What should I do if I miss my dose of medication?

Dealing with a condition can be stressful and taking medication is a crucial aspect of managing different health conditions. Remembering to take medication at the right time is crucial for the medication to work effectively. What happens when you miss a dose of medication that you need to take regularly? What should you do to make up for the missed dose?

In this blog post, we will tackle what to do if you miss your dose of medication to treat certain conditions in the UK. Always consult with your doctor or pharmacist before making any changes to your medication regime.

Epilepsy medication

For people with epilepsy taking their medication regularly is essential. The consequences of a missed dose could be extremely dangerous. It can increase the likelihood of seizures and make current seizure control less effective. This can in turn lead to problems such as injuries, impairments in daily activities and disruptions to work or school.

Where to find guidance

It is normally advised that people who miss a dose should take the missed dose as soon as they remember unless the next dose is due within a few hours.

An Epilepsy Society website article on Strategies and tools for taking medication is a good source of information and provides further advice. They recommend that:

• A forgotten dose should be taken as soon as it is remembered. This applies to a once-daily medication
• A forgotten dose can be taken if it is within 6 hours after it was due (i.e. less than 6 hours late). If the dose is more than 6 hours late, it should be missed and the next dose taken at the usual time. This applies to twice-daily medication

Oral contraceptives

Taking oral contraceptives is a popular and effective method to prevent pregnancy. However, missing a pill or taking it later than usual can result in an increased risk of pregnancy. It is important to carefully follow the instructions provided and take the pill at the same time every day to ensure effectiveness. Maintaining consistency in taking oral contraceptives is key to their success. If you have any concerns or questions, don’t hesitate to talk to your healthcare provider.

Specific advice varies according to the following factors:

• The number of tablets that have been missed
• When the tablets have been missed
• If the contraceptive taken is a combined pill or progestogen-only pill (also known as a mini-pill)

Where to find guidance

Speaking to a healthcare professional such as a pharmacist is the first source of advice and guidance Alternatively, call 111 or use the 111 online service for advice on missed doses of oral contraceptive pills.

The Patient Information Leaflet supplied with the pill is also a good source of information. Although this can err on the side of caution and may not necessarily follow official guidance from experts.

Further information and advice

The following organisations are credible sources of advice:

• Your contraception guide – NHS website
• The NHS Inform website advice on missed pills
• NHS 111
• Your Guide to the Combined pill and Your Guide to the Progestogen-only pill – FPA the sexual health charity leaflets
• Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit guidance on recommended actions after incorrect use of combined hormonal contraception

Warfarin

Warfarin is a commonly prescribed medication used to prevent blood clots, which can lead to serious health complications such as stroke and heart attack. If you have been prescribed warfarin, it is important to take your medication as directed by your healthcare provider. Warfarin should be taken as a single dose at the same time each day. Missing a dose of warfarin can increase the risk of developing blood clots,

Where to find guidance

It is important to note that medical advice on missed or forgotten doses in manufacturers’ Patient Information Leaflets (PILs) varies.

Many people will follow the advice in the PIL, but more practical is the advice offered in the Warfarin Anticoagulant Record (Yellow Book):

• If you miss a dose and remember before midnight, you can still take that dose
• If you forget your dose for a longer time, do not take that dose to catch up, but take your next dose when it is due
• Never take a double dose of warfarin to make up for a missed dose

Missed doses should be reported

It is helpful for people to make a note of any missed doses, ideally in their anticoagulant record book, and share this information with a health professional at their next blood test appointment.

Insulin

For people with type 1 and type 2 diabetes, insulin is a lifesaver. It helps regulate blood sugar levels, preventing complications like blindness, kidney damage, and nerve problems. But when doses are missed, it can lead to serious consequences. Without insulin, diabetics are at risk of high blood glucose (hyperglycaemia) and possibly diabetic ketoacidosis causing confusion, dizziness, and even coma. Over time, repeated missed doses can lead to long-term complications, such as heart disease and stroke.

Where to find guidance

Diabetic patients should get in touch with their primary care team and follow individual guidelines given by their prescribing GP or diabetes nurse. Usually, the advice given by healthcare professionals is to:

• Under no circumstances double dose of insulin to make up for a forgotten dose
• Carry out blood sugar level checks, and test urine for ketones, especially if patients have any symptoms
• Make contact with their healthcare provider or diabetes educator if patients have any concerns or need advice on subsequent doses

You can also turn to online diabetes communities or forums where you can connect with others who have gone through similar experiences. Hearing from others can provide a sense of support and understanding. Lastly, don’t hesitate to reach out to the manufacturers of your insulin products. They can offer additional information and advice on what to do if you miss a dose. Remember, it’s important to act quickly and seek guidance in order to get back on track with your diabetes management.

Methotrexate

Methotrexate is a medication that is often used to treat a variety of medical conditions, including arthritis and certain types of cancer. Methotrexate doses are taken once weekly and should normally be taken on the same day each week.

Where to find guidance

Advice on what to do if people forget to take their tablets is available on the NHS Methotrexate medicines page.

