HealthRX.com · Printable medication review sheet
Oral minoxidil safety review for older adults
Use this sheet before or at a visit with your prescriber or pharmacist if you are an older adult considering or taking low-dose oral minoxidil for hair loss. Fill in your current medicines and track any changes over time.
Current medicines and health history
Write what applies to you. Leave blank what does not.
Blood pressure medicines nowNames as printed on the bottles
Water pill or diureticName and who prescribed it
Guanethidine useYes, no, or not sure
Doxazosin useCurrent or past, with approximate end date
Kidney function and dialysisLatest kidney test notes and whether you have dialysis
Heart conditions or anginaDiagnoses and who manages them
Gather before the visit
Bring these to your appointment or pharmacy visit.
- Bring a full list of prescription, over the counter and supplement products
- Bring your recent blood pressure and heart rate readings
- Note the name and strength on any minoxidil label you have
- Confirm which prescriber is managing your blood pressure
- Check with your pharmacist whether any medicine you take interacts with minoxidil
- Write down any past reaction to blood pressure medicines
- Bring recent kidney and heart test results if you have them
Symptom and reading diary
Record changes as they happen and bring this page to your visit.
| Date | Dizziness or light headedness | Swelling | Heartbeat changes | Notes |
|---|---|---|---|---|
Questions to ask your prescriber or pharmacist
- Is there safety data from people my age for this use?
- Which symptoms should prompt me to contact you right away?
- How will my blood pressure and heart rate be checked during treatment?
- Does my current blood pressure regimen change the risk for me?
- Would my kidney function affect how this medicine is handled by my body?
- What heart changes would you want to check before I start?
- Who should I contact if I miss a visit or have a new symptom?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.