Experiences with

Dabigatran

Who can take dabigatran

Most adults aged 18 and over can take dabigatran.

Who may not be able to take dabigatran

Dabigatran is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

• have ever had an allergic reaction to dabigatran or any other medicine
• are trying to get pregnant or you're already pregnant – dabigatran can be harmful to your baby
• have liver or kidney problems
• have any injuries that are currently bleeding a lot, such as a wound
• have a stomach ulcer
• have had a recent spinal injury or surgery
• have ever had surgery to replace a heart valve
• have antiphospholipid syndrome, a condition that affects the immune system and makes you more likely to get blood clots

Dosage and strength

Dabigatran comes as 75mg, 110mg and 150mg capsules.

Your dose of dabigatran depends on why you're taking it.

For a heart problem called atrial fibrillation or a blood clot (DVT or pulmonary embolism), the usual dose is 150mg twice a day.

For a hip or knee joint replacement the usual dose is 110mg twice a day.

Your doctor may give you a lower dose if you're at increased risk of bleeding. This includes if you:

• are aged 75 years or older
• take verapamil (a medicine for high blood pressure)
• have problems with your kidneys, stomach or throat

If you're unsure what dose you need to take, check with your pharmacist or doctor.

How to take it

You can take dabigatran with or without food, but try to take it at the same time every day.

Swallow the capsules whole with a drink of water. Do not open dabigatran capsules before taking them as this increases the risk of side effects.

If you have trouble swallowing pills, speak to your doctor or pharmacist.

How long to take it for

How long you need to take dabigatran for will depend on why you're taking it.

If you're taking it for:

• a knee joint replacement – you'll usually take dabigatran for 10 days
• a hip joint replacement – you'll usually take dabigatran for 4 to 5 weeks
• a blood clot – depending on what caused the blood clot, you'll usually take dabigatran for at least 3 months
• atrial fibrillation – you might need to take dabigatran long term or even for the rest of your life

If you forget to take it

If you're taking dabigatran for:

• atrial fibrillation or a blood clot – take the forgotten dose as soon as you remember. If your next dose is due in less than 6 hours, skip the forgotten dose and take your next dose at the usual time
• a hip or knee joint replacement – skip the forgotten dose completely and then take your next dose when it's due

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember to take your medicines.

If you take too much

Taking too much dabigatran puts you at risk of bleeding.

• you take more than your prescribed dose of dabigatran

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the dabigatran packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Your doctor or pharmacist will give you an anticoagulant alert card.

Carry this with you all the time. It tells healthcare professionals that you're taking an anticoagulant. This can be useful for them to know in case of a medical emergency.

If you need any medical or dental treatment, show your anticoagulant alert card to the nurse, doctor or dentist. This includes before you have vaccinations and routine sessions with the dental hygienist.

Your doctor may advise you to stop taking dabigatran or reduce your dose for a short time.

Switching from warfarin to dabigatran

If you need to switch from warfarin to dabigatran, your doctor will advise you when to stop taking warfarin.

This will probably be a few days before you start dabigatran.

Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting.

This is to help decide exactly when you should start taking dabigatran.

Switching from dabigatran to warfarin

If you need to switch from dabigatran to warfarin, you may need to take both medicines together for a few days.

Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting.

This is to help decide exactly when you should stop taking dabigatran.

Bleeding and what to do about it

While dabigatran has enormous benefits, the downside is that it can make you bleed more than normal.

This is because while you're taking dabigatran, your blood will not clot as easily.

Less serious bleeding

It's usual to bleed more easily than normal while you're taking dabigatran.

The kind of bleeding you might have includes:

• periods that are heavier and last longer than usual
• bleeding for a little longer than usual if you cut yourself
• occasional nosebleeds (that last for less than 10 minutes)
• bleeding from your gums when you brush your teeth
• bruises that come up more easily and take longer to fade than usual

This type of bleeding is not dangerous and should stop by itself. If it happens, keep taking dabigatran, but tell your doctor if the bleeding bothers you or does not stop.

Things you can do to help yourself:

• Cuts – press on the cut for 10 minutes with a clean cloth.
• Nosebleeds – sit or stand upright (do not lie down), pinch your nose just above your nostrils for 10 to 15 minutes, lean forward and breathe through your mouth, and place an icepack (or a bag of frozen peas wrapped in a teatowel) at the top of your nose.
• Bleeding gums – try using a soft toothbrush and waxed dental floss to clean your teeth.
• Bruises – these are harmless, but can be unsightly. It might help to make them fade more quickly if you put an ice pack wrapped in a towel over the bruise for 10 minutes at a time several times a day.

