Oops! I Missed My Medication… What Should I Do Now?

If you have recently experienced a blood clot, you’re most likely being treated to prevent future blood clots as your body recovers and heals. The standard treatment for blood clots, including blood clots in the legs or arms (deep vein thrombosis or DVT) and blood clots in the lung (pulmonary embolism or PE), is taking a prescribed medication called an anticoagulant, or what most people refer to as a “blood thinner.” However, anticoagulants do not thin the blood. They instead cause the blood to take longer to form a clot. Remember, clotting is a necessary process that your body needs (to stop bleeding and heal wounds, for example), so we don’t want to eliminate it completely. However, excessive clotting or clotting in places where we shouldn’t, like DVT and PE, can lead to serious health consequences and must be treated and prevented. So, if you’re here because you missed your medication, it can be very overwhelming.

Before we get to managing a missed or skipped dose, let’s talk a little bit about what anticoagulants are and how they work. If you’re here because you missed your medication, scroll down for some steps you can take now to get it resolved. If you miss a dose, the standard advice is to call your healthcare professional (doctor, pharmacist, or nurse line) for advice.

Thankfully, many anticoagulant medications exist to treat and prevent blood clots. Warfarin is the most commonly prescribed oral anticoagulant. It decreases the body’s ability to form blood clots by blocking the formation of vitamin K–dependent clotting factors. It is usually taken once a day and requires regular testing of the international normalized ratio (INR) blood test to tell you how long it takes for your blood to clot. A test called the prothrombin time (PT) actually measures how quickly your blood clots to ensure it is working properly. People who take warfarin need to be aware of their INR or have an idea of what it is at any given time. The standard INR range is 2.0-3.0 for most people on warfarin, but your range my be slightly different, so check with your doctor. My INR actually runs a little higher because I have antiphospholipid syndrome as a risk factor for clotting.  

In addition to needing monitored, warfarin works best when you eat about the same amount of vitamin K in your food every day. You should tell your doctor before changing your diet drastically and avoid big changes in how much vitamin K you eat. Some foods that have a high amount of vitamin K are asparagus, broccoli, brussels sprouts, cabbage, and green leafy vegetables like spinach. People taking warfarin typically do not need to avoid vitamin K, or these foods, entirely, but instead be aware the amount they are consuming and try to stay consistent. You should also talk to you doctor if you plan to take any herbal supplements or drink large amounts of alcohol as these can also interfere with the way warfarin works.

Direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, edoxaban, apixaban, and betrixaban are newer anticoagulants that work well for many people. These drugs intervene directly in the coagulation cascade and inhibit directly specific clotting factors such as Factor Xa and Factor IIa (thrombin). Unlike warfarin, DOACs no not require regular blood monitoring for dosing and are generally not impacted by food or alcohol like warfarin is. However, they have a shorter duration of action compared to warfarin, making it very important to take them as prescribed as missing a dose could increase the likelihood of experiencing a blood clot. Additionally, some DOACs require two doses a day, which can lead to a higher likelihood of missed or skipped doses. As the saying goes, when you have more to remember, you have more to forget.

There are also injectable blood thinners that you can take at home, like low molecular weight heparin, for example. Like with any oral anticoagulant, it is important to follow your dosing schedule when you are prescribed injected medications too.

Anticoagulants of all types need to be taken exactly as prescribed, and you should never increase or decrease your dose unless told to do so by your health care professional. Missing or skipping a dose can increase a person’s risk for clotting, and is in fact one of the main causes of a blood clot happening again (recurrence). So, when we miss a dose, or can’t remember if we took our dose, it can feel overwhelming and maybe even a little bit frightening.

I have missed my medication more than once. When it happens, it helps me to take a deep breath and remember: I am not perfect. I have been through this before. It will be okay. I have been taking warfarin for more than 10 years, so I am adept at adjusting my dose myself; however, if I’m not sure or become really worried about it, I still rely on my hematologist’s office to help me figure out how to get back on track. If I don’t know what to do, I wait until I can talk to my hematologist, or my pharmacist, before making a decision.

Missed Your Medication? Here Is What You Can Do:

  • Call your pharmacist. This is often the easiest and fastest way to get an answer. They are trained medical professionals who are specialists in medication management. They will tell you exactly what to do and they get these questions frequently, so don’t be afraid or embarrassed to ask.
  • Call your doctor’s office. They will often advise you via phone. If you take warfarin and get your INR monitored at an anticoagulation clinic, you can also contact the clinic.
  • Look at the medication’s prescribing instructions. These instructions usually come with your medication, or if you don’t have them available, you can look them up from the manufacturer or distributor online. It is still a good idea to discuss your medication schedule with a healthcare professional, but these prescribing guides can help you know what to expect or help you out in a pinch.
  • Call a nurse line. If you have health insurance and your insurance provider has a nurse line, you can call them for guidance. Many offer assistance and advice 24/7. In addition, some health insurances offer free, online or virtual consultations with a doctor who you can speak with about your missed medication.

Taking too much of your anticoagulant can increase your risk of serious bleeding. If you’re concerned you overdosed or took too much of your medication, call your doctor. You can also call or chat with poison control for immediate assistance. You should never try to force yourself to expel the medication though vomiting or other means. Try to remain calm while waiting to speak to a healthcare provider. Reversal agents, as they are called, exist for most anticoagulants, and can be used in very extreme situations of an overdose. If you’re concerned about serious or life-threatening bleeding, call 911 or go to the nearest emergency room or hospital.

