Most MS medications need to be taken regularly – so it can happen from time to time that a medication is forgotten. Is that actually a problem? And how should one behave “correctly” if a dose has been missed?
Basically, it is of course no drama if a dose is forgotten – this can happen, especially if the daily routine changes, such as on vacation or when traveling. Nevertheless, it is advisable to stick to the approved dosage of a medication. Medications are tested within their approval studies at a certain dosage – in these studies it is also meticulously controlled that all doses are taken. Accordingly, the effect of a drug can only be guaranteed outside of clinical trials if it is taken in the intended dosage.
Scientific studies on interferon-beta preparations have shown that if less than 70% of the intended dose is taken, no significant effect can be expected. Accordingly, neither self-chosen medication breaks nor “individual” dosages of MS medications are a good idea.
Nevertheless, this is not so rare – patients often tell me that they do not take their medication while on vacation, or that they use a different dosage than the one intended, usually a lower one, in case of tolerance problems.
Although I understand the argument of tolerance, I would appreciate it if it were openly addressed that there are problems with the dosage of a medication – usually a solution can be found in view of the variety of medications available today. It is not a solution to come up with a dosage yourself – because this usually affects the effectiveness.
Therefore, a clear appeal – be transparent about taking your medication. No doctor will take it personally if you are unable to take a medication as prescribed. A problem only arises when you do not say that you have problems taking it and have used much fewer or perhaps no doses at all. This can lead to your doctor drawing wrong conclusions and possibly recommending stronger medications than you need.
Of course, doctors are aware of this problem and pay close attention to signs of lack of adherence – be it that they check whether the number of prescriptions matches the assumed need, or that laboratory values are carefully examined, as many medications leave a certain “fingerprint” in the blood count. But believe me, this kind of detective game is no fun at all – it is much more meaningful if there is an open discussion about the frequency of taking or the dosage of a medication.
There are studies that have shown that the actual intake of MS medications (whose intake is the responsibility of the patients) only corresponds to about 40% of the actually intended amount. And this is indeed a big problem, because medications can only work if they are taken. It must also be taken into account that this results in high costs for the health system without a corresponding benefit.
So, occasionally forgetting an injection or a pill is not a problem – it happens and has no major effects. Systematic changes to the prescribed dosage, without medical consultation, should be avoided in any case. If problems with the prescribed dosage or the frequency of administration occur, it is important to talk to your neurologist and consider alternatives. Openness is needed on both sides here.
In the next post, I will describe how to proceed if you have (unintentionally) forgotten a medication.
