HealthRX.com · Printable restart record
Zepbound stopping and restart record for prescriber visits
Use this sheet if you have stopped Zepbound (tirzepatide) or plan to restart it after a break. Fill it in by hand, then take it to your prescriber or pharmacist, or keep it at home.
Stop and restart details
Write what you know. Leave a line blank if you are not sure.
Date of last Zepbound injectionWrite the month, day and year
Strength on last injectionCopy it from the pen or carton label
Reason for the breakWrite it in your own words
Planned restart dateWrite it only if your prescriber has given one
Weight at last injectionUse the same scale and units each time
Weight at restart
Before the visit
- Bring your Zepbound pen or carton label showing the strength.
- List every medicine and supplement you take now.
- Write down any stomach symptoms since your last injection.
- Note whether your pharmacy supply has run out or been held.
- Check with your insurer whether restarting needs a new approval.
- Bring this sheet and your weight log to the appointment.
Questions to ask your prescriber or pharmacist
- Does the Zepbound label give a restart schedule for my length of break?
- Should I restart at the starting strength or at a different one?
- How long was my break, and does that change how I restart?
- What should I do if I miss a dose after restarting?
- Which stomach symptoms should I report to you right away?
- Will my insurer cover the restart without a new approval?
- Should I schedule a weight check a few weeks after restarting?
Weekly injection and symptom log
Fill in one row each week, starting with your first injection after the break.
| Date | Injection given | Appetite notes | Stomach symptoms | Weight |
|---|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.