How Do You Know Pradaxa Is Working
Introduction
Dabigatran etexilate is a prescription medication used to slow and inhibit the germination of claret clots. Dabigatran is known by the trade name Pradaxa in the Usa and all other countries in which it is marketed except Japan (Prazaxa) and Canada (Pradax). Although forming claret clots is a normal and of import torso function needed to stop haemorrhage, for some people the blood clot formation procedure can become harmful. For example, people with an irregular centre rhythm known as atrial fibrillation are at an increased hazard of stroke because of the germination of harmful blood clots. Dabigatran is an anticoagulant type of medication. Anticoagulants prevent blood clots from forming. The medication warfarin (Coumadin) is another example of an anticoagulant. Anticoagulants are also commonly called blood thinners, although they work by preventing blood clot formation and not by making the blood thinner.
How Does Dabigatran Work?
The formation of blood clots in the body is a very complex process that requires multiple steps occurring in a particular society. Substances known as clotting factors are used and produced in each step in the process. I of the terminal steps of jell germination involves a clotting factor known as thrombin. Dabigatran works in the blood by blocking the action of thrombin, which inhibits the clot-making process.
Tips on Taking Dabigatran
Dabigatran has been approved in the United States to reduce the risk of stroke and other harmful claret clots in people with nonvalvular atrial fibrillation. Dabigatran is available as a capsule in doses of 75 and 150 mg (Figure, A and B). The usual dose of dabigatran is a 150-mg capsule twice a day by mouth. For people with certain types of kidney problems, the dose may be decreased to 75 mg twice a twenty-four hours. The dabigatran capsule may exist taken with or without nutrient and must be swallowed whole. The capsule cannot be cleaved or chewed, and the pellets inside the capsule should non exist sprinkled onto foods or into liquids.
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Effigy. A, Dabigatran 75-mg capsule. B, Dabigatran 150-mg sheathing. C, Dabigatran bottle. D, Dabigatran blister pack. The figure is reproduced with permission from Boehringer Ingelheim International GmbH. Further reproduction is prohibited without permission.
Dabigatran should exist taken as prescribed and should not be stopped without first talking to your md, considering this may increment your risk of stroke. If you miss a dose, yous should take that dose as soon as you call up. However, if you think <6 hours from when y'all are scheduled to take your next dose, you should skip the missed dose. You should non take 2 doses of dabigatran at the same time.
Your chemist volition manipulate dabigatran in the original bottle or in an private unit dose blister package because the medication is sensitive to wet (Effigy, C and D). The medication must exist stored in the original bottle with the hat tightly closed or in the original package at room temperature away from excessive moisture. The dabigatran capsules should not be placed or stored in some other container, such as a pill box or pill organizer. Once the dabigatran bottle is opened, it must be used within 60 days or safely thrown away.
Differences Between Dabigatran and Warfarin
Although dabigatran and warfarin are both anticoagulants, there are meaning differences between the medications. Whereas dabigatran is currently approved in the Usa only for people with nonvalvular atrial fibrillation, warfarin has been approved for use in people not simply with atrial fibrillation, but with other clotting diseases, such as blood clots in the leg veins or the lungs or subsequently a heart attack.
Warfarin needs to exist monitored at least monthly with a blood exam known as the prothrombin time test, most normally reported as an international normalized ratio (INR). The prescriber adjusts the dose of warfarin according to the results of the INR. Dabigatran does not require INR testing because the same dose is used (adjusted for kidney part) with a consistent outcome. Because the dose of dabigatran depends on a patient's kidney function, some laboratory testing may be needed periodically.
Warfarin has more interactions with other medications that could increase or subtract its effectiveness. In addition, changes in diet, such equally increased or decreased intake of certain foods containing vitamin K, may affect the power of warfarin to preclude blood clots. Therefore, it is important that patients taking warfarin always let each of their healthcare providers know that they are taking the medication. Dabigatran appears not to exist affected past most medications or food, just patients should all the same make sure to alert all of their healthcare providers that they are taking the medication.
The inhibition of blood clots in people taking warfarin can exist reversed by utilise of oral or intravenous vitamin Grand, which may be important to do if someone is at loftier run a risk for haemorrhage or is actively haemorrhage. At this time, at that place is no available medication to reverse the blood clot prevention furnishings of dabigatran. Still, the effects of dabigatran on clotting wear off faster (in most people within 24 hours of stopping dabigatran) than the effects of warfarin, which takes days to clothing off.
A research written report comparing the efficacy and safe of dabigatran and warfarin in patients with nonvalvular atrial fibrillation found that patients taking dabigatran 150 mg twice daily had a 34% reduced risk of stroke compared with patients taking warfarin, with similar rates of major haemorrhage. Patients taking dabigatran 150 mg twice daily had more tum upset and stopped taking their medication more than oft than patients taking warfarin.
