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If you've ever taken a daily medication, you've likely missed taking it at least once. Life gets busy, travel plans change, and people simply forget things sometimes.
Missed doses can make medication less effective. That's true for PrEP, which becomes less effective at preventing HIV when taken inconsistently. Yeztugo (lenacapavir), the new twice-yearly injectable PrEP, could provide more consistent protection against HIV for people who struggle to take pills daily. But just like with daily PrEP, staying on top of your dosing schedule is critical.
What happens if you miss a Yeztugo appointment? It’s a little more complicated than missing a single daily PrEP pill — but if you’re proactive, there are ways to help ensure you remain protected.
How Yeztugo compares to oral PrEP when it comes to missing doses
Knowing how PrEP works in general can help you understand what a missed dose means. PrEP (pre-exposure prophylaxis) maintains a certain level of HIV-fighting medication in your bloodstream at all times. This way, if you're exposed to HIV, your body can fight the virus to prevent an infection.
Missing doses lowers the certain level of HIV-fighting medication in your system; if that level drops too much, PrEP won’t protect you as well against HIV. That’s why the most important part of keeping PrEP effective is taking it on time, consistently.
With daily oral pills, a single missed PrEP dose is likely nothing to worry about. But missing multiple doses or taking it inconsistently can greatly reduce its effectiveness. That's one of the reasons that Yeztugo, the long-lasting injectable PrEP, showed such promising results in studies: people taking oral PrEP were more likely to miss doses than those receiving Yeztugo injections, meaning those taking Yeztugo had more consistent protection.
The Yeztugo schedule
To get the best level of protection, stick with the Yeztugo schedule and know what to do if you need to make adjustments. Here's how it works:
Starting Yeztugo (Initiation):
- Day 1: You'll receive two subcutaneous injections (under the skin) and take two 300mg tablets by mouth
- Day 2: Take two more 300mg tablets by mouth
This combination of injections and pills helps build up the right level of medication in your body.
Ongoing Yeztugo (Continuation):
- Every 6 months (26 weeks), you'll receive one dose (two subcutaenous injections)
- You have some flexibility here — your injections can be booked anywhere from 24 to 28 weeks after your previous one
- This ±2-week window gives you flexibility for travel, work schedules, or life events
The twice-yearly injections are designed to release slowly and keep you protected between doses.
When you stay on schedule, you maintain the medication levels that research has shown to be highly effective at preventing HIV. But life happens, and we understand it's not always possible to stick to it perfectly. Here's what to do in different scenarios.
If you miss your Day 2 oral pills
Let's start with the most straightforward scenario. When you begin Yeztugo, you'll take oral tablets on both Day 1 (the day of your injection appointment) and Day 2 (the next day).
If you miss taking your Day 2 tablets, don't worry. Simply take the missed Day 2 dose as soon as you remember. Be sure to space out the Day 1 and Day 2 pills as intended.
If you think you'll miss a scheduled injection
Maybe you're planning a long trip or something else that might interfere with your injection appointment. Flexibility is one of the advantages of Yeztugo — it has a built-in backup plan.
What to do:
- Contact your healthcare provider immediately to discuss your situation and PrEP options
- Consider oral Yeztugo as a bridge: If your injection will be delayed by more than 2 weeks, you can take oral Yeztugo tablets once weekly to maintain your protection
- Start pills on time: You need to start oral Yeztugo within 26 to 28 weeks (6 to 6.5 months) of your previous injection
- Plan your return: Make sure you can schedule your next injection within 6 months of starting the oral tablets
The oral bridge schedule:
- Take one 300mg Yeztugo tablet once every 7 days
- You can do this for up to 6 months if needed
- Resume your regular injection schedule within 7 days after your last oral dose
If you've already missed your injection
If it's been more than 28 weeks (6.5 months) since your last Yeztugo injection and you haven't been taking oral tablets in the meantime, it requires more immediate attention.
What to do:
- Contact your healthcare provider right away
- Be open about potential exposures: Discuss any events during this time that could have exposed you to HIV (such as unprotected sex or sharing needles)
- Prepare for testing: You'll need to complete lab testing again to ensure you're HIV-negative and that Yeztugo is still appropriate for you
- Plan to restart: You'll need to begin the full initiation process again
Essentially, if you miss your scheduled injection by more than 2 weeks without taking oral Yeztugo in the meantime, you'll start Yeztugo over from the beginning. While this isn't ideal, it's designed to give you the best possible protection.
When you'll need HIV testing after a missed dose
HIV testing is a crucial part of PrEP care, and missing doses can affect when and how often you need testing. Here's what to expect:
- Regular schedule: You should be tested for HIV before each Yeztugo injection (every 6 months) as part of your routine care.
- After a PrEP missed dose: If you've missed your injection window and haven't taken oral Yeztugo, your healthcare provider will want to test you before restarting.
No matter your situation, your provider will tell you when it’s time to test.
With a Yeztugo (lenacapavir) missed dose, you have options
Between oral PrEP pills and injectable PrEP like Yeztugo, there are now more options for HIV prevention that work for different needs and lifestyles. Whichever PrEP you choose — with your healthcare provider’s support — the most important part of staying protected is staying on schedule.
But missing a dose doesn't mean you're without options. There are strategies to get back on track while keeping yourself protected. Your healthcare provider can help you navigate these situations without judgment, ensuring you can maintain the HIV prevention that works best for your life.
Want to talk to a clinician about PrEP? Book a free appointment with a Freddie clinician.
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