HealthRX.com · Printable lab tracker
Rapamune sirolimus trough and lab tracker
Use this sheet to record sirolimus trough levels, lipid, blood count, kidney and liver results and dose changes for Rapamune or rapamycin. Bring it to each lab draw and prescriber visit.
Prescription and prescriber details
Copy these from your prescription label and most recent visit notes.
Medicine name and formWrite Rapamune or the name on your label
Current maintenance dose as writtenCopy exactly from the latest prescription
Date of most recent dose changeWrite the month and day
Target trough range given by prescriberWrite the range as your lab report states it
Taking cyclosporine tooWrite yes or no and the timing your prescriber gave
Prescriber name and clinic
Pharmacy name and contact
Lab results and dose change record
Write each lab date and result as reported. Note any dose change on the same row.
| Date drawn | Trough level | Cholesterol and triglycerides | Platelets and blood counts | Kidney and liver tests |
|---|---|---|---|---|
Before each lab draw or visit
- Confirm the exact draw timing your prescriber gave after any dose change
- Note the time of your last Rapamune dose and of any cyclosporine dose
- Bring the current prescription label or a photo of it
- List every other medicine, supplement and herbal product you take
- Check with your pharmacist about any new drug before starting it
- Bring the previous lab reports and this completed log
- Note any grapefruit or cannabidiol use and bring details
- Write down any new infections, mouth sores, swelling or wound problems to report
Questions to ask at your visit
- What trough range should my results fall within for my situation?
- How many days after a dose change should my next trough be drawn?
- Which lipid tests will you order and how often?
- Which blood count and kidney tests are needed at each check?
- Should my liver tests change my maintenance dose?
- Which of my current medicines could change my sirolimus levels?
- Do I need a different check if I start a new antibiotic or antifungal?
- What symptoms should prompt me to call the clinic before my next lab?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.