DabigatranDabigatran Etexilate

About Dabigatran

Dabigatran blocks thrombin, a key clotting enzyme. In adults it lowers stroke risk in atrial fibrillation not caused by a valve problem, treats deep vein thrombosis and pulmonary embolism after 5 to 10 days of an injected anticoagulant, lowers the chance of them returning, and prevents them after hip replacement. For clots in children, capsules are approved from age 8 to under 18 and pellets from 3 months to under 12; doses depend on weight and age, and the two forms cannot be swapped milligram for milligram.

The boxed warning has two parts: stopping it early, other than for serious bleeding or at the end of a planned course, raises the risk of clots and stroke, so it is not stopped without the prescriber; and spinal or epidural anesthesia or a spinal puncture can cause bleeding around the spinal cord and long-term or permanent paralysis.

Bleeding is the main risk and can be fatal; indigestion and burning stomach pain are common. It must not be used with active abnormal bleeding, after a serious allergic reaction to it, or with a mechanical heart valve, and is not recommended in triple-positive antiphospholipid syndrome. The dose depends on kidney function, which is checked before starting: in atrial fibrillation 150 mg twice a day, or 75 mg twice a day when kidney function is severely reduced.

Taking Dabigatran

How to take it

Capsules twice a day, about 12 hours apart (once a day after hip replacement), with or without food. Swallow them whole with a full glass of water; breaking, chewing or emptying them increases the amount absorbed. Pellets are mixed with two teaspoons of applesauce, mashed carrots or mashed banana, or given with apple juice, within 30 minutes, never with milk products, a syringe or a feeding tube.

If you miss a dose

Take it as soon as you remember. If the next dose is less than 6 hours away, skip the missed dose and keep to your regular schedule.

Storage

Capsules at room temperature in the original bottle or blister to keep them dry, never in a pill organizer; close the bottle tightly and use it within 4 months of opening. Pellets stay in the original aluminum bag, used within 6 months of opening.

Interactions to know about

Aspirin, long-term NSAIDs, warfarin, heparin, clopidogrel and prasugrel add to bleeding. Rifampin lowers its levels and is generally avoided; dronedarone and ketoconazole raise them, which can change the dose. Tell any doctor or dentist you take it before surgery, and get help right away for unusual bleeding, pink or brown urine, red or black stools, or leg numbness or weakness after a spinal procedure.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Dabigatran differs from pharmacy to pharmacy

Generic capsules have several makers, fewer than everyday generics, and pharmacies pay different amounts depending on their supplier, so quotes vary; a pharmacy stocking only Pradaxa quotes the brand.

The pellets are brand-only, so quotes for them differ mainly by markup.

Ways to pay less for Dabigatran without insurance

• Ask the prescriber to allow generic substitution, and ask whether each quote is for generic or Pradaxa.
• Once the dose is settled, ask for a ninety-day supply.
• For the pellets, ask the manufacturer about patient assistance.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Dabigatran

1. 1.Is this generic dabigatran or Pradaxa, at the strength my prescriber wrote?
2. 2.Which painkillers or supplements raise my bleeding risk with it?
3. 3.Which bleeding signs mean I should get help right away?
4. 4.Who decides when to stop it before surgery or dental work?

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