HealthRX.com · Printable medication review sheet
Hydroxytryptophan and tretinoin medication review sheet
Use this sheet before a visit with your prescriber or pharmacist if you use tretinoin on the skin and are considering or already taking a hydroxytryptophan supplement. Fill it in by hand and bring it along.
Products and clinicians
Write each item exactly as it appears on the label or prescription.
Tretinoin strength and formCream, gel or lotion, as printed
Hydroxytryptophan supplement nameName on the bottle, including any added ingredients
Supplement amount per serving and how oftenCopy from the bottle label
Gather before the visit
Bring these so the review uses your actual products.
- Bring the tretinoin box or tube and the supplement bottle
- List every prescription medicine you take now
- List every over-the-counter medicine and other supplement you take
- Note any antidepressant, migraine or pain medicine you have used recently
- Check the tretinoin label for its drug interactions section
- Write down when you started each product
- Confirm the pharmacy you use for all your medicines
Skin and symptom diary
Track both products for several weeks and bring the diary to the visit.
| Date | Skin changes | Sun exposure | Other symptoms |
|---|---|---|---|
Questions to ask
- Has this tretinoin product been tested alongside a hydroxytryptophan supplement?
- Does my tretinoin label list any product that I take as an interaction?
- Are any of my current medicines in a group that can interact with a serotonin supplement?
- Which signs should make me call you or seek urgent care while using both?
- Should I tell you before starting or stopping any supplement?
- Is there a safer way for me to track changes in my skin with these products?
- Can you note this supplement in my medical record and pharmacy profile?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.