Talking to your prescriber: a checklist for the first visit, every follow-up, and the conversations people avoid

Appointments on a GLP-1 are short and the medication is complicated. The labels contain everything a prescriber should ask about and most of the options they can offer, but the person who benefits from those options is usually the one who raises them. This checklist is organised by visit. Print the provider visit question list from the tools site to take with you; this page explains why each question is on it.

Before the first prescription

History the label screens for. Every one of the four labels contraindicates the drug in anyone with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, and in anyone with a prior serious hypersensitivity reaction to the drug. The warnings sections add pancreatitis, gallbladder disease, kidney impairment, diabetic retinopathy in people with type 2 diabetes, severe gastrointestinal disease including gastroparesis, and depression or suicidal thoughts, which prescribers should still ask about even though the specific label warning was removed in 2026. Bring the answers ready. Volunteer them if you are not asked.

Every medication and supplement, especially insulin and sulfonylureas (the labels warn of hypoglycaemia in combination and say the dose of those drugs may need reducing), oral hormonal contraceptives if tirzepatide is being considered (the label says to add a barrier or non-oral method for 4 weeks after starting and after each increase), and anything with a narrow therapeutic window such as warfarin, which the labels flag because delayed gastric emptying can change absorption of oral drugs.

Pregnancy plans, now or in the next year. The pregnancy guide explains the semaglutide two-month rule and the tirzepatide contraception warning; both change what should be prescribed.

Planned procedures. Any surgery, endoscopy or sedation in the coming months; the surgery guide explains the label warning and the society guidance.

Questions to ask. Which product and which presentation (pen, multi-dose pen, vial), and why. Which label indication is being claimed, since insurance criteria follow it (see the insurance guide). The escalation plan, in writing, with dates. What the plan is if a step is not tolerated, with the label options named: delay four weeks, hold at a lower maintenance dose, step down. What labs are being taken before starting and at what intervals; the lab guide site explains the usual set. How to reach the practice between visits, and what symptoms should trigger a same-day call. If a compounded product is being prescribed: the pharmacy's name and state licence, the concentration, and how the pharmacy provides injection training; compounded products are not FDA approved and are not interchangeable with brand products, and a prescriber offering one should say so.

At every follow-up

Bring numbers, because "not great" is not actionable and the clinical recommendations for managing GI effects (Wharton 2022, PubMed 34775881) rely on the pattern over the step.

Days with nausea, vomits, and bowel pattern in each week since the last visit. Weight, from the same scale at the same time of day, weekly. What you are actually eating: a typical day, and whether protein is reaching the target from the muscle guide. Fluid intake and any dizziness or reduced urine output, since the labels' acute kidney injury warning hangs on volume depletion (see the hydration guide). Injection sites used and any lumps, persistent redness or bruising; the rotation planner printout is a ready-made record. Any missed or delayed doses with dates. Hair shedding, mood changes, sleep, energy. Alcohol, honestly (see the alcohol guide). Anything new prescribed by anyone else.

Ask: is the next step on schedule, and if I would rather wait, is that acceptable? What weight-loss rate are we aiming for? When are the next labs? Has anything on the label changed since I started (labels are revised several times a year; the prescriber may not know either, and the DailyMed date is easy to check)?

When a step is going badly

The dose escalation guide covers this in full. The conversation in one paragraph: report the pattern with numbers, name the label option you want considered, ask the pharmacy or program to hold the next strength until the prescriber decides, and do not change anything yourself.

When something might be a warning sign

Call the same day, and say the words the label uses, because they trigger the right response: severe persistent abdominal pain that may radiate to the back (pancreatitis); right upper abdominal pain, fever, jaundice (gallbladder); cannot keep fluids down, little urine, dizzy on standing (volume depletion, kidney); hives, facial or throat swelling, difficulty breathing (hypersensitivity); a lump in the neck, hoarseness, trouble swallowing (the thyroid warning); vision changes in someone with diabetes (retinopathy). For any of these, a practice that says "mention it at your next appointment" has not understood; ask to speak to the prescriber or go to urgent care.

Before a procedure

Tell the surgeon and the anaesthesia team, early and in writing: product, dose, injection day, time on the current dose, any GI symptoms. Ask whether to hold, and from when, and write down the answer and the name. Ask how to restart. The surgery guide has the label text and the 2023 and 2024 society positions to refer to if you are given no answer.

Before switching

The switching guide lists the decisions: why, what starting dose and on whose judgement, what day, what happens to prior authorisation, and for tirzepatide the contraception warning. Ask for all of them before the new prescription is sent.

Before stopping

Why, and whether a lower labelled dose would meet the same goal. What you will measure and how often. What resistance training and protein plan is in place first. What regain would prompt a conversation about restarting, as a number. If for pregnancy, the stop date relative to trying. The stopping guide has the trial evidence to bring.

The conversations people avoid

"I have been getting it from somewhere else too." Two prescribers, two products, or a brand pen plus a compounded vial from a telehealth service, is a real pattern and a dangerous one; the labels do not contemplate two GLP-1s at once. Tell both prescribers.

"I have been adjusting the dose myself." Splitting, stretching, skipping steps. The prescriber cannot interpret your side effects or your weight curve without knowing. Say so.

"I do not want to go higher." A legitimate position with label support (lower maintenance doses are labelled, and the trials show most of the effect at them). Say it plainly and early.

"I cannot afford next month." Raise it before the gap, not after; the insurance guide and the pricing site exist for this, and a planned lower dose beats an unplanned stop.

"Is this prescriber right for me?" A prescriber who did not take the label history, who has no plan for a rough step other than "push through", who will not put the escalation in writing, or who cannot say which label indication they are treating, is not running the programme the label describes. The clinics site covers what a good intake and follow-up look like.

Compounded products

Compounded semaglutide and tirzepatide are not FDA approved and are not interchangeable with brand products. Everything above applies to a prescriber of a compounded product, with the additions in the first-visit section. FormBlends describes what its pharmacies dispense on its semaglutide and tirzepatide pages, and that commercial interest is disclosed on every page of this network.