Switching Betwixt Dabigatran and Warfarin
If you and your healthcare provider decide that it would be in your best medical interest to switch from one oral anticoagulant medication to the other, it is of import that you closely follow your healthcare provider'south instructions. When you switch from warfarin to dabigatran, your healthcare provider will instruct you to terminate your warfarin, obtain INR levels, and offset the dabigatran when the INR claret test reaches a certain level. When you switch from dabigatran to warfarin, your healthcare provider volition have y'all commencement the warfarin up to 3 days before yous finish the dabigatran.
Side Effects
The most of import side issue associated with taking dabigatran is bleeding. You are at greater take a chance of haemorrhage if y'all take a history of bleeding, are older than 75 years of historic period, accept kidney problems, have a stomach ulcer or other problems with stomach or intestinal bleeding, or are taking other medications that also increase your risk of bleeding (Table 1). Check with your doc earlier discontinuing whatever prescribed medications. Whatsoever unusual bleeding (including bleeding from the gums or nose, excessive menstrual bleeding, pink or brown urine, carmine or black stools, bruising, coughing or vomiting blood); severe, persistent headache; or dizziness should exist reported to your healthcare provider immediately. The virtually mutual side effects from dabigatran are those associated with the stomach, such as indigestion, upset tummy, and stomach hurting.
| Medication | Trade Name | Prescription or Over the Counter |
|---|---|---|
| Aspirin | Multiple | OTC and prescription |
| Nonsteroidal antiinflammatory drugs | Multiple (Advil, Motrin, Aleve) | OTC and prescription |
| Warfarin | Coumadin, Jantoven | Prescription |
| Heparin | Not applicable | Prescription |
| Enoxaparin | Lovenox | Prescription |
| Dalteparin | Fragmin | Prescription |
| Clopidogrel | Plavix | Prescription |
| Prasugrel | Effient | Prescription |
| Aspirin plus dipyridamole | Aggrenox | Prescription |
When to Call Your Healthcare Provider
You should call your healthcare provider or become immediate medical help if yous have any of these signs or symptoms of haemorrhage:
-
Unexpected or uncontrollable bleeding
-
Coughing or vomiting blood
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Scarlet or black stools
-
Severe, persistent headache, dizziness, or weakness
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Autumn or injury to the head
Dabigatran and Lifestyle
Because dabigatran is an anticoagulant, care must be taken when you lot undertake activities that increase your take chances of serious injury. Stopping dabigatran abruptly or missing doses increases your risk of stroke. It is important to know the common do'south and don'ts of dabigatran therapy (Table 2).
| What to Practise | What Not to Do |
|---|---|
| • Do lookout for signs of bleeding. | • Never double a dose if you miss a dose. |
| • Do tell your prescriber if you injure yourself and experience bleeding. | • Don't take dabigatran stored in bottles if it has been longer than 60 days since the canteen has been opened. |
| • Do take dabigatran at the same time each day, almost 12 hours apart. | |
| • Exercise take a missed dose of dabigatran within half dozen hours or else skip the dose and take the next one when scheduled. | |
| • Do tell all of your healthcare providers and dentist that yous are taking the blood thinner dabigatran. | |
| • Exercise contact your pharmacy for refills before you run out. | |
| • If in a bottle, store dabigatran in the original canteen with the hat tightly airtight. | |
| • Vesture a medical identification bracelet or carry a medical identification bill of fare that indicates that yous take an anticoagulant or blood thinner. |
Pregnancy
Dabigatran has non been shown to impairment the fetus in animal reproduction studies but has non been studied in pregnant women. Potential benefits of taking dabigatran while pregnant may outweigh the risks. A woman who becomes pregnant or plans to get significant while taking dabigatran should notify her prescriber or md immediately to discuss potential risks versus benefits of standing dabigatran.
Surgery and Dental and Other Medical Procedures
It is important to tell your healthcare providers that you are taking dabigatran if you demand to take any surgery, dental piece of work, or other medical procedures that increase your take a chance for bleeding. Dabigatran may demand to be stopped temporarily.
Where to Go More Information
Your pharmacist volition give you a dabigatran medication guide with each prescription. Yous should read the medication guide with each refill, considering there may exist new information. Enquire your pharmacist or prescriber any questions you lot accept. Keep a periodical with your questions to ask them at your adjacent visit. Reliable information about dabigatran and atrial fibrillation may too be plant on the Internet at Due north American Thrombosis Forum (http://www.natfonline.org) Resources for Patients and Caregivers, as well as ClotCare Online Resource (http://www.ClotCare.org) and the Heart Rhythm Society (http://world wide web.hrsonline.org) Patient Information.
Disclosures
Dr Spinler consults for Daiichi Sankyo. Dr Willey reports no conflicts.
Source: https://www.ahajournals.org/doi/10.1161/circulationaha.111.019786
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