosuvastatin strength on the bottleWrite the strength and how often it is taken
Most recent eGFR result and dateFrom your latest kidney blood test report
Most recent creatinine clearance and dateOnly if your report lists it
Other kidney or liver conditions notedWrite each condition as your doctor named it
Antacids, supplements or other medicinesInclude aluminum or magnesium antacids and their usual time
Before and at the visit
Bring this sheet and the items below to your prescriber or pharmacist.
- Bring every bottle of metformin and rosuvastatin you have at home
- Bring your most recent kidney and liver blood test reports
- List any cyclosporine, gemfibrozil or antiviral prescriptions you take
- Note any planned contrast scan, surgery or procedure and its date
- Check with your pharmacist which antacids and supplements you use
- Write down any new muscle pain, weakness or tenderness since the last visit
- Confirm who to call if symptoms appear between appointments
Questions to ask
- Do my kidney results mean either medicine needs a dose change?
- Should my metformin be checked again before any contrast scan?
- Does my rosuvastatin dose still fit my current kidney results?
- Which symptoms should make me stop metformin and call you right away?
- How should I space my rosuvastatin from my antacid?
- When should my liver enzymes be tested again?
Symptom and reading diary
Record between visits and bring this page with you.
| Date | Muscle pain or weakness | Blood sugar reading | Stomach or breathing symptoms | Notes |
|---|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.