Starting Pradaxa - Initiation and dosing in pVTEp

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How easy is it to initiate Pradaxa in my pVTEp patients?

Pradaxa should be initiated orally within 1–4 hours of completed surgery with a single capsule, increasing to 2 capsules, once daily, thereafter.1

If Pradaxa treatment is not started on the day of surgery then treatment should be initiated the next day with 2 capsules, once daily.1

An image showing the dose progression for Pradaxa (Dabigatran)

What is the recommended dose of Pradaxa in pVTEp?

The recommended daily dose of Pradaxa is 220 mg once daily following treatment with a parenteral anticoagulant for at least 5 days.1

Certain patients may need to take Pradaxa at the 150 mg once daily dose.

An image showing dose adjustments for Pradaxa (Dabigatran)

 

  • Patients with moderate renal impairment [creatinine clearance, (CrCL 30–50 mL/min)]
  • Patients who receive concomitant verapamil, amiodarone or quinidine.
  • Patients aged ≥75 + years (see Pradaxa SPC)

How do my patients take Pradaxa?

Pradaxa can be taken with or without food. Pradaxa should be swallowed as a whole with a glass of water, to facilitate delivery to the stomach.1

Patients should be instructed not to open the capsule as this may increase the risk of bleeding.1

Both capsules (i.e. 2 x 110 mg or 2 x 75 mg) should be taken at the same time.1

 

For how long should my pVTEp patients take Pradaxa?

Following elective knee replacement surgery, Pradaxa should be taken (as 2 capsules, taken at the same time) for 10 days.1

Following elective hip replacement surgery, Pradaxa should be taken (as 2 capsules, taken at the same time) for 28–35 days.1

What happens if my patient misses a dose?

It is recommended to continue with the remaining daily doses at the same time the next day. No double dose should be taken to make up for missed individual doses.1

 

Why is renal assessment necessary before initiation of Pradaxa?

Patients with mild to moderate renal impairment can be treated with Pradaxa however, it is contraindicated in those with severe renal impairment (CrCL <30 mL/min). Renal function should therefore be assessed by calculating the CrCL prior to initiation of treatment with Pradaxa to exclude patients with severe renal impairment.1

While on treatment the patient’s renal function should also be assessed in certain clinical situations when you suspect that their renal function could decline or deteriorate.1

References: 
  1. Pradaxa Summary of Product Characteristics 2016. Boehringer Ingelheim.