What you can do to prevent bleeding

While you're taking dabigatran, be careful when you do activities that might cause an injury or a cut or bruising.

It can help to:

• avoid playing contact sports or other activities than can cause an injury, such as football, rugby, hockey and horse riding
• wear gloves when you use sharp objects like scissors, knives and gardening tools
• stop wet shaving or removing hair with wax – use an electric razor or hair-removing cream instead
• take false teeth (dentures) or retainers out for a few hours a day, if you wear them, to give your gums a rest – do not wear dentures or retainers that do not fit properly
• tell your doctor, dentist or nurse that you take dabigatran before you have any medical or dental procedures or surgery – this includes vaccinations and routine appointments with the dental hygienist

Other common side effects

These common side effects of dabigatran happen in more than 1 in 100 people.

They're usually mild and do not last long. There are things you can do to help cope with them:

Talk to your doctor or pharmacist if these side effects bother you or do not go away.

Serious side effects

Serious bleeding

Occasionally, you can have serious bleeding from taking dabigatran. This can be dangerous and needs urgent medical attention.

• you have red pee or black poo
• you get bruises that happen for no reason, or bruises that are larger than you'd expect or keep growing in size

• you get nosebleeds that you cannot stop and that last longer than 10 minutes
• you have blood in your vomit or you're coughing up blood
• you get severe headaches
• you have any bleeding from a cut or injury that will not stop or slow down

These are symptoms of serious bleeding. If you have any serious bleeding, stop taking dabigatran.

Very rarely, dabigatran can lead to bleeding in the brain.

you have any of these symptoms:

• a very severe headache
• a seizure or fit
• sudden loss of vision or blurred vision
• numbness or tingling in your arms or legs

You may also feel very tired, weak or sick.

In rare cases, dabigatran can cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of dabigatran. For a full list, see the leaflet inside your medicine's packet.

Dabigatran and pregnancy

Dabigatran should not be taken during pregnancy.

If you take dabigatran and are planning a pregnancy or you become pregnant while taking it, speak to your doctor or specialist. They will change you to a different medicine.

Dabigatran and breastfeeding

It may be OK to take dabigatran while breastfeeding, but talk to your doctor or pharmacist first.

Dabigatran gets into breast milk in tiny amounts, and it is unlikely to cause side effects in your baby. However, we do not have very much information about dabigatran and breastfeeding, so your doctor may recommend a different medicine we know more about.

If your doctor says it's OK to take dabigatran while breastfeeding, then monitor your baby for any possible side effects.

Talk to your health visitor, midwife, pharmacist or doctor as soon as possible if:

• your baby is not feeding as well as usual
• your baby seems to bleed or bruise easily
• you have any other concerns about your baby

Dabigatran and fertility

There's no evidence to suggest that taking dabigatran reduces fertility in either men or women.

Speak to a pharmacist or your doctor before taking it if you're trying to get pregnant.

Cautions with other medicines

Some medicines can affect how dabigatran works. This can lead to serious side effects.

Tell your doctor if you're taking any of these medicines before you start taking dabigatran:

• any other anticoagulant, such as warfarin or enoxaparin
• any other medicines that affect blood clotting, such as clopidogrel, ticagrelor or prasugrel
• medicines to treat heart problems, such as verapamil, amiodarone or dronedarone
• medicines to treat fungal or bacterial infections, such as fluconazole, ketoconazole or clarithromycin
• medicines to treat depression, such as fluoxetine, sertraline or citalopram
• medicines to treat HIV, such as ritonavir
• medicines to treat epilepsy, such as carbamazepine or phenytoin
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin

Taking dabigatran with everyday painkillers

You can take paracetamol while you're taking dabigatran.

Do not take aspirin or ibuprofen while you're taking dabigatran unless a doctor has said it's OK. They increase the chance of bleeding.

Mixing dabigatran with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you're taking dabigatran. It can increase your risk of side effects.

There's not enough information to say that other herbal remedies and supplements are safe to take with dabigatran. They're not tested in the same way as pharmacy and prescription medicines.

Related links

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