HealthRX.com · Printable side-effect diary
Liraglutide side effect diary for Saxenda and Victoza
Use this sheet to record which liraglutide product you take and the stomach, heart rate and other effects you notice day to day. Bring it to your prescriber or pharmacist to discuss what you have seen.
Your medicine and start details
Copy these from your pen box or pharmacy label. Write only what you know.
Product nameSaxenda or Victoza, as printed on the box
Strength on the labelWrite the strength exactly as printed
Date you startedWrite the day you first injected
Dose change datesNote any lower or higher dose and the day it began
Prescriber name and clinic
Pharmacy name and phone
Daily side effect record
Mark none, mild, or bad for each effect. Add any other effect in the last column.
| Date | Nausea | Vomiting | Diarrhea | Constipation | Heart racing or other |
|---|---|---|---|---|---|
Before your visit
- Bring the pen and box you are using
- List every other medicine and supplement you take
- Note whether you take a sulfonylurea or insulin
- Write any stomach pain that lasted and where it was
- Note any dizziness, shakiness or low sugar readings
- Check with the pharmacist which side effects need a call
- Confirm the pharmacy phone number and clinic hours
- Note any fluid loss, very little urine or lightheadedness
Questions for your prescriber or pharmacist
- Which of the side effects I recorded should I report right away?
- How often will my heart rate be checked during treatment?
- Should my other diabetes medicines be reviewed with this one?
- What should I do if vomiting or diarrhea stops me drinking fluids?
- Which signs of pancreatitis should prompt an urgent call?
- Is my family history of thyroid cancer relevant to my treatment?
- What gallbladder symptoms should I watch for and report?
- How long should I expect nausea to last before it should improve?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.