What Should I Do If My Dog Misses a Dose of Palladia?

Do not give a double dose. This is the one rule that matters most. Palladia has a narrow margin of safety, meaning even a modest amount above the prescribed dose can cause toxic effects.

Beyond that, contact your veterinary team for instructions rather than deciding yourself. Depending on how much time has passed, they will usually advise one of two things: give the missed dose late and shift the schedule accordingly, or skip it entirely and resume at the next scheduled dose.

The reason to call rather than follow a general rule is that dosing schedules vary considerably between dogs. Some are on alternate days, some on a Monday/Wednesday/Friday pattern, and many are on a reduced dose after earlier side effects. Only the team managing your dog knows which applies.

A single missed dose is not an emergency. It is worth keeping perspective here: the drug's own label allows for deliberate treatment interruptions of up to two weeks to manage side effects. One forgotten dose will not undo your dog's treatment.

Key points

• Never double up. Palladia has a narrow margin of safety and overdose causes real harm.
• Call your veterinary team rather than guessing — schedules and doses differ between dogs.
• One missed dose is not a crisis. Planned interruptions of up to two weeks are built into the label.
• If your dog spits out the tablet, wear gloves to pick it up, and call before giving another.
• If your dog vomits shortly after a dose, do not automatically re-dose — ask first.
• If a double dose was given accidentally, treat it as urgent and call your veterinarian or a pet poison helpline.
• Do not decant these tablets into a weekly pill organiser. The label directs that tablets be given immediately after removal from the bottle.
• Write the schedule down and designate one person to give it — double-dosing usually happens when two people each assume the other forgot.

Detailed explanation

Why doubling up is genuinely dangerous

With many medications, giving a missed dose alongside the next one is harmless. Not here.

Palladia is described on its label as having a narrow margin of safety — even a small amount over the prescribed dose can produce toxic effects. Signs of overdose include appetite loss, vomiting, diarrhea, low energy, bleeding or bruising, limping, and muscle cramping. In toxicity studies, dogs given substantially elevated doses developed anemia, low white cell counts, weight loss, and gastrointestinal bleeding.

So the instinct to "catch up" is the one instinct to override.

Why you should call rather than follow a general rule

You will find conflicting advice online. Some sources say simply resume at the next dose; others say contact your veterinarian because the drug must be dosed carefully. Both are defensible, and the discrepancy exists because dogs on Palladia are not all on the same regimen.

Your dog may be on strict alternate days, or a Monday/Wednesday/Friday schedule, or a reduced dose following earlier side effects, or a temporary pause you have partly forgotten about. Timing relative to upcoming monitoring bloodwork can matter too.

A phone call takes two minutes and removes the guesswork.

What your veterinary team will usually advise

In most cases, one of two things:

Give the missed dose now, and shift the schedule forward. Usually appropriate if you have realised within a few hours and the proper interval before the next dose can still be maintained.

Skip it and resume as normal at the next scheduled dose. Usually appropriate if most of the interval has already passed.

The guiding principle in either case is that the proper interval between doses must be preserved. Never compress two doses closer together than the schedule allows.

Does one missed dose actually matter?

Not much, and it is worth saying so plainly, because owners frequently feel they have damaged their dog's chances.

Palladia is given every other day precisely because it persists in the body — the elimination half-life in healthy dogs is around 17 hours. And the drug's label explicitly permits treatment interruptions of up to two weeks when needed to manage side effects, which tells you something about how tolerant the treatment is of gaps.

Dogs on this drug commonly have planned pauses and dose reductions. One accidental gap sits well within what the treatment is designed to absorb.

If your dog spits out the tablet

This happens, and the answer is not simply to give another one.

Handle the tablet with gloves — the label specifically directs that protective gloves be worn for broken or moistened tablets, since the film coating is what contains the drug. Then call your veterinary team before giving a replacement. Whether a full dose was absorbed is impossible to judge, and they will advise whether to re-dose.

If the tablet is damaged or wet, do not attempt to reuse it. Seal it in a bag and ask how to dispose of it.

If your dog vomits after a dose

Do not automatically give another tablet. Whether the drug was absorbed depends on how long ago the dose was given, and re-dosing risks an effective overdose.

Call and describe the timing — how long after the dose the vomiting occurred, and whether you can see tablet material. Vomiting is also itself a recognized side effect worth reporting: more than two episodes in 24 hours is one of the thresholds at which the drug should be paused pending advice.

If you are not sure whether you gave it

Assume it was given, and do not give another. The risk of an accidental double dose outweighs the cost of a missed one. Note the uncertainty, mention it at the next appointment, and improve the tracking system.

If a double dose was given by accident

Treat this as urgent. Contact your veterinarian immediately, or an emergency clinic if it is out of hours. In the US you can also call the ASPCA Animal Poison Control Center on (888) 426-4435 or the Pet Poison Helpline on (855) 764-7661 — both are staffed 24/7 by veterinary toxicologists, and a consultation fee applies.

Have the tablet strength and your dog's weight ready. Watch for vomiting, diarrhea, appetite loss, lethargy, bruising, or bleeding, and report any of these.

This most often happens when two people in a household each give the dose, so it is worth agreeing in advance who is responsible.

If several doses have been missed, or you have run out

If more than one or two doses have been missed, or the medication has run out and there is a gap before a refill, call rather than simply restarting. Depending on how long the gap has been, your team may want to restart at the same dose, restart lower, or check bloodwork first.

