Ask your health care provider these questions about each new medicine which is recommended or prescribed. Write the answers in the spaces provided.

Use a separate sheet for each medicine.

Name of Medicine: _________________________________________________

 

• What are the brand and generic names of the medicine? Can I use a generic form?
  

 

• What is the medicine for and what effect should I expect?
  

 

• Does this drug replace any other medicine I have been using?
  

 

• How and when will I use it, what amount will I use, and for how long?
  

 

• What do I do if I miss a dose?
  

 

• Should I avoid any other medicines, (prescription or over-the-counter), dietary supplements, drinks, foods or activities while using this drug?
  

 

• When should I notice a difference or improvement? When should I report back.

 

• Will I need to have any testing to monitor this drug's effects?
  

 

• Can this medicine be used safely with all my other medications and therapies? Could there be interactions?
  

 

• What are the possible side effects? What do I do if a side effect occurs?
  

 

• How and where do I store this medicine?
  

 

• Where and how can I get written information about this medicine? What other sources of information can I use to learn about this medicine?

Call 1-888-INFO-FDA or go to Be An Active Member of Your Health Care Team