Has your doctor prescribed you a medicine like Pradaxa to prevent blood clots? Or is a family member or friend using this medicine? This is a very important medicine that can really save lives. But at the same time, there are a few things we need to be very careful about when using it. So today, let's talk about this medicine, Dabigatran, which is simply known in our country as Pradaxa.
What is Dabigatran (Pradaxa)?
Simply put, this is a blood thinner . In medical terms, we call this an ``Anticoagulant''. Our blood has a clotting property. That's why bleeding stops when there is an injury. But sometimes, blood clots can form unnecessarily inside the body, inside the veins. This is a dangerous condition.
Dabigatran works by preventing the formation of unwanted blood clots. It is mainly used to:
- Prevent Stroke: Reduce the risk of blood clots in the brain and stroke in patients with an irregular heartbeat (Atrial Fibrillation).
- Treat blood clots: Dissolve blood clots that have formed in the lungs (Pulmonary Embolism) or deep veins of the legs (Deep Vein Thrombosis - DVT).
- Prevent blood clots: This medicine is given to prevent blood clots from forming again after surgery, such as a hip replacement, or to someone who has had a blood clot in the past.
Things you need to tell your doctor before starting this medication
Before your doctor prescribes Dabigatran, it is very important that he or she knows your complete health history. Be sure to tell your doctor if you have any of the conditions listed below.
| Health condition or opportunity | Why should you care? |
|---|---|
| Bleeding disorders | This medicine may increase the risk of bleeding. |
| If you have a mechanical heart valve | This medicine is not recommended for such patients. |
| Kidney disease | Since the medicine is eliminated from the body through the kidneys, the dosage may need to be adjusted. |
| If you have had stomach bleeding before | The risk of rebleeding may increase. |
| If you have recently had or are about to have a spinal or epidural procedure | There is a risk of bleeding in the spinal cord. |
| If you are pregnant, trying to get pregnant, or are a breastfeeding mother | In these cases, you should talk to your doctor about the safety of the medication. |
| If you have allergies to other medicines, foods or substances | This is important to know if you may be allergic to dabigatran. |
How exactly do I use this medicine?
To get the most out of this medicine and avoid any risks, it is very important to use it correctly.
Most importantly: Do not break, crush, chew, or open the capsule and drink the contents of this medicine for any reason. Doing so can cause too much medicine to enter the body at once, which can cause dangerous bleeding. The capsule should be swallowed whole.
- How to take: Swallow the medicine whole with a glass of water.
- Taking with food: This can be taken before or after meals. However, if you experience indigestion or stomach discomfort, taking the medicine with a meal may help reduce it.
- Don't skip doses: Take your medication exactly as prescribed, at the right time, and in the right dosage. Skipping doses or stopping your medication without your doctor's advice can suddenly increase your risk of blood clots or stroke.
- If you miss a meal:If you forget to take a dose, take it as soon as you remember. However, if it is less than 6 hours until your next dose, skip the missed dose and take your next dose at the scheduled time. Never take two doses at once.
- If you take too much of this medicine: If you think you have taken too much of this medicine, do not waste time and go to the nearest hospital Emergency Department (ETU) immediately. Or call the National Poisons Information Centre at the Colombo National Hospital for advice.
Things to keep in mind when taking this medicine
You need to think especially about your safety while taking this medicine.
- Avoid injuries: Stay away from sports (e.g. rugby, football) and work that can cause injury to the body. Even a small fall can cause significant internal bleeding.
- Sharp tools: Think twice before using sharp tools like knives and scissors. If you are shaving, it is safer to use an electric razor instead of a blade.
- Brushing your teeth: Be careful not to injure your gums when brushing and flossing.
- Surgery: If you are going to have surgery or have a tooth extracted, be sure to tell your doctor or dentist that you are taking Dabigatran. You will usually be asked to stop taking this medicine a few days before the surgery.
- Visiting the doctor: Visit the clinic on the scheduled days and see the doctor. He will monitor your condition and give you the necessary advice.
