Dabigatran

In Aotearoa New Zealand dabigatran comes as capsules which are available in different strengths: 75 mg, 110 mg and 150 mg.

• Your dose of dabigatran will depend on what it's being used for.
• Your doctor or pharmacist will tell you the strength that's right for you.
• How long you will need to take dabigatran for will depend on why you're taking it. Some people only need it for a few weeks (eg, after surgery), or for a few months (eg, for deep vein thrombosis). Others may need to take it for the rest of their lives (people with atrial fibrillation).
• Always take your dabigatran exactly as your doctor has told you. The pharmacy label will tell you how much dabigatran to take, how often to take it and any special instructions.

• Know your capsule strength: Dabigatran capsules are available in different strengths: 75 mg, 110 mg and 150 mg. If you're unsure which capsule strength you're taking, ask your pharmacist.
• Timing: Take your dabigatran dose at the same times each day. You can take dabigatran with or without food.
• Swallow the capsules whole with a large glass of water: It's important to drink enough water so the capsule doesn't get stuck in your throat. Do not crush, chew or open the capsules. This will release all the medication at once and increase the risk of side effects. 
• Missed dose: Missing doses increases your risk of getting blood clots. If you forget to take a dose, don't take a double dose – this increases your risk of bleeding. 
  • Stroke prevention or blood clots: If the next dose is less than 6 hours away, skip the missed dose and take your next dose as normal. If there are more than 6 hours until the next dose, take the missed dose as soon as you remember. Do not take 2 doses at the same time.
  • Knee or hip replacement: Skip the missed dose and take your next as normal at the same time the next day. Do not take 2 doses at the same time.
• Storing your dabigatran capsules: Dabigatran capsules must be kept in the original foil package to protect them from moisture. If you store the capsules in a pill box or medication reminder box, keep them in the foil packaging. Only remove them from the foil packaging when you are ready to take them.
  

When taking dabigatran, it's important to use the medicine safely and correctly. The benefits of dabigatran need to be carefully balanced with possible side effects. Not enough anticoagulation can lead to a blood clot or stroke, but too much anticoagulation can lead to serious bleeding.

Here are some things to know when you're taking dabigatran. Other things may be important as well, so ask your healthcare provider what you should know about.

• Dabigatran increases your risk of bleeding: Avoid contact sports, tattoos, piercings and deep massage. It's also important to look out for signs of bleeding and report them to your healthcare provider. Signs include bleeding gums, red or black bowel motions (poo) and if you're bruising easily.
• Avoid injury: To reduce your risk of severe bleeding, avoid cuts and grazes by taking care when brushing your teeth (use a soft toothbrush) and shaving (consider using an electric razor) and protecting yourself when gardening, sewing or playing sports. You may be advised to avoid contact sports because of the risk of excessive bleeding.
• Tell all healthcare providers that you're taking dabigatran (eg, your doctor, dentist, pharmacist or podiatrist). You may need to stop taking your anticoagulant before surgery, dental care and some tests.
• Other medicines: Dabigatran can interact with some medicines and herbal supplements, so check with your doctor or pharmacist before starting dabigatran and before starting any new products. This includes over-the-counter anti-inflammatories including diclofenac (eg, Voltaren Rapid), ibuprofen (eg, Nurofen) and naproxen (eg, Naprogesic).
• Pregnancy: Dabigatran isn’t given to pregnant women. If you're taking it and could become pregnant, you should make sure you use contraception. If you're on dabigatran and find out you're pregnant (or you're planning a pregnancy) talk to your doctor or anticoagulant clinic about stopping or changing your prescription.

Like all medicines, dabigatran can cause side effects, although not everyone gets them.

Common side effects include nausea (feeling sick), indigestion, tummy cramps and headache. These may go away with time. Tell your doctor if they bother you.

You might bleed or bruise more easily while you're taking dabigatran.

• Be careful when shaving, clipping fingernails, brushing and flossing your teeth, or playing sports.
• Avoid new tattoos and piercings as these can cause bruising and bleeding.
• If you have a fall or hurt your head or body, get medical attention immediately, even if you feel okay.
• Some types of bleeding are more serious than others. If bleeding concerns you, is heavier than usual or takes an unusually long time to stop, you should talk to your healthcare provider quickly.