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Taking medications on time and regularly is hard to commit to and it can be very easy to lose track and miss a dose. This...
Taking medications on time and regularly is hard to commit to and it can be very easy to lose track and miss a dose. This is a common problem hence why many people struggle with taking medications on time and with managing their doses.
According to the World Health Organisation (WHO) 50% of patients do not take their medications as it has been prescribed which includes missing doses. Therefore, medication non-adherence is a common reason as to why patients get re-hospitalised and deal with severe consequences and this also adds to the burden of healthcare systems to manage these cases.
This Meds for Less article aims to educate and inform about the dangers of missing medication doses. Although missing doses occasionally is not harmful, doing so very often can prove quite damaging to one’s health and wellbeing. This article will investigate why patients miss a dose and how this could be managed better with some tips and tricks for a better lifestyle.
Taking medications on time is crucial for the way medications can take effect in the body and to maximise a drug’s therapeutic outcome. Taking medications on time is especially important to maintain the correct therapeutic effects of the drug and maximise its efficacy whilst minimising any adverse reactions which may occur. This is termed as the ‘therapeutic window’.
A dosing regimen provided by your doctor is crucial because this is designed meticulously according to your treatment needs to ensure the drug concentrations are within the therapeutic timeframe.
A study done by the Royal College of Emergency Medicine (RCEM) investigated data from 136 emergency departments around the United Kingdom for more than 13,000 patients. These patients were identified with conditions such as diabetes, epilepsy, Parkinson’s and so on. These patients were taking time-critical medications (TCM) which consists of insulin, levodopa, epilepsy medications and blood clotting medications.
The study found that over 50% of patients were not correctly identified as TCM patients within 30 minutes of arriving at the emergency departments. Furthermore, more than 68% of TCM doses were not administered within the crucial timeframe of 30 minutes.
In the above case of patients who take prescribed TCM, a delay in administering these drugs can be extremely dangerous and cause other complications and may even lead to death hence missing doses of TCM prescribed drugs poses a high mortality risk.
Furthermore, missing doses for certain medications can be quite detrimental to one’s health in the long term. This is especially true of antibiotics. Antibiotics tend to be prescribed by doctors and other prescribing professionals to treat acute bacterial infections or as a preventive measure for chronic bacterial infections which are ongoing.
Antibiotic resistance is currently on the rise and has led to several hospital admissions and caused around 35,200 estimated deaths in the UK in 2023 and around 1.3 million deaths worldwide. Data statistics show that this number will rise to 8.22 million deaths by 2050.
Therefore, taking the correct dose of medications like antibiotics at the correct time is especially important to ensure the bacterial infections are eradicated. Missed doses may cause harmful bacteria to survive and become resistant to further treatment and lead to further complications or even death.
Taking medications on time is crucial to maintain and maximise the therapeutic effects of a drug whilst minimising any potential side effects. However, many patients struggle to adhere to dosing regimens and tend to miss doses quite often. This may cause the patient to deteriorate and lead to dire consequences for the patient.
Here are some common reasons why patients miss a dose according to the American Medical Association (AMA) outlined in the table below:
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What is causing the problem?
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Why would this lead to a missed dose? |
How can this be resolved? |
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Fear |
– Patients may not take their medications on time or may even completely stop their medications due to fear of side effects of the drugs.
– Some patients may have experienced seeing other family members suffer from side effects and not want the same for themselves. |
– Patients could speak to their healthcare providers about what is worrying them, what their concerns are and have a open conversation about side effects and how these can be managed.
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Cost |
– Many patients may not be able to afford the expenses of buying medications every month especially if it is a long-term medication so may choose to miss a dose. |
– Ensure healthcare professionals use the patient’s insurance formulary when prescribing medication so it can be cost-effective for the patients.
– Patients can subscribe to annual or monthly prescription services which may reduce the cost over long term instead of paying every day.
– Some patients may be entitled to free healthcare costs, so it is recommended to speak to a doctor about these concerns and see if there are any alternatives to paying.
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Complex and multiple dosing schedules |
– Patients who take several medications for multiple comorbidities may struggle to keep in check with all their medications and may miss several doses. |
– Pharmacists and Doctors can look at a patient’s medication history and see if a once-a-day medication regime can be adopted instead.
– Long-acting medications as an alternative
– Use combination of medications to treat multiple issues if possible.
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Depression |
– Patients who are dealing with depression as more likely to miss medication and are likely to not adhere to medication regimes. |
– Doctors can ensure to check in on patients especially those on depression medications to ensure medication regimes are being adhered to and to offer alternatives if this is not the case.
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Poor instructions provided by the healthcare providers |
– Many patients miss a dose simply because they were not given the correct instructions on how and when to take their medications |
– Ensure healthcare providers take the time with each patient and carefully explain how and when to take certain medications to improve patient safety and reduce medication non-adherence.
