Mosby's 2014 Nursing Drug Reference (114 page)

• Adult: PO
150 mg bid

• 
When converting from warfarin to dabigatran, discontinue warfarin and initiate dabigatran therapy when the INR is <2.0; when converting from a parenteral anticoagulant to dabigatran, initiate dabigatran 0-2 hr before the time of the next scheduled anticoagulant dose or at the time of discontinuation of a continuously administered anticoagulant (e.g., intravenous unfractionated heparin)

•
Adult:
CCr >50 ml/min, start warfarin 3 days before discontinuing dabigatran; CCr 31-50 ml/min, start warfarin 2 days before discontinuing dabigatran; CCr 15-30 ml/min, start warfarin 1 day before discontinuing dabigatran

•
Adult: PO
discontinue dabigatran, start parenteral anticoagulant 12 hr (CCr ≥30 ml/min) or 24 hr (CCr <30 ml/min) after the last dabigatran dose

•
Adult: PO
CCr 15-30 ml/min, 75 mg bid

•
Adult: PO
220 mg or 150 mg/day × 28-35 days, starting with 1/2 dose 1-4 hr after surgery

• 
Do not crush, break, chew, or empty contents of capsule

• 
If dose is missed, take as soon as remembered if on the same day; do not administer if <6 hr before next dose

• 
Without regard to food

• 
Store in original package at room temp until time of use; discard after 30 days, protect from moisture

Increase:
bleeding risk—amiodarone, other anticoagulants, clopidogrel, ketoconazole, quiNIDine, thrombolytics, verapamil

Decrease:
dabigatran effect—rifampin

Decrease:
dabigatran effect—P-glycoprotein inducers (carBAMazepine, rifampin, tipranovir

Increase:
thrombin time, aPTT

•
 
Bleeding:
blood in urine or emesis, dark tarry stools, lower back pain; caution with arterial/venous punctures, catheters, NG tubes; monitor vital signs frequently; elderly patients more prone to serious bleeding, monitor aPTT, ecarin clotting time baseline and during treatment

•
 
Thrombosis/MI/emboli:
swelling, pain, redness, difficulty breathing, chest pain, tachypnea, cough, coughing up blood, cyanosis

•
 
Postthrombotic syndrome:
pain, heaviness, itching/tingling, swelling, varicose veins, brownish/reddish skin discoloration, ulcers; use of ambulation, compression stockings, adequate anticoagulation can prevent this syndrome

•
 
Surgery:
discontinue 24-48 hr before surgery in those with CCr ≥50 ml/min, 72-96 hr in those with CCr <50 ml/min; longer times may be needed in major surgery

• 
Therapeutic response: decreased thrombus formation/extension, absence of emboli, post-thrombotic effects

• 
About the purpose and expected results of this product, to take at same time of day, not to skip or double doses

• 
To take without regard to food, swallow cap whole

• 
To avoid all other products unless approved by prescriber

• 
To notify all providers that this product is being used

•
 
To report any bleeding including blood in stool, emesis, urine; nosebleeds

Black Box Warning:

Pregnancy (C) 1st trimester, radiation therapy, hepatic disease, bone marrow suppression, secondary malignancy

•
Adult: IV
2-4.5 mg/kg/day × 10 days or 100-250 mg/m
²
/day × 5 days; repeat q3-4wk depending on response

•
Adult: IV
150 mg/m
²
/day × 5 days with other agents, repeat q4wk; or 375 mg/m
²
on days 1 and 15 when given in combination, repeat q28days

• Adult and child: IV
250 mg/m
²
/day as continuous inf × 4 days q28days

• Adult and child: IV
250-300 mg/m
²
/day as continuous inf × 3 days q21-28days

•
Adult: INTRATHECAL
5-30 mg in a fixed dose 2-3 ×/wk until disease controlled

• 
Antiemetic 30-60 min before giving product to prevent vomiting, nausea; vomiting may subside after several doses

• 
Antibiotics for prophylaxis of infection