Restarting Somatropin After Missing Four Days
Resume somatropin 1.4 mg immediately at the next scheduled dose without any dose adjustment, loading dose, or catch-up dosing. Simply restart the daily injection regimen as if no interruption occurred.
Immediate Restart Protocol
Administer the next scheduled 1.4 mg dose subcutaneously as soon as possible, without attempting to "make up" the four missed doses by taking multiple injections or increasing the dose. 1
Continue the regular daily dosing schedule at the same time each day moving forward, maintaining the 1.4 mg dose that was prescribed before the interruption. 1
No additional monitoring, dose titration, or medical intervention is required after this brief interruption, as growth hormone therapy does not require re-titration following short gaps in treatment. 2
Why This Approach Is Safe
Growth hormone has a relatively short half-life (approximately 20-30 minutes after subcutaneous injection), but its effects on growth and metabolism are mediated through insulin-like growth factor-1 (IGF-1), which has a much longer half-life of 12-15 hours. A four-day gap does not require dose escalation or special restart protocols. 2
Missing several consecutive doses reduces treatment efficacy but does not create a safety concern or require gradual re-introduction. Studies demonstrate that adherence gaps primarily affect growth velocity outcomes rather than creating withdrawal or rebound phenomena. 3
Long-term somatropin therapy is initiated with gradual dose escalation to minimize fluid retention and other adverse effects, but this titration is only necessary at treatment initiation—not after brief interruptions in established therapy. 2
Monitoring and Follow-Up
Document the missed doses and inform the prescribing endocrinologist at the next scheduled appointment, as patterns of non-adherence may warrant discussion of barriers to treatment or consideration of alternative formulations (such as once-weekly somatrogon). 4
No immediate laboratory testing (IGF-1, glucose, or other parameters) is needed solely because of the four-day gap, though routine monitoring should continue per the established treatment protocol. 2
Watch for any unusual symptoms after restarting (such as significant edema, joint pain, or headaches), though these are uncommon with resumption of an established dose and would more typically occur with dose escalation. 2
Preventing Future Missed Doses
Set daily alarms or reminders to maintain consistent injection timing, as adherence is the primary determinant of treatment success in growth hormone therapy. 3
Keep medication accessible in the primary location where injections are administered, and ensure adequate refrigeration and storage. 4
Consider once-weekly somatrogon if frequent missed doses become a pattern, as this formulation significantly reduces treatment burden while maintaining comparable efficacy. 4