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Patient related issues |
– Some patients may have cognitive issues, mobility issues, have stressful day-to-day routines and may not be able to manage a strict dosing schedule hence miss doses. |
– Patients can set up phone or email reminders to remember taking medications on time.
– Pill boxes for those taking multiple medications and forget when to take them.
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These are the following steps you can take if you realise you have missed a dose of your medication:
In most cases, do not take a second dose without first assessing the timing of the missed dose and checking with a doctor or another healthcare processional for guidance as double doses can lead to drug toxicity, further complications and even death.
The following outlines special considerations that must be taken in the event of a missed dose for the following types of medications and what to do in this case:
With medications for chronic conditions such as high blood pressure medications, diabetes medication, thyroid condition medication, cholesterol medication and so on. Missing doses occasionally is not harmful however missing a dose often can lead to the condition not being managed adequately.
These are for acute bacterial infections or for prevention of ongoing chronic infections. Missing an antibiotic dose is not ideal as this may lead to harmful bacteria not being eradicated effectively by the medication and leading to antibiotic resistance. If you’ve missed a dose:
These are useful for managing pain. These can be prescribed or bought over the counter. Medications for pain can be paracetamol, ibuprofen (NSAID) and many others. Taking a double dose can lead to drug toxicity and side effects leading to liver failure. If a dose is missed:
In the case of birth control pills, the guidelines are different for each medication and are highlighted as follows:
Certain medications should be skipped when a dose is missed instead of attempting to catching up with the dose. These are highlighted below:
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Class of drug |
What to do in the event of missing a dose?
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Why is catching up with a dose dangerous? |
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Anticoagulants such as Warfarin, Clopidogrel |
– In the case of missing doses of anticoagulants, it is only recommended to take a dose if you have only missed the dose by a few hours, but it has to be the night before the next dose.
– If you remember the next day, it is better to skip the dose entirely and continue with the next one as prescribed.
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– If you take a double dose, you have a significant risk of bleeding with anticoagulants. |
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Methotrexate – cytotoxic medication for psoriasis, rheumatoid arthritis, and other inflammatory conditions |
– If you miss a dose, take it the next day.
– If you are more than 2 days late, skip the dose and contact your doctor for further instructions.
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– Highly toxic is a double dose is taken, can lead to serious complications and even death. |
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Opioids such as morphine, codeine |
– If you miss a dose, it is advised to skip the missed dose entirely and resume as normal with the next dose.
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– Taking a double dose or more than necessary can lead to respiratory depression. |
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Insulin |
– If you miss a dose of insulin, skip the missed dose and continue as normal. – If you take your insulin weekly and have missed a dose, do not take a second dose and instead contact your doctor for further instructions.
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– Taking more insulin than needed can be detrimental and lead to hypoglycaemia (low blood glucose) which may require hospital intervention. |
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Immunosuppressant medications such as tacrolimus, prednisolone, and cancer treatments |
– If you miss a dose, contact your doctor or specialist as soon as possible and wait for further instructions |
– Transplant rejection risk is high with missing doses of medication like tacrolimus. – Cancer treatment may cease to be effective if doses are missed regularly. |
Missing doses as evidenced above occasionally may cause no harm, however, repeated missing doses may lead to deterioration of health and can lead to serious complications. Medication non-adherence can be improved in many ways and evidence suggests improvement is greatest when multiple strategies are used consistently alongside each other. These are outlined below:
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Strategy |
How to do this? |
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Patient based |
1. Technology – patient can use apps on their phone which can set them reminders and notifications to remind them to take their medications on time.
2. Pill/Dossett boxes – these are designed to help patients who are on multiple medications and helps them to keep track of what medication to take when and makes it easier to manage their condition. These can be supplied monthly or weekly.
3. Visualise essential information – write down important reminders, if possible, on the kitchen board or in your living room where you are more likely to see the reminder and act on it.
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Healthcare system based |
1. Pharmacist reviews – healthcare professionals such as pharmacist should aim to conduct medication reviews with patients especially those on medications for conditions such as Parkinson’s, Alzheimer’s etc and assess if any intervention is required.
2. Simplify over-complex medication routines – switch patient to long-acting once-aa-day medications to improve adherence and manage symptoms better.
3. Easy accessibility for patients – makes it easier for patients to access their medication. This includes a repeat medication system which can be ordered online by the patient using an app or calling a pharmacy and so on so prescriptions can be refilled on time and minimise missed doses.
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Behavioural interventions |
1. Educate patients – educating patients right at the start about why adhering to medication routines is important allows them to see for themselves the potential risks of failing to take medication on time. This gives them autonomy over their health and allows them to make informed choices.
2. Family or carer support – including families into the therapy process can allow family members to support patients (with their consent) and makes it easier for patients to manage their conditions and adhere to dosing regimens with support from others. If a patient is unable to do this, carer support could also be provided. |
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