HealthRX.com · Printable medication review sheet
Zepbound constipation medication review sheet
Bring this sheet to your prescriber or pharmacist when constipation starts or continues while taking Zepbound. Record your current dose, the laxatives you have tried, any warning signs, and daily bowel movements so the options can be reviewed together.
Current Zepbound and bowel details
Write what applies to you. Leave blank if unsure and ask at the visit.
Zepbound dose nowas printed on the pen or pharmacy label
Date of most recent dose changewrite the month and year
Laxative or stool softener in usename, and how often you take it
Date of last bowel movementwrite the day and time
Rectal bleeding seenyes or no, and when it happened
Nausea, vomiting or abdominal painnote how long it has lasted and how it has changed
Other medicines and supplementsinclude any blood thinner such as warfarin
Before the visit
- Bring the Zepbound pen or box and every laxative bottle you use
- List which laxatives you have tried and how each one worked
- Note any warning sign from the labels that has happened since your last visit
- Check with your pharmacist how Zepbound may affect absorption of your other medicines
- Write down your kidney history and any past stomach or gallbladder problems
Questions to ask at the visit
- Should my Zepbound dose be reviewed because of constipation?
- Is a lower maintenance dose an option for my situation?
- Which laxative is suitable for me, and how long should I use it?
- What warning signs mean I should contact you the same day?
- Should my other medicines be checked for changed absorption while on Zepbound?
- Would a prescription option for constipation be considered for my case?
- What should I track between visits to help decide the next step?
Daily bowel and symptom log
Fill in one row each day. Bring the log to every visit.
| Date | Bowel movement | Stool firmness | Laxative taken | Notes |
|---|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.