What happens if you take PrEP an hour late?

If you are on daily PrEP ... If you are less than 12 hours late with your dose, go ahead and take it now, and then take your next dose at the regular time. If you are more than 12 hours late, skip the dose you forgot, and then take your next dose at the regular time.

sites.google.com - PrEP FAQ - Missed Doses - Google Sites

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What to do about a missed dose depends on whether you are taking PrEP daily or following the event-driven (or on-demand) schedule. Read the appropriate section below for details. TIPS! If you have trouble remembering to take your doses on-time, these tips may be helpful.

If you are on daily PrEP ...

First of all, don't worry. There is solid research showing that "After 30 days of daily dosing, the estimated protection offered by the PrEP remaining in the body ... was 97%, 24 hours after the time of the first missed dose, 96% after three days, 93% after five days, and was still 90% a week later." If you've been on PrEP for at least 30 days, you are very well protected even if you missed several doses.

That said, if you have missed a dose, here's what to do:

If you are less than 12 hours late with your dose, go ahead and take it now, and then take your next dose at the regular time. If you are more than 12 hours late, skip the dose you forgot, and then take your next dose at the regular time. Missing one dose does not meaningfully reduce the protection you get from daily PrEP. Example 1: Let’s say you take your Truvada every night at 10 PM. One morning you wake up at 8:00 and realize you forgot to take your dose last night. Because you’re less than 12 hours late, go ahead and take a pill now, and then take your next pill as usual at 10 PM that night. Example 2: Let’s say you take your Truvada every night at 10 PM. One day, at 3 o’clock in the afternoon, you realize you forgot to take your dose last night. Because you’re more than 12 hours late, skip the dose you missed, and take your next pill as usual at 10 PM that night. Once you have been taking Truvada daily for 30 days, the active drugs have built up in your body and are not eliminated quickly. Even when you miss doses, the remaining drug in your body continues to protect you from HIV. If you miss doses or stop taking the medication, the accumulated drug in your body continues to reduce your risk by 97% after 24 hours, 96% after 3 days, 93% after five days, and 90% after a full week. Note that these numbers apply only to exposures through anal sex. We do not yet know how PrEP’s protection builds up and decays for vaginal/front hole sex. If you have receptive vaginal/front hole sex, every dose matters.

If you are on PrEP 2-1-1 ...

If you are following the PrEP 2-1-1 schedule (only before and after sex), it is important that you take every required dose on schedule. There is no solid research yet about the effect of missed doses with event-driven PrEP, but missing doses is likely to reduce your level of protection from HIV.

Suggestions for Avoiding Missed Doses

You can help yourself remember to take your pills on schedule using a keychain pill reminder, a pill bottle with a built-in alarm, a 7-day pill box, or a reminder app for your smartphone. Here are some links that may help:

More ideas:

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What happens if I don't take PrEP for two days?

If you miss one, or even two pills occasionally, this will be fine on a daily regimen. Don't stop PrEP, just carry on once you remember. Drug levels will still be high enough to protect against HIV. If you are missing several doses each week, please talk to the clinic about support.

i-base.info - What to do if you miss a pill | Guides - HIV i-Base

What to do if you miss a pill

Guides

What to do if you miss a pill

If you miss one, or even two pills occasionally, this will be fine on a daily regimen.

Don’t stop PrEP, just carry on once you remember.

Drug levels will still be high enough to protect against HIV.

If you are missing several doses each week, please talk to the clinic about support. If you use daily dosing and miss more than a week of pills, you have to start again. This will involve either seven days of daily dosing (including for women and transgender people) or the double dose for 2:1:1 dosing.

You only need one double dose at the start.

You never need more than a total of seven pills in one week, unless you restart daily PrEP with a double dose for earlier protection. A pill box makes it easy to see if you missed a dose. Aim for the same time each day. Link it to a routine task like brushing your teeth. If you have risks during a break from PrEP, it is important to have another HIV test. With 2:1:1 dosing, if you miss the BEFORE dose completely, still take a double dose AFTER sex, and continue daily. Contact your clinic in case PEP is recommended. Missed doses matter more with 2:1:1 dosing.

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