HealthRX.com · Printable side-effect diary
Oral minoxidil side effect diary for prescriber visits
Use this sheet to record your oral minoxidil tablet details and any swelling, breathing, heart, dizziness, hair or skin changes week by week. Bring it to your prescriber or pharmacist to talk through the serious effects the label describes.
Medicine and care team details
Copy these from your bottle, prescription and insurance card.
Date you first started the tabletsWrite the day, month and year
Other medicines you take, including guanethidine if anyList every medicine, supplement and over the counter product
Weekly side effect tracker
Write what you noticed this week. Write none if nothing changed. Bring this page to every visit.
| Week ending | Swelling or weight change | Chest pain or breathing | Dizziness or fainting | Hair or skin changes |
|---|---|---|---|---|
Gather before the visit
- Bring the medicine bottle or box with the printed label
- Bring this completed diary and your weekly tracker
- List any new symptoms since your last visit
- Write down your body weight readings if your prescriber asked you to track them
- Note any hair growth or skin changes and when you first saw them
- Check with your pharmacist that all your medicines are listed here
- Bring your insurance card if you need to discuss cost or coverage
Questions to ask your prescriber or pharmacist
- Which of the serious effects on the label should I watch for most closely?
- How should I record swelling, weight changes or breathing changes between visits?
- Do you want an echocardiogram or other heart check, and when?
- Could any of my other medicines interact with this one?
- What symptoms mean I should call you the same day?
- If I stop taking it, how long might hair changes take to settle?
- Is this tablet being prescribed for a use the label approves?
- Are there other options if this medicine is not suitable for me?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.