HealthRX.com · Printable medication review sheet
Viagra and bupropion medication review sheet
Use this sheet before a visit about taking Viagra (sildenafil) with bupropion. Write down your medicines, blood pressure history and seizure history, then bring the sheet to your prescriber or pharmacist.
Your medicines and history
Write what applies to you. Leave blank lines empty if none apply.
Viagra (sildenafil) strength and how often you take itCopy the wording from your pharmacy label
Bupropion product name and formInclude brand, extended or immediate release, and whether it is Contrave
Nitrates in any form or riociguatList any you use, even if rarely
Alpha-blocker or other blood pressure medicineName each one and when you started it
Seizure history or seizure threshold drugsNote any seizure disorder or other drugs that may lower the seizure threshold
Other medicines, supplements and herbal productsInclude antibiotics, antifungals and anything bought without a prescription
Before the visit
- Write the full name of every medicine and supplement you take
- Bring all pill bottles or boxes for Viagra and bupropion
- Confirm whether the Viagra label you were given mentions bupropion
- Note any nitrate or riociguat prescriptions and bring their names
- Bring recent blood pressure readings from home or the clinic
- Check with your pharmacist whether they have a full interaction screen on file
- List how much alcohol you drink and when you usually take Viagra
Questions to ask your prescriber or pharmacist
- Does the Viagra label cover bupropion, and does it give any data on taking the two together?
- Which medicines on my list should be checked against sildenafil before I start?
- Given my other medicines, is a lower starting dose of Viagra worth considering?
- Should my blood pressure be checked before and after the first doses taken together?
- Does bupropion change how Viagra is broken down in the body?
- Which blood pressure or heart warning signs should I watch for on bupropion?
- Does my seizure history change whether bupropion is suitable with Viagra?
- Can you review whether my sexual function changes relate to bupropion or to my depression?
Daily tracking notes
Record each day you take Viagra or bupropion, and note any symptoms.
| Date | Medicines taken | Blood pressure reading | Dizziness or flushing | Notes for visit |
|---|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.