Forgotten to take medication
Two aspects are important in this context. The first is the possible loss of effect that may result from incorrect use. The second a possible overdose if the forgotten intake is incorrectly made up. Caffeine addicts know that effects are possible from caffeine withdrawal, which can manifest itself after just a few hours in the form of headaches, fatigue and irritability. Forgetting can be potentially problematic because of the possible consequences in serious illness. In emergency medicine, forgotten doses can be life-threatening. With psychotropic drugs and narcotics to which the body has become accustomed, there is a risk of withdrawal symptoms.
Measures
The course of action depends on the drug involved, the patient, the dosing interval, the pharmacokinetics, the therapeutic window, and the indication, among other factors. It must be assessed individually by a healthcare professional. Sources include the drug information leaflet, the patient information leaflet, the scientific literature and information from the pharmaceutical companies. It should be noted that for some drugs, the information can only be found in the patient information, but not in the professional information. In the absence of information, foreign documents can also be used.
Examples
Sometimes the omission is harmless, for example, in the daily substitution of vitamin D with drops or tablets. This is because vitamin D has a relatively wide therapeutic range, and a forgotten dose has no acute consequences. The administration can be made up or omitted. The same is true for many dietary supplements such as probiotics and omega-3 fatty acids, for vitamins and minerals. For the antihypertensive perindopril, a study showed that skipping it during a day had no adverse effects. However, this does not apply to all antihypertensive drugs. The German patient information leaflet recommends for the antiepileptic drug lamotrigine not to make up the intake and to continue with the next one as usual. Lamotrigine has a long half-life. The amount of time that has passed before the error is noticed is also important. For example, if there is only an hour or two in between, the dose can usually be made up. This does not apply in the case of a short dosing interval, e.g. several times a day. With many hormonal contraceptives (“the pill”), the missed dose can be made up within 12 hours. Protection is still guaranteed. The following dose is taken at the usual time. As a rule, it is not recommended to take a double next dose to compensate for the forgotten dose. This could result in an overdose and adverse effects.
Tips for prevention
- Regularly administer medicines always at the same time.
- Provide medications in advance.
- Use a medication dispenser.
- Electronic reminders (eg, apps, alarm clocks).
