HealthRX.com · Printable question sheet
Low-dose naltrexone heart and blood pressure questions sheet
Use this sheet before a visit with your prescriber or pharmacist about low-dose naltrexone (LDN) and heart health. Fill in your medicines, bring your labels, write your questions, and keep a short log of any heart or blood pressure changes you notice.
Your medicines and prescriber
Write what you have now. Leave a line blank if it does not apply.
Prescriber nameDoctor or clinic that manages your naltrexone
Naltrexone product and formCompounded capsule, compounded liquid, or tablet, as shown on the label
Pharmacy name and phoneWhere the naltrexone is filled
Opioid medicines in useWrite none if you take no opioid pain, cough, cold or antidiarrheal products
Heart or blood pressure medicinesName each one as written on the label
Other medicines, supplements or productsInclude store-bought cold or sleep products
Bring and confirm before the visit
Bring this sheet and the items below to your appointment.
- Bring the naltrexone container and its label so the form is clear.
- Confirm which pharmacy compounds or dispenses your naltrexone.
- Note any opioid medicine in your home, including old prescriptions.
- List every heart and blood pressure medicine you take.
- Check with your pharmacist whether your other medicines were reviewed alongside naltrexone.
- Bring any recent blood pressure readings you have recorded at home.
- Write down any heart symptoms you have noticed since starting naltrexone.
Questions to ask your prescriber or pharmacist
- Has long-term heart outcomes research been done for the naltrexone form I take?
- Do you check my blood pressure or heart rhythm while I take this medicine?
- Could naltrexone interact with my heart or blood pressure medicines?
- Is there a heart symptom that would mean I should contact you right away?
- How do you confirm the strength and quality of my compounded naltrexone?
- Would you review whether an opioid medicine or product in my home is a concern?
- Is the naltrexone in Contrave the same product as the one I take?
- What should I bring to my next visit to track my heart health?
Heart and blood pressure symptom diary
Record what you notice and bring this log to your next visit. Write what happened, not advice.
| Date | Symptom or reading | What you noticed |
|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.