Often, a medication is simply forgotten unintentionally. Then the question arises of how to behave correctly. As already mentioned, the sporadic forgetting of a tablet or an injection is not a drama. However, you should not try to make up for the missed dose by taking a double dose next time. Instead, you should simply continue the planned dosing schedule.
Specifically, this means that if you forget an injection with Betaferon/Extavia®, Rebif® or Copaxone/Clift®, then you simply continue taking it at the next scheduled time. If you miss the time of a weekly Avonex® or a bi-weekly Plegridy™ injection, you can still make up for this dose 1 – 2 days later. If the failure is noticed later, it is better to stay in the given rhythm. It may also be reassuring to know that even a Plegridy injection every 4 weeks showed a significant superiority over placebo in the approval study, although not as pronounced as with an injection every two weeks, which is why the bi-weekly dose was approved.
If you have forgotten Tecfidera® or Aubagio®, you should also not double the next dose, but stay in the prescribed rhythm and continue the next dose as planned. Longer downtime should be avoided, especially with Tecfidera®, as this drug has a relatively short half-life.
Longer downtimes should also definitely be avoided with Gilenya®. Gilenya® is one of the immunomodulators used for more active courses – unlike the previously mentioned drugs. However, taking it is also the patient’s responsibility. Therefore, an important remark about Gilenya®: The start of the intake should be medically supervised. Formally, this monitoring must be repeated if Gilenya® is discontinued for a certain period of time – the length of this period is only > 1 day in the first week after therapy starts, max. seven days three to four weeks after therapy starts, and two weeks from the first month after therapy starts. Therefore, it is advisable – also for safety reasons – to take Gilenya® very regularly, especially at the beginning.
Another drug that is given for active courses and whose intake is also the responsibility of the patient is Mavenclad®. Mavenclad® is based on an induction concept, i.e. tablets are only taken for a certain period within the first and second year of treatment. Therefore, it is of great importance for the effect that the individually calculated dosage is actually taken – higher dosages can be dangerous for the patient. Therefore, special care is required here. If a tablet is forgotten within a cycle, the dose should not be “made up”, but the cycle is extended by one day, or by two if the dose is missed on two days, etc. – although I hope that such a situation does not occur in reality.
All the MS drugs not yet mentioned have the advantage that they are administered as an infusion and therefore the preparation and administration is the responsibility of the doctor. As a rule, it works very well with these drugs that the patient receives the prescribed dosage in the prescribed periods. With infusion therapies, it is also not necessary to schedule the intervals exactly, shifts of one week are not a problem either with Tysabri®, Alemtuzumab® or Ocrelizumab®.
Nevertheless, it is also important with these drugs that the agreed appointments are reliably kept.
