HealthRX.com · Printable question sheet
Trulicity heart-protection questions for your prescriber
Use this sheet to prepare for a visit with your prescriber or pharmacist about whether the Trulicity heart-protection indication from the REWIND trial article may apply to you. Fill it in by hand and bring it along.
Your details for the visit
Write what is on your records. Leave blank if unsure.
Name and date of birthAs shown on your pharmacy label
Diabetes type on my recordWrite the wording your prescriber used
Current Trulicity strength and how oftenCopy from the pharmacy label
Heart history on my recordPrevious heart attack, stroke, or other event
Heart risk factors my prescriber has notedFor example blood pressure or cholesterol notes
Thyroid or pancreas history notedWrite any history your prescriber has recorded
Records to gather before the visit
Bring copies if you have them.
- Bring your current pharmacy label for Trulicity
- List every other diabetes medicine you take, including any insulin or sulfonylurea
- Bring any warfarin or other narrow-range medicine list you currently use
- Note any family history of thyroid cancer your records show
- Check with your pharmacist which over-the-counter products you use
- Bring your most recent eye exam report if you have one
- Write down the names of your heart and diabetes doctors
Questions to ask your prescriber
- Do I fit the heart-protection indication based on my heart history?
- How does Trulicity compare with tirzepatide for someone in my situation?
- Which Trulicity warnings apply to me given my records?
- Should my insulin or sulfonylurea be reviewed if Trulicity is started?
- How will my eye health be monitored if I have a history of retinopathy?
- Will any of my other medicine levels need checking after a change?
- Is Trulicity being considered for weight in my case, and is that covered?
- What would make you stop or change the medicine for me?
Stomach symptoms and eating record
Write what you notice and when. Share this log at your next visit.
| Date | Symptom | How long it lasted | Did it change eating? |
|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.