For reference: liraglutide · ten days.
I have read the obvious sources and they disagree with each other, so I would rather ask people who have actually done this.
I have a working setup and a notebook, and I am prepared to be told that my setup is inadequate if that is the answer.
Concretely, what should I do, and how would I know afterwards whether I did it right?
10 days past a due dose is 1.43 half-lives at the seven-day half-life this class runs on, which leaves about 37.1 per cent of that dose still circulating. One line of arithmetic: remaining fraction is one half raised to days over half-life, so 0.5^(10÷7) = 0.3715. At 37.1 per cent you have not been off it in any meaningful sense. The interval stretched from 7 days to 17 and the trough went lower than usual; that is the whole of what happened. What the product label says and what the pharmacokinetics say are two different answers here, and the first is the one that governs. Restarting, holding or stepping down after a gap is decided under supervision, and nothing here is medical advice.
Answer first: it depends on the half-life and on how long ago the dose was due, and for a weekly agent the tolerance is much wider than people fear.
For a daily agent with a thirteen-hour half-life, a missed dose is a much larger proportional loss. The usual approach is to skip it and take the next scheduled one rather than doubling.
| Week | Fraction of steady state | Trough as × dose |
|---|---|---|
| 1 | 50 % | 0.50 |
| 2 | 75 % | 0.75 |
| 3 | 88 % | 0.88 |
| 4 | 94 % | 0.94 |
| 5 | 97 % | 0.97 |
| 6 | 98 % | 0.98 |
This is why a four-week step interval is approximately, but not exactly, steady state.
To change your regular dosing day, move the next dose later rather than earlier, keeping at least three days between doses for a weekly agent. Moving earlier compresses the interval and raises exposure.
Set a recurring reminder attached to something you already do weekly.
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Browse resultsAnswering this needs the agent, since the answer for a thirteen-hour half-life and a one-week half-life are entirely different.
With a one-week half-life dosed weekly, missing one dose means exposure falls by about half over the following week — the same trough you would reach if you simply extended the interval. That is well within the range the agent operates in.
Put another way, if more than two consecutive weekly doses are missed, tolerance to the gastrointestinal effects begins to fade and re-titration from a lower step becomes the sensible approach.
Two or more missed weekly doses means considering a lower restarting step.
The relevant arithmetic is that one missed dose of a weekly agent produces a trough about half the usual, which is well inside the normal range.
Set a recurring reminder tied to something you already do weekly. The commonest cause of a missed dose is not forgetting the drug but losing track of the day.
In practice, the published guidance for the weekly agents is broadly: if the missed dose is remembered within about five days, take it and continue on the usual day; if more than five days have passed, skip it and take the next scheduled dose.
Loss of tolerance during a treatment gap is documented and is the basis for re-titration after an interruption.
Within about five days for a weekly agent, take it. Beyond that, skip and resume.
Start with the interval since the missed dose, because that single number determines the answer.
One missed dose is not a reason to change the schedule or the dose. Two or more is a reason to consider where you are restarting from.
The caveat is that anyone on other glucose-lowering medication has an interaction question here that needs a prescriber.
Never double up. Peak exposure is what drives the symptoms.
Changing the regular dosing day is possible and should be done by moving forward, not by squeezing two doses together.
Never take two doses close together to compensate. The peak exposure is roughly doubled, and gastrointestinal tolerability tracks peak exposure closely.
Half-lives across the class span roughly thirteen hours to one week, which is why the answer is agent-specific.
To move your dosing day, move it later and keep three days between doses.
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