What if I miss my scheduled injection day?

If it's been 4 days or less since your missed dose, take your injection as soon as you remember. If it's been more than 4 days, skip the missed dose entirely and take your next injection on your regular scheduled day. Never take two doses at once or within a few days of each other.

4 days or less: Take your injection as soon as you remember. You can keep your original weekly schedule or start a new schedule based on the day you took the late dose - whichever is easier to remember.

More than 4 days (a single missed dose): Skip the missed dose. Resume on your regular scheduled day. Don't try to "catch up" by taking extra medication - this increases the risk of side effects like nausea without improving results.

Everyday situations

One missed dose does not set you back. The medication stays in your system, so you do not need to restart or lower your dose. Resume your normal schedule. This is also true if you chose to skip a single dose before a trip, for example because of nausea concerns.

If your increased dose was due this week, stay at your current dose for one more week, then increase when you are ready and feeling well. You do not need to catch up.

Your injection day does not have to be exact. Aim for roughly weekly, and try to keep the same day and time most weeks, because steady timing helps the medication work well. A day or two off is fine. Just never take two doses close together.

Replacement or new vial and you already injected by habit? Wait until next week to inject again so you do not double up, then continue your plan, including any scheduled dose increase.

Switching to a new tirzepatide product? Take your last dose of the old product on your regular injection day, then start the new product the following week.

Longer breaks

Off the medication for 1 to 4 weeks: You can usually restart at your current dose if you were tolerating it well before the break. If you had side effects before you stopped, or you're not sure where to restart, message your care team first and we'll help.

Off the medication for more than 4 weeks: Contact your care team before restarting. The right restart dose after a longer break depends on how you were doing before you stopped, and your provider will recommend the safest dose for you. Do not assume you can pick back up at your previous dose.

How to count your gap: count from the date of your last injection, not from when you ran out or stopped paying attention. If you switch from one product to another, the clock still runs from your last injection of any GLP-1.

Between 4 and 8 weeks off: do not go back to your previous dose. Restart at least one step lower than where you were, then step back up every 4 weeks. Message your care team before your next injection so they can confirm your restart dose and units. Please do not restart at your previous dose, even if you tolerated it well before.

Why lower? Your body loses its tolerance for the medication during a long gap. Going back to your old dose can bring back strong side effects, including nausea and vomiting. A lower restart is safer, and you step back up as you tolerate it.

Off the medication for more than 8 weeks: If it has been more than 8 weeks since your last dose of a GLP-1 medication, such as tirzepatide or semaglutide, it is important to restart at the standard starting dose. This ensures a safe reintroduction of the medication and minimizes the risk of side effects. Contact your care team for personalized advice and to confirm the appropriate starting dose for your situation.

The 8-week rule also applies to medication you already have at home but never started.

Stepping back up after a restart:

• Stay on your restart dose for about 4 weeks before moving up, just as you did when you first started. Move up one step at a time, as you tolerate it. Do not jump straight back to your previous dose.
• If you tolerated a higher dose well before, your provider can approve returning to it once you have worked back up. It is your provider's decision, not something to do on your own.
• A lower dose on your new prescription is expected after a break. It reflects how long you were off. If your prescription looks lower than you expected, tell your care team the date and dose of your last injection so they can confirm the plan.
• Your units may change. A new vial often has a different concentration, so you may draw a different number of units even for the same dose. Always use the units on your current prescription label. See Dose vs. concentration and How to find your dose and how many units to inject.

If side effects are the problem

If you had strong side effects at your last dose, do not go back to that dose. Message your care team before your next injection. They will usually lower your dose, and sometimes suggest waiting a short while before your next shot. You can then step back up slowly.

If you restarted at a high dose and now feel sick: stay hydrated (electrolyte drinks can help), eat small bland meals, and avoid fatty, sugary or heavy foods. Message your care team before your next dose if you still cannot eat comfortably, so they can lower it. See GLP-1 side effects and what's normal for more tips.

Get urgent care if vomiting is severe, you cannot keep fluids down, or you feel dizzy or faint.

If you are sick and can only manage clear liquids, hold your injection until you can eat solid food again, to avoid more side effects or low blood sugar. When you are eating normally, you can resume at your current dose.

Surgery and procedures

Follow your surgeon's or procedure team's instructions first. Do not inject if they have told you to hold. You will need clearance from your surgeon or doctor before you restart.

Then use your time off to find your restart dose. If you are cleared to restart within 4 weeks of your last injection, you can usually resume your previous dose. If it has been longer, use the gap guidance above. Message your care team with your last injection date so they can confirm the dose.

If your shot day is close to a procedure, wait the full week and take your next injection on your regular day, once your procedure provider says it is okay. A short break does not interfere with your overall plan.

For more on procedures, anesthesia and illness, see What should I do with my GLP-1 before surgery, dental work, or another procedure?

Specific Instructions for Tirzepatide

For tirzepatide, if more than 8 weeks have passed since your last dose, you must restart at the standard starting dose. This precaution is necessary to ensure safety and to allow your body to reacclimate to the medication.

Specific Instructions for Semaglutide

If more than 8 weeks have passed since your last dose of semaglutide, begin again at the introductory dosage. The medication’s half-life requires a gradual reintroduction to ensure good tolerance and to minimize potential side effects.

Why Gradual Reintroduction is Important

The gradual reintroduction of GLP-1 medications after a prolonged gap is crucial for several reasons:

1. Safety: Restarting at a lower dose reduces the risk of adverse reactions.
2. Tolerance: It allows your body to adjust to the medication gradually, minimizing side effects such as nausea or gastrointestinal discomfort.
3. Efficacy: A gradual titration process ensures the medication works effectively without overwhelming your system.

What to expect after a restart

• Appetite effect. Appetite control usually starts returning within a few days, but it takes time to rebuild at each dose level after a gap. Do not expect your earlier results right away.
• Weight loss. A lower restart dose is safer, but results may take a little longer to come back. Be patient through your step-up. See What results should I expect, why does the scale jump around, and what if I plateau? for what to check.
• Long gaps. Several weeks without medication can make it harder to keep earlier weight loss. If a gap was unavoidable, tell your care team. They can help you plan the restart.