Two missed doses in a row, and what restarting means numerically

Two missed doses in a row, and what restarting means numerically

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One missed dose is a gap. Two in a row is often treated as a reason to restart the schedule, and restart is a word that hides several quite different numeric operations. It is worth being explicit about which one is meant.

Take a ramp at week nine, dose 0.75 mg weekly, with doses due on the 5th and 12th both missed. The last dose taken was the 29th of the previous month. The next dose, whenever it happens, is at least 21 days after the last one. Three intervals of seven have become one of twenty one.

Restart can mean: resume at 0.75 mg and continue the ramp on the original week numbering, so week ten follows and the ramp endpoint arrives on the original date. Or resume at 0.75 mg but shift all subsequent weeks by two, so the endpoint arrives two weeks later. Or return to an earlier level, say 0.5 mg, and re-climb, which adds however many weeks the re-climb takes. Or return to the ramp start at 0.25 mg, which for this example adds two full steps and eight weeks if holds are four weeks.

Each of those has a different material cost. Continuing at 0.75 costs nothing extra. Re-climbing from 0.5 with four week holds costs 4 x 0.5 = 2.0 mg and four weeks to get back to where you were. Re-climbing from 0.25 costs 4 x 0.25 + 4 x 0.5 = 3.0 mg and eight weeks. If the endpoint was 2 mg and the ramp had 5 steps left, the full restart turns a 20 week remaining ramp into a 28 week one.

The cumulative total also needs handling. Two missed doses at 0.75 mg is 1.5 mg not administered, so the running total is 1.5 mg below the planned curve at that point. Whether that gap is closed or simply carried forward is a decision, and it should be recorded as one rather than left implicit. I note the gap explicitly in the tracker where the schedule lives so that the planned and actual curves stay separately visible.

Supply arithmetic moves in your favour here and it is worth capturing. Two skipped doses at 0.75 mg leaves 1.5 mg more in the vial than planned, which at the current rate is two extra weeks of cover, and at a later 1.5 mg rate is one. Adjust the reorder date rather than ignoring it; a plan that keeps the original date is quietly over ordering. A peptide dose calculator that works from the actual draw log rather than the plan will make that adjustment without being asked.

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