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Missed dose (revision 3)

Old revision·10:13, 17 Oct 2024·Chromatokid

This is an old revision of this page, as it stood at 10:13, 17 Oct 2024, saved by Chromatokid with the summary add the preservative point: unpreserved diluent changes the interval. It may differ substantially from the current revision, and any error it contains may since have been corrected.
Missed dose
Governing quantityHalf-life relative to dosing interval
Weekly agentsLong half-life; concentration falls slowly
Daily agentsSteady state re-established within days
Topic infobox · conventions

A missed dose is a scheduled administration that is not taken. How much it matters depends almost entirely on the ratio between the drug's half-life and its dosing interval: a long half-life relative to the interval means concentrations fall slowly and a single omission changes exposure little.[1]

For a weekly agent with a half-life of several days, the concentration at the end of a normal dosing interval has fallen to a substantial fraction of its peak, and a missed week extends that decline rather than producing a sudden loss of exposure. For a daily agent with a half-life of hours, a missed day is a larger proportional change but is corrected within a day or two of resuming.[2]

The governing arithmetic

[edit]

After a dose, concentration falls by half each half-life. For a peptide with a half-life of seven days on a weekly schedule, trough concentration is about half the peak and steady-state accumulation is roughly two-fold. Omitting one dose allows a further halving before the next dose is taken.[2]

Half-lifeIntervalFall over one missed interval
≈7 daysWeeklyTo about half
≈5 daysWeeklyTo about two fifths
≈13 hoursDailyTo a few per cent
≈2.4 hoursTwice dailyEssentially complete

References

  1. ^ Drucker DJ. "Mechanisms of action and therapeutic application of glucagon-like peptide-1." Cell Metabolism 27(4):740–756 (2018). PMID 29617641.
  2. ^ a b Knudsen LB, Lau J. "The discovery and development of liraglutide and semaglutide." Frontiers in Endocrinology 10:155 (2019). PMID 31031702.