# Dabigatran -- leave title blank below
#+TITLE:  
#+AUTHOR:    David Mann
#+EMAIL:     mannd@epstudiossoftware.com
#+DATE:      [2015-03-06 Fri]
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* Dosage and administration
** Nonvalvular atrial fibrillation
| CrCl                   | Dose            |
|------------------------+-----------------|
| >30 mL/min             | 150 mg PO BID   |
| ≥15 to <30 mL/min      | 75 mg PO BID    |
| <15 mL/min or dialysis | Not recommended |
** DVT and PE
| CrCl                   | Dose            |
|------------------------+-----------------|
| >30 mL/min             | 150 mg PO BID   |
| ≤30 mL/min or dialysis | Not recommended |
Start after 5-10 days of parenteral anticoagulation.
** Reduction in risk of recurrence of DVT and PE in patients who have been previously treated
| CrCl                   | Dose            |
|------------------------+-----------------|
| >30 mL/min             | 150 mg PO BID   |
| ≤30 mL/min or dialysis | Not recommended |
** Dosing modifications (atrial fibrillation)
- CrCl 30-50 mL/min and coadministration of P-gp inhibitors dronedarone or ketoconazole: Consider reducing dose to 75 mg BID.  Dose adjustment not necessary when coadministered with other P-gp inhibitors
- CrCl <30 mL/min with concomitant use of P-gp inhibitors: Avoid coadministration.
** Dosing modifications (DVT/PE)
- CrCl <50 mL/min with concomitant use of P-gp inhibitors: Avoid coadministration.
* Dosage forms and strengths
- Capsules
  - 75 mg
  - 150 mg
* Contraindications
- Active pathological bleeding
- History of serious hypersensitivity reaction to dabigatran
- Mechanical prosthetic heart valve
* Warnings and precautions
- Bleeding: Can cause serious and fatal bleeding.
- Bioprosthetic heart valves: Use is not recommended.
* Adverse reactions
- Most common adverse reactions (>15%) are gastritis-like symptoms and bleeding.
* Drug interactions
- P-gp inducers rifampin: Avoid coadministration with dabigatran.
- P-gp inhibitors in patients with CrCl 30-50 mL/min: Consider reducing dose or avoid.
- P-gp inhibitors in patients with CrCl <30 mL/min: Not recommended.
* Use in specific populations
- Geriatric use: Risk of bleeding increases with age.
