Missed That Pill!

Question 1

≥ 9 days since last active COCP

Answer 1

Take most recent missed pill ASAP
Condoms for 7 pill days
Consider EC if UPSI during HFI

Question 2

1 COCP missed in week 1 (48 to 72 hrs since last pill)

Answer 2

Take missed pill ASAP
Continue as normal
No extra precautions needed

Question 3

1 COCP missed in week 2 or beyond (48 to 72 hrs since last pill)

Answer 3

Take missed pill asap
Continue as normal
No extra precautions needed

Question 4

2 - 7 COCP missed in week 1 (≥ 72 hrs)

Answer 4

Take most recent missed pill ASAP
Continue pill taking as normal
Condoms for 7 pill days
EC if UPSI during HFI or week 1

Question 5

2 - 7 COCP missed in week 2 or beyond (≥ 72 hrs)

Answer 5

Take most recent pill ASAP
Continue pill taking as normal
Omit HFI for 7 days
Condoms for 7 pill days
EC not required

Question 6

> 7 pills missed in any week

Answer 6

Manage as new start contraception
Consider immediate pregnancy test
Condoms for 7 pill days
Consider EC

Question 7

> 27 hours since POP or > 36hrs if DSG POP

Answer 7

Take most recent missed pill ASAP
Take next pill as normal
Use additional contraception for 48 hrs
EC if UPSI from first pill missed to pills resumed

Question 8

What do you need to be aware of when levothyroxine pills have been missed?

Answer 8

Restarting at high dose can cause angina / SOB / heart failure
Important to retitrate dose up

Question 9

Clozapine - after how many hours would you need to retitrate the dose?

Answer 9

48 hours
Restarting after missing a dose for > 48 hours can result in orthostatic hypotension possibly + cardiac / resp arrest

Question 10

Do you need to retitrate ACEi after a period of cessation?

Answer 10

Yes to avoid first dose hypotension