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Drug Interactions between dabigatran and dalteparin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

dalteparin dabigatran

Applies to: dalteparin and dabigatran

GENERALLY AVOID: Drugs that can affect hemostasis such as glycoprotein IIb/IIIa inhibitors, thienopyridine antiplatelet agents, unfractionated and low molecular weight heparins, heparin derivatives, hirudin derivatives and analogs, thrombolytics, dextran, vitamin K antagonists, factor Xa inhibitors and other anticoagulants may potentiate the risk of bleeding complications associated with the use of dabigatran.

MANAGEMENT: In general, any agent that can enhance the risk of hemorrhage including other anticoagulants should be discontinued prior to initiation of dabigatran therapy. If coadministration is necessary, it should be undertaken with caution and only after thorough assessment of risks and benefits. A 24-hour interval is recommended before switching from dabigatran to parenteral anticoagulation. When switching from parenteral anticoagulation to dabigatran, the first dose of dabigatran should not be given before the next scheduled time of the parenteral anticoagulant dose. Unfractionated heparin may be used concomitantly at doses necessary to maintain intravenous or arterial catheter patency. Close clinical and laboratory observation for bleeding complications is recommended.

GENERALLY AVOID: In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during dabigatran therapy may be increased by the concomitant use of other drugs that affect coagulation. The development of epidural and spinal hematoma can lead to long-term or permanent paralysis.

MANAGEMENT: In patients undergoing neuraxial intervention, administration of dabigatran alone or with other drugs that can affect hemostasis should be approached with extreme caution and only after thorough assessment of risks and benefits. Besides bleeding complications, these patients should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction. Urgent diagnosis and treatment (e.g., spinal cord decompression) are required if signs or symptoms of spinal hematoma develop. To reduce the potential risk of bleeding, placement or removal of an epidural catheter or lumbar puncture should ideally be performed when the anticoagulant effect of dabigatran is low. An optimal interval has not been established, but should take into consideration the pharmacokinetic profile of dabigatran.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. "Product Information. Pradax (dabigatran)." Boehringer Ingelheim (Canada) Ltd (2008):
  3. "Product Information. Pradaxa (dabigatran)." Boehringer-Ingelheim (2010):

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Anticoagulants

Therapeutic duplication

The recommended maximum number of medicines in the 'anticoagulants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'anticoagulants' category:

  • dabigatran
  • dalteparin

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.