HealthRX.com · Printable question sheet
Rybelsus rare serious side effects questions sheet
Fill this in before a visit with your prescriber or pharmacist about oral semaglutide (Rybelsus). Use it to note your history, bring your questions about the rare but serious warnings, and track any symptoms you notice between visits.
Your Rybelsus details
Write what is on your bottle and your records. Leave blank if unsure.
Strength on the bottleOne of the three strengths listed on the label
Date you started Rybelsus
Prescriber name and phone
Pharmacy name and phone
Family history of medullary thyroid carcinomaWrite yes, no or not sure
Other diabetes medicines you takeInclude insulin or any sulfonylurea
Gather before the visit
Bring this sheet, your medicine list and your symptom log.
- Bring the Rybelsus bottle or a photo of its label
- List all prescription, over-the-counter and supplement products you take
- Note any recent eye exams and any retinopathy diagnosis
- Note any gallbladder problems, stones or gallbladder tests you have had
- Note any planned surgery, procedure or sedation dates
- Check with your pharmacist whether your other medicines interact with Rybelsus
- Write down any past reaction to a tablet or its ingredients
Questions to ask at the visit
- What symptoms of pancreatitis should I report to you right away?
- What thyroid symptoms, such as a neck lump or hoarseness, should I watch for?
- Do I need calcitonin testing or a thyroid ultrasound, and why or why not?
- Does my eye history change how I should be monitored for retinopathy?
- What signs of kidney problems should I report if I have vomiting or diarrhea?
- Should my insulin or sulfonylurea dose be reviewed with Rybelsus?
- What should I do if I develop severe allergic symptoms?
- Given the European NAION warning, should I report any sudden vision change to you?
- How should Rybelsus be handled before any surgery or deep sedation?
Symptoms to track between visits
Write what you notice, when it started and whether you told a clinician.
| Date | Symptom | How long | Told clinician |
|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.