Medication Interaction Checker Template

Track all medications and supplements to catch potential interactions

How to Use This

How to Use This: Fill in the medication and supplement tables completely, then run through the interaction check steps. Bring the completed form to every medical and pharmacy visit. Update it whenever a medication or supplement is added or changed.

List every medication, supplement, and regular OTC product your child takes. Bring this to every medical appointment.

Current Medications

Name	Dose	Frequency	Prescriber	Start Date	Purpose

Current Supplements

Name	Dose	Frequency	Brand	Start Date	Purpose

Interaction Check Steps

List ALL medications including OTC (Tylenol, Benadryl, etc.)

List ALL supplements including vitamins and herbs

Check each pair using an interaction checker (see resources below)

Ask pharmacist to run a full interaction check at pickup

Inform each prescriber about all other medications

Re-check interactions whenever a new medication or supplement is added

Note any foods that interact (grapefruit, dairy, high-vitamin-K foods)

Free Interaction Checkers

Drugs.com Interaction Checker

drugs.com/drug_interactions.html

Medscape Interaction Checker

reference.medscape.com/drug-interactionchecker

Quick Interaction Check

Quick check: Enter your medications and supplements at drugs.com/interactions or ask your pharmacist. Common interactions to watch: St. John's Wort + most medications, iron + thyroid medication, calcium + antibiotics.

Important

Supplements can interact with medications just as strongly as other drugs. Common examples: fish oil + blood thinners, St. John's Wort + SSRIs, calcium + thyroid medication, iron + many antibiotics. Always disclose supplements to prescribers.

Next Steps

Next Steps: Share this completed template with every healthcare provider your child sees. Use the Medication Risk-Benefit Worksheet when considering any new medication, and the Medication Alternatives Chart to explore evidence-based options with your doctor.

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