HealthRX.com · Printable medication review sheet
Viagra and alpha-lipoic acid medication review sheet
Use this sheet before a visit with your prescriber or pharmacist if you take sildenafil (Viagra) and alpha-lipoic acid (ALA) together or are thinking of starting ALA. It collects your medicines, what to bring, and questions about blood pressure, blood sugar and timing.
Medicines I take
Write each product exactly as the label or bottle shows it.
Viagra or sildenafil product nameWrite the brand or generic name on the box
Viagra or sildenafil strength and how oftenCopy from the prescription label
Alpha-lipoic acid product and strengthCopy from the supplement bottle
Other blood pressure medicinesInclude alpha-blockers and amlodipine if taken
Nitrate or other heart medicinesWrite none if you take none
Diabetes medicines or insulinWrite none if you take none
Bring or confirm before the visit
- Bring the Viagra box and the ALA bottle with their labels
- Bring a list of all prescription and over-the-counter products
- Confirm whether you have diabetes or a history of low blood sugar
- Note any heart condition, eye problem or hearing change you have had
- Note how much alcohol you usually drink
- Check with your pharmacist whether any new medicine interacts with these two
- Write down the dates you started ALA and any symptoms since
Questions to ask
- Is there any known interaction between my Viagra and alpha-lipoic acid?
- Does my blood pressure history change how safe this combination is for me?
- If I have diabetes, how should I watch my blood sugar while taking ALA?
- Should I tell you right away if I have shaky, sweaty or confused spells?
- Is there a timing gap I should ask about between Viagra and ALA doses?
- Would a different option be better for my situation?
- What warning signs mean I should seek help the same day?
Symptoms and readings diary
Record each day you take either product. Bring this page to your visit.
| Date | Medicines taken | Dizziness or faintness | Blood sugar reading | 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.