Overdosing the application of the drug may be accompaniedtestosterone blend 400hemorrhagic complications due to the drug pharmacodynamic characteristics. When bleeding occurs, stop using the product.Displaying symptomatic treatment. No specific antidote.
Given the main route of elimination of dabigatran (kidneys), it is recommended to ensure adequate urine output. Spend a surgical hemostasis and replenishment of circulating blood volume. Possible use of fresh whole blood or transfusion of fresh frozen plasma. Since dabigatran has a low ability to bind to plasma proteins, the drug can be output in hemodialysis; however, clinical experience on the use of dialysis in these situations is limited (see. “Pharmacokinetics” section).
If overdose possible use of activated prothrombin complex concentrates or recombinant Factor VIIa or concentrates II, IX or X coagulation factors. There is experimental evidence supporting the effectiveness of these tools in countering the anticoagulant effect of dabigatran, but specific clinical studies have been conducted.
In the case of thrombocytopenia, or in the application of long-acting antiplatelet agents, can be considered the use of platelets.
Interaction with other drugs:
The combined use of the drug PRADAKSA with drugs that affect hemostasis or coagulation system, including vitamin K antagonists, can significantly increase the risk of bleeding.
In studies conducted in vitro, , established by inducing or inhibiting effect of dabigatran on cytochrome P450. In studies in vivo, in healthy volunteers were observed between dabigatran etexilate interaction and atorvastatin and diclofenac.
Interaction with inhibitors / inducers of P-glycoprotein:
The substrate for a transporter molecule P-glycoprotein is dabigatran etexilate. Simultaneous use of P-glycoprotein inhibitors (amiodarone, verapamil, quinidine, ketoconazole for systemic use or clarithromycin) leads to an increase in dabigatran plasma concentrations.
The simultaneous use of inhibitors of P-glycoprotein:
Dose selection in the case of these inhibitors for the prevention of stroke, systemic thromboembolism and reduced cardiovascular mortality in patients with atrial fibrillation is not required .
In the case of use in the prevention of venous thromboembolism in patients undergoing orthopedic surgery – see sections “Dosage and Administration” and “Interaction with other medicinal products.”.
Amiodarone. With simultaneous use of dabigatran etexilate with a single dose of amiodarone (600 mg), taken orally, the extent and rate of absorption of amiodarone and its active metabolite, dezetilamiodarona not changed. The values of AUC and C max dabigatran increased approximately 1.6 and 1.5 times (60% to 50%), respectively.
In a study in patients with atrial fibrillation, dabigatran concentration increased by not more than 14%, increase the risk of bleeding was not recorded.
Dronedarone. After the simultaneous testosterone blend 400 use of dabigatran etexilate and dronedarone 400 mg once,
AUC 0-∞ , and C max dabigatran increased 2.1 and 1.9 times (114% and 87%), respectively, and after repeated use of dronedarone 400 mg per day – 2.4 and 2.3 (136% and 125%) respectively. After single and repeated use of dronedarone in 2 hours after administration of dabigatran etexilate AUC 0-∞ was increased to 1.3 and 1.6 times, respectively. Dronedarone does not affect the final T1 / 2 and renal clearance of dabigatran.
Verapamil. With simultaneous use of dabigatran etexilate and verapamil, are administered orally, the values of the C max and AUC of dabigatran were increased depending on the time of application and formulation of verapamil.
The greatest increase in dabigatran effect observed with the first dose of verapamil in the dosage form immediate release which was applied for 1 hr before receiving dabigatran etexilate (C max increased by 180%, and the AUC – 150%). When using a dosage form of verapamil with sustained release, this effect is progressively decreased (C max increased by 90%, and AUC – 70%), as well as by using multiple doses of verapamil (C max increased by 60%, and AUC – 50%) , which may be explained by induction of P-glycoprotein in the gastrointestinal tract of verapamil with prolonged use.
If you are using verapamil after 2 hours of clinically significant interactions were observed after administration of dabigatran etexilate, as 2 hours dabigatran completely absorbed (see “Dosage and Administration” section.).
In a study in patients with atrial fibrillation, dabigatran concentration increased by not more than 21%, increase the risk of bleeding was not recorded.
Data on the interaction between dabigatran etexilate and verapamil, parenteral administration, no; clinically significant interaction is expected.
. Ketoconazole Ketoconazole for systemic use purpose after a single dose of 400 mg increases the AUC 0-∞ , and C max dabigatran approximately 2.4 timestestosterone blend 400, respectively, and after multiple destination ketoconazole at a dose of 400 mg per day – approximately 2.5 times (153% and 149%), respectively. Ketoconazole did anabolic steroids buy