HealthRX.com · Printable side-effect diary
Trulicity delayed side effects diary and visit sheet
Use this sheet to record Trulicity doses and any nausea, vomiting, diarrhea, stomach pain or other symptoms over time. Bring it to your prescriber or pharmacist to discuss delayed-onset effects the article describes.
Your Trulicity details
Fill in from your pharmacy label and medicine box.
Medicine name and strengthCopy from the pharmacy label
Current weekly doseWrite the dose exactly as labeled
Date of first doseWrite the month and day
Date of most recent dose changeLeave blank if none
Prescriber name and phone
Pharmacy name and phone
Other diabetes medicines you takeInclude any insulin or sulfonylurea
Daily symptom and dose diary
Note how long each symptom lasted and how much fluid you drank.
| Date | Dose taken | Nausea or vomiting | Diarrhea or constipation | Stomach or back pain | Fluids and notes |
|---|---|---|---|---|---|
Before your visit
- Bring your Trulicity pen box and the pharmacy label
- Bring this completed diary for the past weeks
- List all medicines and supplements you take
- Note any new abdominal pain, including pain that spreads to the back
- Note any lumps or swelling in the neck, trouble swallowing or hoarseness
- Note any rash, swelling of the face or trouble breathing
- Write down any planned surgery, procedure or anesthesia
- Check with your pharmacist about your fluid intake during vomiting or diarrhea
Questions for your prescriber or pharmacist
- Based on my symptoms, should my dose be changed or paused?
- How long after a dose change should I watch for stomach symptoms?
- What signs of kidney problems should I report to you right away?
- Which symptoms would mean I need to stop Trulicity and seek care?
- How will you check my kidney function during dose increases?
- Should I be checked for gallbladder problems given my symptoms?
- What symptoms of pancreatitis should I watch for at home?
- Do I need a thyroid check given my family history?
- Should my insulin or sulfonylurea dose be adjusted with Trulicity?
- What should I tell my surgeon or anesthesia team about Trulicity?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.