Dabigatran Dosage

This dosage information may not include all the information needed to use Dabigatran safely and effectively. See additional information for Dabigatran.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Prevention of Thromboembolism in Atrial Fibrillation

To reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation:
150 mg orally twice daily

Renal Dose Adjustments

CrCl 15 to 30 mL/min: 75 mg orally twice daily.
Recommendations for patients with a CrCl less than 15 mL/min cannot be provided.

Reduce the dose to 75 mg twice daily when dronedarone or systemic ketoconazole is coadministered in patients with moderate renal impairment (CrCl 30 to 50 mL/min). Avoid use with P-gp inhibitors in patients with severe renal impairment (CrCl 15 to 30 mL/min).

Liver Dose Adjustments

Data not available

Dose Adjustments

When converting patients from warfarin therapy to dabigatran, discontinue warfarin and start dabigatran when the international normalized ratio (INR) is below 2.0.

When converting from dabigatran to warfarin, adjust the starting time of warfarin based on creatinine clearance as follows:
CrCl greater than 50 mL/min, start warfarin 3 days before discontinuing dabigatran.
CrCl 31 to 50 mL/min, start warfarin 2 days before discontinuing dabigatran.
CrCl 15 to 30 mL/min, start warfarin 1 day before discontinuing dabigatran.
CrCl less than 15 mL/min, no recommendations can be made.

When converting from a parenteral anticoagulant, start dabigatran 0 to 2 hours before the scheduled administration of the parenteral anticoagulant or at the time of discontinuation of a continuously administered parenteral anticoagulant. When converting to a parenteral anticoagulant, start the parenteral anticoagulant 12 hours (CrCl greater than or equal to 30 mL/min) or 24 hours (CrCl less than 30 mL/min) after the last dose of dabigatran.

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Dabigatran can be removed by hemodialysis or charcoal hemofiltration. Hemodialysis can be expected to remove 40% to 65% of the drug during a 4-hour session.

Other Comments

Storage requirements: Dabigatran must be stored in its original package, and once opened, it must be used within 4 months.

General:
Temporarily discontinue dabigatran 1 to 2 days (CrCl greater than or equal to 50 mL/min) or 3 to 5 days (CrCl less than 50 mL/min) before invasive or surgical procedures, consider longer times for patients who may require complete hemostasis, and then restart promptly.

Periprocedural Management:
Low risk of bleeding (dental cleaning or extraction, skin biopsy, or cataract extraction): Procedures should be performed greater than or equal to 10 hours after dosing.

Moderate risk of bleeding: Hold treatment for 2 to 3 half-lives.

High risk of bleeding: Hold treatment for 4 to 5 half-lives.

If urgent surgery or intervention is required, the risk of bleeding should be weighed against the clinical need for the procedure. Surgery should be delayed, if possible, for greater than or equal to 1 half-life after the last dose or until the aPTT is normal or near normal.

Monitoring: If monitoring is necessary for bleeding or emergency surgery, the dilute-thrombin (dilute-TT) or the ecarin clotting times (ECT) are best suited for measuring dabigatran's anticoagulation effect.

Patient advice: Capsules should be swallowed whole, because breaking, chewing or emptying capsule can result in increased exposure. A missed dose should be skipped if it cannot be taken 6 hours before the next scheduled dose.

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