Dabigatran

Sounds like 'da-be-ga-tran'

Dabigatran is an anticoagulant. It is used to treat and prevent clots in your blood. Find out how to take it safely and possible side effects. Dabigatran is also called Pradaxa.

What is dabigatran?

Dabigatran is an anticoagulant. Anticoagulants work by interrupting the clot-forming process and increasing the time it takes for blood clots to form. This helps prevent blood clots from forming and stops existing clots from growing bigger. 

When is dabigatran used?

  • If you have atrial fibrillation (irregular heart beat), which increases your risk of stroke. Read more about atrial fibrillation and stroke.
  • After hip or knee surgery when your risk of blood clots is increased.
  • To treat and prevent recurrent deep vein thrombosis (DVT) or pulmonary embolism (PE). Read more about DVT and pulmonary embolism. 

The following video is about the use of dabigatran in atrial fibrillation.

(Bay of Plenty DHB, NZ, 2018)

Dose

Dabigatran capsules are available in different strengths: 75 mg, 110 mg and 150 mg. Your doctor or pharmacist will tell you the strength that is right for you. Your dose of dabigatran will depend on what it is being used for. 

  Dose of dabigatran
To prevent stroke in people with atrial fibrillation 150 mg twice a day
To prevent clots after knee or hip surgery 220 mg once a day
To treat and prevent recurrent DVT or PE 150 mg twice a day
  • Your dose may be lower if you have other medical conditions such kidney problems or if you are 80 years old or more.
  • If you have had knee or hip surgery, you will need to take dabigatran for 10–35 days.
  • If you are taking it for other reasons, you will need to take it for longer.
  • Don't stop taking dabigatran until your doctor tells you to. Stopping too early can put you at greater risk of getting blood clots or stroke.

Always take your dabigatran exactly as your doctor has told you. The pharmacy label will tell you how much dabigatran to take, how often to take it and any special instructions.

How to take dabigatran

  • Know your capsule strength: Dabigatran capsules are available in different strengths: 75 mg, 110 mg and 150 mg. If you are unsure which capsule strength you are taking, ask your pharmacist.
  • Timing: Take your dabigatran dose at the same times each day. You can take dabigatran with or without food.
  • Swallow the capsules whole with a large glass of water. It is important to drink enough water so the capsule doesn't get stuck in your throat. Do not crush, chew or open the capsules. This will release all the medication at once and increase the risk of side effects. 
  • Missed dose: Missing doses increases your risk of getting blood clots. If you forget to take a dose, do not take a double dose – this increases your risk of bleeding. 
    • Stroke prevention or blood clots: If the next dose is less than 6 hours away, skip the missed dose and carry on as normal. If there are more than six hours until the next dose, take the missed dose as soon as you remember. Do not take two doses at the same time.
    • Knee or hip replacement: Skip the missed dose and carry on as normal at the same time the next day. Do not take 2 doses at the same time.
  • Tell your healthcare provider: It is important to let anyone who gives you treatment know that you are taking dabigatran, including your dentist, pharmacist, podiatrist and nurse. You may need to stop using this medicine for several days before having surgery, dental appointments or medical tests. 
  • Storing your dabigatran capsules: Dabigatran capsules must be kept in the original foil package to protect them from moisture. If you store the capsules in a pill box or medication reminder box, keep them in the foil packaging. Only remove them from the foil packaging when you are ready to take them.

Testing and monitoring

When you first start taking dabigatran, you will need blood tests to check how well your kidneys and liver are working.

  • This will help your doctor make sure it is safe for you and the dose is correct.
  • Regular blood testing to check the level of dabigatran is not needed.

Precautions before taking dabigatran

  • Do you have problems with your kidneys or liver?
  • Are you pregnant or breastfeeding?
  • Have you ever had a stomach ulcer or bleeding in your brain?
  • Are you taking any other medicines? Tell your doctor or pharmacist about any medicines you are taking (including over the counter medicines), herbal and complementary medicines.

If you answered yes to any of these questions, it’s important that you tell your doctor before you start taking dabigatran. Sometimes a medicine isn’t suitable for a person with certain conditions or taking other medicines, or it can only be used with extra care.

What are the side effects of dabigatran?

Like all medicines, dabigatran can cause side effects, although not everyone gets them. Common side effects include nausea (feeling sick), indigestion, tummy cramps and headache. These may go away with time. Tell your doctor if troublesome.

Increased risk of bleeding

Taking dabigatran means that blood takes longer to form clots, and this can increase your risk of bleeding. The benefits of using anticoagulants usually outweigh the risks of bleeding and your doctor will consider this before starting treatment. You might bleed or bruise more easily while you are taking dabigatran.

  • Be careful when doing things that may cause bruising and bleeding, such as shaving, clipping your fingernails, brushing and flossing your teeth or playing sports.
  • Avoid getting new tattoos and piercings as these can cause bruising and bleeding.
  • Minor bleeding should usually stop on its own.
  • If you have a fall or hurt your head or body, get medical attention immediately, even if you feel okay.
Signs of severe bleeding

If you have any of the following signs of bleeding, contact your doctor immediately or phone Healthline on 0800 611 116 for free 24 hour advice:

  • If you become pale, very weak and tired, or short of breath.
  • Bleeding from your gums.
  • Cuts or nosebleeds that won’t stop (longer than 10 minutes).
  • Blood in your stools (poo) – black, tarry stools.
  • Blood in your urine (wee) – pink, red or brown-coloured urine.
  • Heavy periods (menstrual bleeding).
  • Coughing up blood or vomit that looks like coffee grounds.

Interactions with other medicines

Dabigatran should not be taken with some other medicines and herbal supplements. Tell your doctor or pharmacist about all medicines you are taking (including over the counter medicines), herbal and complementary medicines or recreational drugs. Your doctor or pharmacist will be able to check for any interactions.

The following may increase your risk of bleeding and should be avoided:

  • over-the-counter anti-inflammatories such as diclofenac (eg, Voltaren Rapid), ibuprofen (eg, Nurofen), naproxen (eg, Naprogesic)
  • herbal extracts such as garlic, ginkgo or ginseng.

If you are already taking other medicines that act on your blood such as aspirin or clopidogrel, ask your doctor about the use of these with dabigatran. Sometimes the combination can be dangerous.

Learn more

The following links have more information on dabigatran:

Dabigatran (Te reo Māori) New Zealand Formulary Patient Information
Pradaxa Medsafe Consumer Information Sheet 

References

  1. The safe and effective use of dabigatran and warfarin in primary care BPAC, NZ, 2017
  2. An update on managing patients with atrial fibrillation BPAC, NZ, 2017
  3. Dabigatran etexilate New Zealand Formulary

Additional resources for healthcare professionals

Dabigatran etexilate NZ Formulary
Creatinine clearance calculator NZ Formulary
Pradaxa Medsafe, NZ
Translated medicine leaflets Health Navigator NZ
Dabigatran – safe prescribing – not a magic bullet SAFERx Bulletin, NZ, 2017
The use of dabigatran in general practice BPAC, NZ, 2011

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 18 Dec 2019