HealthRX.com · Printable question sheet
Tesamorelin compounding pharmacy questions to ask
Use this sheet before talking with your prescriber or pharmacist about a compounded tesamorelin product, or any compounding pharmacy or outsourcing facility offering it. Fill it in by hand and take it to the visit.
Pharmacy and prescriber details
Write what is on your prescription and the pharmacy label.
Pharmacy or facility nameName as printed on the label
Pharmacy or outsourcing facility?Circle or write which one the label says
Prescriber nameDoctor or nurse practitioner
Egrifta product you were told aboutEgrifta SV or Egrifta WR, if either
Compounded tesamorelin strength and formCopy exactly from the compounded label
Date of visitDate you will ask these questions
Bring to the visit
Gather these before you go.
- Bring the current prescription or order for the compounded product
- Bring the compounded product label or packaging
- Bring the Egrifta label insert if you have one
- List every other medicine and supplement you take
- Note any past blood test results for growth hormone markers and glucose
- Write down any questions you still have from earlier visits
- Confirm the name and phone number of the pharmacy you will use
Questions to ask
- Is this pharmacy a compounding pharmacy or an outsourcing facility?
- Is tesamorelin on FDA's list of bulk substances with significant safety risks?
- Does FDA list tesamorelin in any category for pharmacies or outsourcing facilities?
- Is tesamorelin one of the peptides covered by the HHS draft enforcement policy?
- Is my prescription written for one patient, and is it kept on file?
- Has this compounded product been reviewed by FDA for safety or quality?
- How does this product compare with the FDA-approved Egrifta labels?
- What blood tests will you order to monitor my growth hormone and glucose?
- How will you report any side effects or problems with this product?
- Is this product on the WADA prohibited list, and does that affect my sport or testing?
Answers received at the visit
Record each answer and where you can check it.
| Question | Answer given | Where to check |
|---|---|---|