HealthRX.com · Printable medication review sheet
Spironolactone and atorvastatin medication review sheet
Use this sheet to list your spironolactone and atorvastatin medicines, gather what to bring, and write questions for your prescriber or pharmacist about potassium, muscle symptoms and blood tests.
Medicines and prescribers
Copy these details from your bottle labels and prescriptions before the visit.
Spironolactone prescribed forReason written on your prescription
Atorvastatin dose and how oftenCopy from the bottle label
Prescriber name and phone
Pharmacy name and phone
Other medicines and supplementsInclude potassium products, salt substitutes and pain relievers
Before and at the visit
Tick each item as you complete it.
- Bring all pill bottles, including supplements and over the counter products
- Write down the date of your most recent potassium blood test
- Note any salt substitute or potassium-rich food you use regularly
- List any grapefruit or grapefruit juice you drink
- Confirm whether your liver enzyme and kidney test results are on file
- Check with your pharmacist which of your other medicines you fill there
- Write down any muscle pain, tenderness or weakness you have noticed
Questions to ask
- Is spironolactone still the right treatment for my reason for taking it?
- Which potassium blood tests do you want me to have, and when?
- Does any other medicine or supplement I take need a review with these two?
- What muscle symptoms should I report to you, and how quickly?
- Should my kidney function be checked, and how does it affect my potassium?
- Who should I call if I have questions between visits?
Muscle symptoms and test tracker
Record new symptoms and test results as you notice them. Bring this sheet to each visit.
| Date | Symptom or test | Result or detail | 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.