First of all, you are not alone. Patients miss doses for a variety of reasons—everything from a change in routine, such as travel or an unscheduled appointment or event, to a lapse in memory. But skipping a dose can render medication less effective or cause symptoms to reappear. For example, missing a dose of blood pressure medication may require additional blood pressure monitoring throughout the day. And forgetting to take blood thinners may raise the risk of having a blood clot or stroke.
As for what to do when you miss a dose, the recommendation can vary depending on the type of medication, how many times a day you take it, and when you realize you missed it. If you miss just one dose, your pharmacist may be able to help you. You should not necessarily take the dose as soon as you remember, especially if it's close to the time of the next dose. If you miss two or more doses in a row, call your doctor. It's almost never recommended to double the dose to catch up, as this could result in side effects, an overdose, or other harm.
If you are on anticoagulants to prevent blood clots and forget to take a dose, call your doctor or pharmacist to ask for guidance. Instructions vary for different medications in the class. For example, if you take rivaroxaban (Xarelto) once a day and forget a dose, you should take it as soon as possible on the same day. If you don't remember until the next day, do not double up and take two doses. If you take rivaroxaban twice a day and forget a dose, take the missed dose as soon as you remember. If it is close to the time of the next scheduled dose, ask your neurologist if you can take two doses at the same time to make up for the missed dose.
If you can't reach your doctor or pharmacist, contact the Poison Help line (800-222-1222), which will route you to your local poison control center, usually at a hospital. It is staffed by pharmacists, nurses, and physicians 24 hours a day who can advise what to do next; they may tell you to go to the emergency department for evaluation. Always follow up with your own doctor.
To reduce the risk of missing a dose in the future, follow these suggestions.
Review instructions. When starting or changing medications, clarify when and how often to take them with your doctor. Update any personal records you keep about your medications, including the frequency and time to take them.
Read the label. Always take medications as directed. If the information is unclear, or you have questions, ask your doctor or pharmacist. Don't guess or make assumptions, even if you have taken the medicine previously.
Set reminders. Program your smartphone to remind you or put sticky notes on your refrigerator or where you keep your medications. Consider using pill organizers with the days and times displayed. Enlist your spouse or another relative to remind you.
Maintain a medication list. Medicines work best when taken as prescribed. Keep an updated account of all medicines you take—both prescription and over the counter, as well as vitamins, supplements, and herbal products—and note any changes or side effects as soon as possible. Apps like Medisafe and Round Health can help you keep track.
Dr. Young is a medication safety specialist with the Institute for Safe Medication Practices in Plymouth Meeting, PA.