Most situations of skipping or missing a medication dose, or even taking too much of your anticoagulant, are correctible at home. In addition, there are several things you can do to not miss your medication in the first place, even though it happens occasionally (and it’s okay). It is important not to let missing your medication become a habit. I use a pillbox to remember to take my pills, but every once in a while, I still fall asleep or get really busy and it completely slips my mind. You can read more about how to manage your medication schedule in this blog post

Finally, cost can be prohibitive for some people, especially if you are taking a DOAC, but that should not stop you from taking your medication. Talk to your doctor if you need help affording your medication and visit these prescription assistance resources.

You can read more helpful information about managing anticoagulants here:

There is hope for healing from blood clots, and you are not alone.

Why I Use the Sagely Smart Weekly Pill Organizer

Please note, I have been given a Sagely Smart Weekly Pill Organizer by the Sagely company to review. Although this product was a gift, all opinions in this review remain my own, and I was in no way influenced by the company.

For as long as I can remember, I have taken a pill. I was diagnosed with hypothyroid disorder early in my life, and I started taking medication to treat my condition at that time. My parents were really good at teaching me that it was important to take my medication like the doctor instructed, and I carried that knowledge into my adult life. Periodically, I also took other medications, vitamins and supplements, based on various needs or problems as they arose. It was never difficult or problematic to manage two or three medications. I just took my pills out of the container they came in first thing in the morning.

Now, as a patient who must take a blood thinner every day, medication remains important to my daily routine, perhaps now more than ever. When people ask me how I feel about depending on a pill to keep me safe – if not alive – I don’t know how to answer because I have always had to take a pill to stay healthy. What I wasn’t expecting was to take pills multiple times a day and feel like I am years and years older than I am. I wasn’t expecting to get excited by pill containers or medication management systems – maybe because I never thought pills would require managing – yet I do. Currently, I take between six and eight pills total, two times a day.

If you follow me on social media, you may have noticed I often share medication management systems because if you take blood thinners, as with all medications, it’s important to make sure you take them and take them at the right time. I have found that a pill box or container is the easiest way for me to know if I have taken my medication or not. Since I take multiple pills, taking them right our of the prescription bottle is no longer a good solution for me. It makes it hard to remember if and when I took my medication.

I’ve used many different types of pill containers over the last few years and although I have a few I like, lately I have been searching for the perfect one. I need something that has enough space for all of my pills, is easy to use and fits within my budget. I began using the Sagely Smart Weekly Pill Organizer, which is revolutionary in its design and definitely unlike anything I have used before.

Below, I am sharing my thoughts about the Sagely Smart Weekly Pill Organizer. Watch my video to hear what I have to say, or read on for my review.

Sagely Smart Weekly Pill Organizer Review

What I like about this pill container:

  • Each day is a separate box (or Pod) with two distinct compartments.
  • The Sagely system allows you to count out your pills on top of the Pod – so you can see which pills you have already distributed – before pushing them through the lid into the Pod itself (you don’t have to open the Pod at all until you are ready to take them). Watch this video to see how it works.
  • The Pod lids are made of soft, food-grade safe material and are very easy to open if you have pain or swelling in your hands.
  • Each Pod sits on a magnetic base, so if you are traveling, you can grab the days you need and go.
  • The Pods are very deep and can hold multiple pills and capsules.
  • It is a very attractive, contemporary design and is nice to look at.
  • There is an accompanying App to help manage your medication.

What I don’t like about this pill container:

  • The base is long (about 12 inches) and takes up a lot of space on a counter or dresser.
  • The Pods are divided into two compartments which are distinguished by color, but do not have AM or PM printed on them, so I can get easily confused about which is which when I am filling the Pods. This problem is resolved once I make up my mind which color to use for which time of day.
  • The lids close like a Tupperware container, and I find I have to double check to make sure they are closed after I take my pills.
  • This pill container is expensive, but it is worth the cost if you are looking for an extensive or unique medication management, with multiple features.

Average Price: $29.95 – $39.95

Where to purchase: Sagely gifted me this product to share my thoughts with all of you, but you can purchase it on Sagely’s website here, or through my Amazon Influencer Shop.

My bottom line: I am currently using the Sagely to manage my medication, and I really like it. My favorite features are the push-through system for putting pills in the containers, how easy it is to open the containers, and the ability to travel with as many days as I need without the days that I don’t.

Are you purchasing a pill container? Get my buyer’s quick tips:
  1. Pick a pill box that suites your medication schedule. There are a variety of containers, including one day, three day, weekly, AM/PM, and even three or four times a day options.
  2. Pick a pill box that is easy for you to use (e.g. opening, closing, portability, etc.)
  3. Pick a pill box that is within your budget. If cost is prohibitive for you and you need more space, sometimes you can purchase two separate containers (e.g. one for morning and one for evening) that suites your needs.

There is hope for healing and you are not alone,

 

 


Reader Writes In: How do you manage your medication? Do you have a favorite system or pill container? Share your thoughts in the comments.


Do you take warfarin and need to keep track of your INR? Get the OATBook App for iPhone to help make it easier. *Once again available for download*


Do you struggle to remember if you took your pills? Get my tips to help you stop asking, “Did I take my medication?”