What if you miss a dose of romosozumab (Evenity)?

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What to Do If You Miss a Dose of Romosozumab (Evenity)

If you miss a dose of romosozumab (Evenity), administer it as soon as possible and then schedule the next dose one month from the date of the last dose.

Understanding Romosozumab Administration

Romosozumab is administered as a monthly subcutaneous injection with a specific dosing regimen:

  • The recommended dose is 210 mg administered once monthly
  • Each dose consists of two separate 105 mg/1.17 mL prefilled syringes injected subcutaneously
  • Treatment is limited to 12 monthly doses only
  • Administration sites include the abdomen, thigh, or upper arm 1

Protocol for Missed Doses

When a dose of romosozumab is missed:

  1. Administer as soon as possible - The FDA label specifically states: "If the EVENITY dose is missed, administer as soon as it can be rescheduled" 1
  2. Reset the monthly schedule - "Thereafter, EVENITY can be scheduled every month from the date of the last dose" 1
  3. Continue the treatment course - Complete the full 12-month treatment regimen

Important Considerations

Maintaining Treatment Efficacy

  • Adherence to the full 12-month treatment course is crucial for optimal fracture risk reduction
  • Romosozumab works by both increasing bone formation and decreasing bone resorption 2
  • Missing doses may compromise the bone mineral density gains and fracture prevention benefits

Continuation of Supplementation

  • During treatment, including when rescheduling missed doses, patients should continue taking:
    • Calcium (1000-1200 mg daily)
    • Vitamin D (800-1000 IU daily) 3

Sequential Therapy Planning

  • After completing the 12-month romosozumab treatment course, patients must transition to an antiresorptive agent (such as a bisphosphonate or denosumab) 3
  • This sequential therapy is essential to maintain or further increase bone mineral density gains and reduce fracture risk

Clinical Pitfalls to Avoid

  • Do not double-dose - If a dose is missed, do not administer two doses at once to "catch up"
  • Do not exceed 12 doses - The treatment duration is strictly limited to 12 monthly doses total 3
  • Do not delay transition to antiresorptive therapy - After completing the romosozumab course, promptly initiate the next phase of treatment
  • Do not ignore cardiovascular monitoring - Continue monitoring for cardiovascular symptoms even with rescheduled doses, as romosozumab carries a boxed warning for potential cardiovascular events 3

Special Considerations

  • Romosozumab should only be administered by a healthcare provider 1
  • Each dose requires proper preparation and administration of two separate syringes
  • Proper storage and handling of the medication is essential for efficacy

Remember that medication adherence is critical for achieving optimal outcomes in osteoporosis treatment. Missing doses can potentially impact the effectiveness of therapy, so establishing a consistent schedule and planning ahead for appointments is important for successful treatment.

References

3
Guideline

Osteoporosis Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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