Yes, proceed with the depot injection today
If a long-acting depot injection is only one day overdue, you should administer it today without any dose adjustment, backup contraception, or special precautions.
Specific Guidance Based on Injection Type
For Depot Medroxyprogesterone Acetate (DMPA/Depo-Provera)
The CDC guidelines provide clear direction: injections that are less than 2 weeks late (meaning less than 15 weeks since the previous injection) should proceed as scheduled 1. Since your patient is only one day late, this falls well within the safe window where:
- No backup contraception is needed
- No emergency contraception is required
- The regular dosing schedule continues unchanged
- No pregnancy testing is necessary (assuming reasonably certain the patient is not pregnant)
The grace period extends to nearly 2 full weeks past the scheduled date before any modifications to the protocol become necessary 1, 2.
For Long-Acting Antipsychotic Injections
If this concerns an antipsychotic depot medication, one day late is clinically insignificant. Most long-acting antipsychotic formulations have:
- Dosing windows of several days to weeks due to their pharmacokinetic properties
- No dose adjustment needed for delays of only 1-2 days
- Continued therapeutic plasma levels from the previous injection 3, 4
The flip-flop pharmacokinetics of depot antipsychotics create stable plasma concentrations over extended periods, making a one-day delay inconsequential 5.
Key Clinical Pitfall to Avoid
Do not treat a one-day delay as a "missed dose" requiring restart protocols. The restart or dose-adjustment protocols only apply when injections are significantly overdue:
- For DMPA: ≥2 weeks late (≥15 weeks from last injection) 1
- For most antipsychotic LAIs: typically 1-2 weeks beyond scheduled date, varying by specific formulation 3
Bottom Line
Administer the injection today using the regularly scheduled dose. Document the one-day delay but proceed with the established treatment plan without modification. The patient remains protected (contraceptively or therapeutically) and should continue with their regular injection schedule going forward.