Side effects that may occur due to medication
Like any medicine, Dabigatran can cause side effects. Some are serious, some are common. It is important to be aware of these.
| Serious side effects that require immediate medical attention | |
|---|---|
| Allergic Reaction | Skin rash, itching, swelling of the lips/tongue/face, difficulty breathing. |
| Symptoms of bleeding | Black or bloody stools; dark red or brown urine; vomiting something that looks like coffee grounds; unusual bleeding from the nose, gums, or eyes; large bruises or red spots on the body; bleeding that cannot be stopped. |
| Symptoms of a Stroke | Sudden vision changes; slurred speech, difficulty speaking or understanding; severe headache; numbness or weakness in the face, arm or leg; difficulty walking, dizziness. |
| Symptoms of a blood clot | Chest pain; difficulty breathing; pain, swelling, or warmth in a leg (especially the lower leg). |
| Side effects that are usually not serious, but should be reported to your doctor if they persist | |
| Stomach discomfort | Stomach pain, indigestion, nausea (this may be reduced by taking the medicine with food). |
Other medications that may interact with Dabigatran
You should tell your doctor about all the medications you take, not just those prescribed by your doctor, but also over-the-counter painkillers, vitamins, herbal products, and even Sinhala medicines. Some medications can interact with Dabigatran and increase the risk of bleeding.
There are a few main types of medications to be careful of:
- Aspirin and other drugs in this group
- Other blood thinners (e.g. Warfarin, Heparin, Enoxaparin, Apixaban, Rivaroxaban)
- Painkillers (NSAIDs) (e.g. Ibuprofen, Naproxen, Diclofenac)
- Other blood thinners, such as Clopidogrel
- Some antibiotics, such as Rifampin (a medicine used to treat tuberculosis)
- Antifungals such as ketoconazole
This list is not complete, so it's always best to tell your doctor about anything you're taking .
Take-Home Message
- Never break, crush, or chew Dabigatran (Pradaxa) tablets. Swallow them whole.
- Do not stop taking the medicine without your doctor's advice. If you miss a dose, do not worry, just take the missed dose if it is more than 6 hours until your next dose.
- Tell your doctor about all other medications you are taking, especially painkillers.
- Be as careful as possible with falls and injuries. The risk of bleeding is high.
- If you notice signs of bleeding , such as black stools or unusual bruising, notify your doctor immediately or go to a hospital's ETU.
- Before any surgery or tooth extraction, remind your doctor/dentist that you are taking this medicine.
👩🏽⚕️ Additional questions (FAQs)
💬 What disease is Ramipril (Ramipril / Altace) tablets/capsules used for?
This is the most popular and successful ACE Inhibitor blood pressure pill in the world! It not only lowers blood pressure, but it is also prescribed by doctors to prevent future 'heart attacks and strokes' (cardiovascular events) for people over the age of 55, those with diabetes/cholesterol, and those at high risk of heart attack.
💬 How does taking this blood pressure pill (Ramipril) lower blood pressure and save the heart?
Our blood vessels are narrowed/weakened and the pressure rises due to a dangerous chemical called 'Angiotensin II'! When Ramipril enters the body, it completely blocks/closes and locks the factory that makes that chemical (ACE enzyme)! Then all the blood vessels become loose (Vasodilation) and the pressure drops. When the pressure decreases, it becomes easier for the heart to work/beat, so the risk of developing heart disease is reduced by 100%.
💬 What are the annoying and dangerous (Black Box Warning) side effects of taking this medicine (Ramipril)?
The biggest danger to be aware of from the beginning is that it is strictly prohibited for 'Pregnancy' mothers (Pregnancy) (deadly to the fetus)! The other biggest problem is the 'Dry cough' that comes along with taking the medicine, if you can't stand it, you have to switch to another pill (ARB). Also, if some people get 'Swelling of the face/lips and shortness of breath' (Angioedema - Black people are at higher risk), you need to go to the hospital immediately.
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