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Pradaxa (dabigatran etexilate) is a reversible anticoagulant used to prevent or treat blood clots in a variety of applications. It works about as well as warfarin, but requires less monitoring with blood tests.

The medication idarucizumab offers an antidote to Pradaxa, which is effective within moments of administration. Patients taking Pradaxa may want to carry an ID bracelet or similar notifications that Pradaxa is being taken.

In most cases Pradaxa is used to prevent or treat blood clots in the following scenarios:

• To prevent deep vein thrombosis (blood clot in veins) or pulmonary embolism (blood clot in lungs) following hip replacement surgery
• To reduce risk of recurring deep vein thrombosis or pulmonary embolism in patients who have previously had them
• To treat existing deep vein thrombosis or pulmonary embolism
• To reduce risk of stroke or systemic embolism in patients with non-valvular arterial fibrillation

Pradaxa is a potent medication that should not be used frivolously. Doctor instructions should be followed through the duration of treatment and doctor checkups should be attended. Note that this medication should not be ended abruptly; dosage will usually be gradually reduced.

Taking Pradaxa

This product comes in tablets, which should be swallowed whole; do not split, crush, chew, dissolve, or otherwise damage tablet integrity. A full glass of fluid is recommended with each dose, though food is optional. Opened containers of Pradaxa tablets will begin to lose potency after about 4 months.

If a dose is missed, it should be taken as soon as possible unless there are 6 hours or less before the next scheduled dose, in which case it may be skipped entirely. Never take a double-dose of Pradaxa to compensate for a missed dose.

Dosage is very difficult to summarize. Doctors will want to perform a creatinine clearance (CrCl) test before determining dosage to evaluate kidney function. In patients who have moderate or better kidney function---CrCl greater than 30 ml/min---treatment is usually:

• Following hip replacement surgery - 110 mg for the first day, then 220 mg once daily for 28 to 35 days.
• Preventing recurring blood clots - too variable to summarize.
• Treating existing blood clots - 150 mg taken twice per day (total of 300 mg per day).
• Reduce risk of stroke in non-valvular arterial fibrillation - 150 mg twice per day (total of 300 mg per day).

Patients with severe kidney impairment---CrCl less than 30 ml/min---may or may not be suitable candidates for Pradaxa use. Those who are will certainly be given lower doses, usually around 75 mg taken twice per day.

Duration of treatment can be quite variable, spanning months to years depending on the condition and whether or not it can be resolved, among other factors.

Warnings & Side Effects

As mentioned above, this is a potent medication that must be used with care. That said, most patients who do use it as directed have few, if any, problems with it; keep in mind that Pradaxa was prescribed because its benefits---which can save lives---are considered to be worth the risks.

Pradaxa is known to interact with certain other medications. Of greatest concern are:

• Dronedarone
• Rifampin
• Ketoconazole
• NSAIDs, including over-the-counter varieties

Be sure to double-check with a doctor if taking the above with Pradaxa.

Pradaxa should not be used by individuals with a prosthetic heart valve.

Patients taking this medication will bleed easier. Patients over age 75 are at increased risk, as are those who have preexisting ulcers or intestinal bleeding. Uncontrolled or unexplained bleeding should be brought to the attention of a doctor, or emergency medical attention sought if severe. Some things patients can do to minimize risks include:

• Avoid rough sports or other activities
• Use a soft-bristled tooth brush to prevent gums bleeding
• Use an electric razor to minimize risk of cuts
• Handle sharp objects with great caution

Rarely severe side effects will develop. In studies Pradaxa has shown to produce fewer life-threatening bleeds, but did produce slightly more gastrointestinal bleeds. Seek medical attention if experiencing:

• Severe lightheadedness
• Severe or persistant headache
• Blood in stools
• Blood in urine
• Coughing or vomiting blood

The majority of patients who take Pradaxa experience only mild gastrointestinal upset.