HealthRX.com · Printable missed-dose plan
Prometrium missed dose record and questions for prescriber
Use this sheet when a Prometrium capsule is late, skipped or taken at an unusual time. The label gives no missed-dose instruction, so write down what happened and bring this sheet to your prescriber or pharmacist to ask what to do next.
Prescription details
Copy these from the bottle or the label insert you were given.
Capsule strength on the labelWrite the strength printed on the bottle
Regimen named on the labelEndometrial protection or secondary amenorrhea
Prescribed bedtime scheduleWrite the days and time as your prescriber described them
Taken with conjugated estrogens?Yes, no, or not sure
Prescriber name and pharmacy
Gather before the visit
Bring these so the conversation is based on facts.
- Bring the Prometrium bottle and any leaflet that came with it
- Note whether the capsule was taken with food or on an empty stomach
- Write down any peanut allergy so the pharmacist can review the capsule ingredients
- Confirm which prescriber manages your Prometrium schedule
- Check with your pharmacist which number to call after hours for a dosing question
Capsule and missed dose record
Record each late, skipped or unusual dose and any dizziness or drowsiness.
| Date | Time taken | Taken with food | Dizziness or drowsiness | Notes |
|---|---|---|---|---|
Questions for your prescriber or pharmacist
- What should I do if I miss my bedtime capsule for one night?
- Should I take a late capsule or skip it, and how late is too late?
- Does the label's missed-dose guidance apply to my regimen?
- What should I do if I take two capsules by mistake?
- What signs of overdose should prompt me to call for help?
- Should I avoid driving on nights when I feel drowsy after a capsule?
- Does food change how my capsule works for my prescribed schedule?
- Is peanut oil in the capsules a concern given my allergy history?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.