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Sunday, September 11, 2011

I Foresee A Misadventure

As I look into my crystal ball I see a bottle of Pradaxa opening and the capsules placed into a 7-day pill minder. The caregiver filling this pill minder does not know about the storage mandates for this medication leaving the patient open to drug failure and clots.

I am asking each and every practitioner to make sure to double or triple counsel each and every patient you are putting on Pradaxa and any caregiver(s) they are going to have involved in their drug routine.

Pradaxa is extremely sensitive to humidity and should be taken as prescribed every day for 30 days after the seal on the original bottle is broken. Pradaxa SHOULD ONLY BE DISPENSED AND STORED IN ITS ORIGINAL CONTAINER!!!!! Absolutely under no circumstances should this drug be taken out of the bottle or foil pack and put in a pill minder unless you have a foil pack and cut off the cap still in the sealed compartment and put that whole unit in the pill minder.

Pradaxa caps should NOT be opened and the pellets taken by themselves or sprinkled on food because the bioavailability goes from 3 to 7% from the intact capsule and increases another 75% with no capsule. This can lead to a potentially fatal bleed.

Please make sure to go over this info multiple times with each patient and caregiver(s) because this med can easily be misused and when it comes to clot fatality vs bleed out I believe everyone will benefit from some good old education.

10 comments:

badtothebohn said...

Recent guidances have shown that Pradaxa capsules are good up to 60 days when they're kept in the same opened container as the dessicant is in the lid.

Flavius said...

At our pharmacy, we just started ordering the blister pack version of pradaxa. Makes for much easier patient compliance and eliminates many areas where errors could occur. I really think the company should stop selling bottles altogether, I don't think I ever even considered the whole pill-minder thing, so I'm glad you mentioned that. Going to be incorporating it into future sales.

-Flavius

Anonymous said...

I think the bioavailability is increased by 75%, not to 75%. Don't get me wrong, this is still a huge increase, but it's not an increase of 1071-2500%. Source: http://healthcare.utah.edu/pharmacy/bulletins/NDB_221.pdf

Tin said...
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Whit said...
This comment has been removed by a blog administrator.
Big 'N Tasty RPH said...

Anonymous....75% fixed. If only it were that easy to have Congress fix something...

Big 'N Tasty RPH said...

I do have to say I have high hopes for this drug. If we can one day have no need to worry about blood draws for levels and practically everything under the sun interacting with it like we do with warfarin this would be a fantastic drug.

Vickie said...

I feel like this post should also warn about the 75 mg dose. Pradaxa has not been studied in patients with creatinine clearance < 30 mg/dl (in fact, this is a contraindication in other countries), yet the FDA approved this weird dose. A lot of practitioners forget that Pradaxa is 80% eliminated by the kidneys, and concentrations can really jump as your kidney function drops.

Anonymous said...

thanks for the info, as a retail RPh we can't always keep up on these important facts. Sorry, have to go and try to sell a flu shot.

Drive Thru Wench, CPhT said...

We had a pharmacist give some Pradaxa to a patient who needed a PA- guess whose PA was denied? Rage, I tell you. We're good about telling patients to keep this in the original package- whether they're good at listening to us is another story.