Dabigatran reversal agent (specific antidote)
Pregnancy: Limited data. Use if benefit outweighs risk in life-threatening haemorrhage.
Idarucizumab (Praxbind)
Brand names: Praxbind
Adult dose
Dose: 5 g IV (as two consecutive infusions of 2.5 g, or two boluses)
Route: IV (each 2.5 g vial infused over 5–10 min or IV bolus)
Frequency: Single 5 g dose; can repeat once if clinically needed
Max: 5 g (one 5 g dose; up to 10 g in rebound)
Reversal of dabigatran in: life-threatening bleeding, emergency surgery, urgent invasive procedures. Give both 2.5 g vials consecutively. Dabigatran rebound possible at 12–24 hours if anticoagulant remains (single additional 5 g dose can be given if levels remain elevated).
Paediatric dose
Route: IV
Frequency: Single dose
Max: Not established in children
Not licensed in children. Specialist haematology advice required.
Dose adjustments
Renal
No dose adjustment required.
Hepatic
No dose adjustment required.
Clinical pearls
- ONLY reverses dabigatran — not apixaban or rivaroxaban (use andexanet alfa or PCC for those)
- RE-VERSE AD trial: complete dabigatran reversal in >90% within minutes
- Consider reinitiation of anticoagulation as soon as clinically safe (24 hours post-reversal)
- Dabigatran rebound: may occur within 24 hours if significant residual drug levels
- Cost: expensive — ensure correct DOAC before administration
Contraindications
- Hypersensitivity to idarucizumab
Side effects
- Headache
- Hypokalaemia
- Infusion-site reactions
- Thromboembolism (after dabigatran effect reversed — underlying condition now unprotected)
Interactions
- No significant drug interactions
Monitoring
- Haemostasis
- Dabigatran thrombin time (dTT)
- Clinical bleeding
- Thromboembolism signs
Reference: BNFc; BNF; NICE NG196; RE-VERSE AD trial; Praxbind SPC. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Train-of-Four (TOF) Neuromuscular Monitoring · Neuromuscular Blockade
- DOAC Score for Selecting Direct Oral Anticoagulant in Non-Valvular AF · Anticoagulation
- MELD 3.0 Score · Hepatology
- Fresh Frozen Plasma (FFP) Dose Calculator · Transfusion Medicine
- Hour-Specific Bilirubin Risk Assessment (Bhutani Nomogram) · Neonatal Jaundice
Pathways
Same specialty
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109