
Here you will find a checklist to help you discuss the side effects of your treatment with your healthcare professional or other treatment team members. You can print out the checklist, fill it out, and bring it with you the next time you see your healthcare professional. You should speak with your healthcare professional about any questions you have regarding this checklist or any other side effects that may not be on this list. Working with your healthcare professional and treatment team, you can create the optimal treatment plan personalized for you.
In the past 2 weeks, have you experienced:
YOUR SIDE EFFECTS CHECKLIST:
Doctor, I have experienced the following, which I would like to discuss with you
- Blurry vision
- Problems with sexual function
- Change in breasts
- Change in menstrual periods
- Headache
- Lightheaded, dizziness
- Swelling of the hands or feet
- High blood pressure
- Weight
- Lost weight
- Gained weight
- Mouth feels too dry
- Drooling or too much saliva
- Constipation
- Nausea
- Stomach Ache
- Vomiting
- Unexpected increases in urination, thirst, and/or hunger
- Trouble urinating
- Urinating frequently
- Sleepiness, sleeping a lot
- Trouble getting to sleep or staying asleep
- Low energy, easily tired
- Feeling restless or jittery, cannot sit still
- Slowness, trouble getting moving
- Muscles feel stiff
- Shaking or muscle trembling
- Tremor
- Muscle pain
- Lack of bodily strength
- Memory problems, forgetfulness
- Finding it hard to concentrate
- No motivation, loss of interest in usual things
- Anxiety
- Agitation
Other
Any other symptoms (describe other symptoms in the box below):
Comments:
Share This Page
Please see U.S. FULL PRESCRIBING INFORMATION, including


