HealthRX.com · Printable side-effect diary
Metformin side effect diary and visit prep sheet
Use this sheet to track stomach and bowel side effects of metformin day by day, note your kidney, vitamin and alcohol details, and bring it to your prescriber or pharmacist at your next visit.
Medicine and prescriber details
Fill in from your bottle and prescription label.
Metformin tablet typeImmediate-release or extended-release, as printed on the label
Strength on the labelCopy exactly as written
Date you started metformin
Prescriber name and phone
Pharmacy name and phone
Other medicines you takeInclude over-the-counter products and supplements
Daily symptom tracking
Record each day you notice a change. Write none if nothing happened.
| Date | Stools or diarrhea | Nausea or vomiting | Other symptoms | Notes |
|---|---|---|---|---|
Before your visit
Gather these items before you go.
- Bring all medicine bottles, including over-the-counter products and supplements.
- Write down the dates of your last kidney and blood count tests.
- Note any upcoming scans using contrast dye or planned surgery.
- List your alcohol use honestly so your prescriber can plan around it.
- Confirm the metformin tablet type and strength you currently take.
- Check with your pharmacist before starting any new medicine.
Questions to ask
- Is my metformin immediate-release or extended-release, and does that change what I should watch for?
- Should my kidney function be checked again before my next visit?
- Does my age, liver history or alcohol use change my plan?
- Would a vitamin B level test be useful for me, and how often should it be repeated?
- Do any of my other medicines interact with metformin, such as cimetidine or topiramate?
- Which symptoms should make me call you the same day?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.