Running out is worth preventing actively: note the date your supply will run low, and order the refill a week ahead. Monitoring appointments and refills are often linked, so a delayed appointment can quietly become a delayed refill.

How to stop this happening again

Do not use a weekly pill organiser for this drug. The label directs that tablets be administered immediately after removal from the bottle, and these are hazardous drug tablets that should not be sitting loose in a household container. This is a genuine exception to normal medication-management advice.

What does work:

• A repeating phone alarm set for dosing days, dismissed only once the tablet has actually been given
• A paper chart on the fridge, ticked immediately after each dose. Low-tech, and unambiguous when someone asks whether it has been given
• One designated person responsible for dosing, with a clear handover if they are away
• A written schedule from your veterinary practice, showing which days and what dose — particularly useful after a dose reduction, when the routine changes

Storage and handling reminders

• Store at controlled room temperature, away from light. Do not refrigerate
• Keep tablets in the original container, in a secure place away from children
• Never split or crush the tablets — the coating matters
• Wear gloves when handling tablets and wash your hands afterward
• Do not let your dog lick your skin for the first hour after a dose; if it happens, wash with soap and water
• Wear gloves when handling your dog's urine, feces, or vomit, and seal waste in a double bag before binning it
• Wash any contaminated bedding or laundry separately
• Anyone pregnant, trying to conceive, breastfeeding, or immunocompromised should not handle the drug or your dog's waste

One planned interruption worth knowing about

If your dog is scheduled for surgery or a dental procedure, Palladia is usually paused beforehand, because it can affect blood clotting and wound healing. Restarting is also typically delayed afterward.

Tell any veterinarian planning a procedure that your dog is on Palladia, and ask well in advance how long before and after it should be stopped. This is a planned interruption, not a missed dose — but it catches people out when the procedure is arranged by a different practice.

When to contact a veterinarian

Contact your veterinary team the same day if:

• A dose has been missed and you are unsure how to proceed
• Your dog spat out or vomited up a tablet
• You are unsure whether a dose was given
• Several doses have been missed
• You have run out of medication

Treat as urgent — contact your veterinarian, an emergency clinic, or a pet poison helpline if:

• A double dose or extra tablet was given
• A person, particularly a child, has swallowed a tablet — seek medical advice immediately and show the treating doctor the package insert

Seek emergency veterinary care if your dog:

• Is vomiting blood, or passing black tarry stool
• Is collapsed, very weak, or has pale gums
• Has a tense, painful abdomen
• Has unexplained bruising or bleeding
• Has a fever, particularly with lethargy

Emergency numbers worth saving:

• ASPCA Animal Poison Control Center: (888) 426-4435 (24/7, consultation fee applies)
• Pet Poison Helpline: (855) 764-7661 (24/7, consultation fee applies)

Questions to ask your veterinarian

• What exactly should I do if a dose is missed — give it late, or skip it?
• How many hours late is too late to give a missed dose?
• What is my dog's current dose and schedule? Can I have it in writing?
• What should I do if my dog spits out or vomits up a tablet?
• What should I do if a double dose is given by accident, and who do I call out of hours?
• How many doses can be missed before it affects treatment?
• When should I order refills so we do not run out?
• Does my dog need to stop Palladia before any planned procedure, and for how long?
• Are there signs of overdose I should watch for?
• Is there anything about my dog's schedule that differs from the standard alternate-day pattern?

Sources

American Animal Hospital Association. (2026). 2026 AAHA oncology guidelines for dogs and cats: Therapeutic modalities — chemotherapy. https://www.aaha.org/resources/2026-aaha-oncology-guidelines-for-dogs-and-cats/section-5-therapeutic-interventions/therapeutic-modalities-chemotherapy/

ASPCA. (n.d.). ASPCA Animal Poison Control Center. Retrieved August 5, 2026, from https://www.aspca.org/pet-care/aspca-poison-control

Christensen, J., Johnson, K., Ettinger, S., Garrett, L., Gordon, I., Ireifej, S., Love, A., & Wisecup, M. (2026). AAHA oncology guidelines for dogs and cats. Journal of the American Animal Hospital Association, 62(1), 1–37. https://doi.org/10.5326/JAAHA-MS-7549

European Medicines Agency. (2016). Palladia (toceranib) — summary of product characteristics. https://ec.europa.eu/health/documents/community-register/2016/20160308134417/anx_134417_en.pdf

PetMD. (2023). Toceranib (Palladia) for dogs. https://www.petmd.com/pet-medication/toceranib-palladia-dogs

VCA Animal Hospitals. (n.d.). Toceranib phosphate. https://vcahospitals.com/know-your-pet/toceranib-phosphate

Veterinary Information Network. (n.d.). Toceranib phosphate (Palladia). Veterinary Partner. https://veterinarypartner.vin.com/default.aspx?pid=19239&catId=102894&id=4952879

Zoetis. (n.d.). Palladia (toceranib phosphate) tablets — prescribing information. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ae09ae83-0812-4ddc-92e3-730f7a1ae449

Zoetis. (n.d.). Palladia (toceranib phosphate) tablets — client information sheet. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/medguide.cfm?setid=ae09ae83-0812-4ddc-92e3-730f7a1ae449

This article is for educational purposes only and is not a substitute for veterinary care. Never give a double dose of Palladia, and never change your dog's dose or schedule without your veterinarian's direction. If a double dose has been given, or if a person has swallowed a tablet, seek advice immediately. If your dog is vomiting blood, passing black tarry stool, is collapsed or very weak, or has unexplained bruising, seek emergency veterinary care immediately.