Advice is given based on when the missed dose is remembered:

• Take the forgotten dose now, then take the next dose as usual if within 2 days
• Contact a healthcare provider for advice if it is 3 or more days
• Do not make up for missed dose by doubling the dose

It is important to point out that a disease flare-up is unlikely to occur with one single missed dose.

Parkinson’s disease medication

Managing Parkinson’s symptoms is difficult if medicines for Parkinson’s disease are not taken on time. It is extremely important to avoid this happening.

Consequences of missed doses

The consequences of a missed or late dose could mean the patient is incapable to move, get out of bed, swallow, walk or talk.

A small delay of even 30 minutes could be serious, with a risk of Neuroleptic Malignant Syndrome (NMS) when medicines for Parkinson’s disease are suddenly stopped. NMS is a rare but serious side effect of some medications used to treat Parkinson’s and other mental health conditions. Common side effects of a dose delay can cause severe muscle rigidity, high fever, changes in mental status, unstable blood pressure and coma.

It’s important to set reminders or utilise medication management tools to help ensure that doses are not missed. Remember, managing Parkinson’s disease is a team effort between you, your healthcare provider, family and carers. Don’t hesitate to reach out if you have any concerns or questions about your medication regimen.

Where to find guidance

Parkinson’s UK website: Managing drug treatments for Parkinson’s provides general advice and tips on managing medicines for Parkinson’s disease.

A Parkinson’s UK Q&A: The Importance of getting Parkinson’s Medication on Time gives practical advice. It suggests for people who forget to take a dose of their medicine(s):

• Take the forgotten dose as soon as you remember, and then adjust the time of the next dose
• If taking a once-daily medication, you can still take the forgotten dose if you remember on the same day. But, if you don’t remember until the next day, skip that dose
• Do not take two doses together to make up for a forgotten dose or take your late dose close to your next one

Further information and advice

• Parkinson’s UK website: Get it on Time campaign
• NICE guideline NG71: Parkinson’s disease in adults (section 1.3)
• NICE Quality Standard QS164: Parkinson’s disease (quality statement 4)
• Product information (summaries of product characteristics and patient information leaflets) available on the EMC website or MHRA products website 

More advice can be provided by Parkinson’s nurses/clinics, pharmacists or GPs regarding missed or late doses.

Bisphosphonates

This type of medication works to slow down the bone loss associated with osteoporosis (alendronic acid, risedronate, and ibandronic acid), helping to reduce your risk of bone fractures.

Administration

It’s important to follow the instructions carefully to ensure maximum effectiveness. Generally, bisphosphonates should be taken in the morning on an empty stomach, with a full glass of water. You should wait at least 30 minutes after taking the medication before eating or drinking anything else, as this will help the medicine to be absorbed properly. Avoid lying down for at least 30 minutes as well, to prevent any stomach upset. If you experience any adverse effects or have questions about how to take your medication, don’t hesitate to contact your healthcare provider.

It’s important to understand that bisphosphonates are typically prescribed with a specific dosing schedule, such as weekly or monthly, according to your individual needs. Alendronate and risedronate are typically taken once a week, while ibandronate can be taken once a month or once every three months. Zoledronic acid is only administered intravenously once a year. For once-weekly or monthly dosing, people are advised to stick to a schedule, i.e. same day each week or a certain day each month.

Where to find guidance

If they miss or forget a dose, people need to follow the advice in the PIL specific to the bisphosphonate they are taking.

Royal Osteoporosis Society’s advice on getting the best from your osteoporosis medication reassures people that missing the odd dose is unlikely to affect overall bone health.

The following advice can be offered if a PIL is not available:

Alendronic acid

Take the missed dose as soon as you remember, unless it’s nearing your next scheduled dose. In that case, just skip the missed dose and continue with your regular dosing schedule. It’s important not to take a double dose to make up for a missed one.

Risedronate

Take the missed dose as soon as you remember, but make sure to do so on an empty stomach. This means waiting at least 30 minutes after taking the medication before eating or drinking anything other than plain water. If it is already time to take your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses on the same day.

Once weekly alendronic acid or risedronate

If you miss your weekly dose, simply take it the morning after you remember and continue taking your dose on the same day each week. It’s important not to double up on your dose or take more than one tablet on the same day. If it’s been more than seven days since your last dose, talk to your doctor or pharmacist for advice on how to proceed. Do not take two doses on the same day.

Monthly ibandronic acid

If it’s been less than 7 days since you missed your dose, simply take your ibandronic acid as soon as you remember. However, if it’s been more than 7 days, skip that missed dose and wait until your next scheduled dose. It’s important to not take a double dose to make up for the missed one.

Then continue taking one tablet once a month on the scheduled days as planned.

Immunosuppressant (transplant rejection) therapy and cancer medications

People should check with their medical team if they’re unsure what to do, as they have the expertise to guide you through this situation.

In conclusion, missing a dose of medication can happen to anyone, but it is important to take the right steps to minimise any potential harm or negative outcomes. Always follow the advice provided by your healthcare provider and contact them if you have any questions or concerns. Being proactive and honest about missed doses can help you stay on top of your treatment plan and improve your long-term health outcomes.

Sources

• Get help for your symptoms – NHS 111
• Advising on missed or delayed doses of medicines – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice