Switching from Pradaxa 150 mg BID to Apixaban: Equivalent Dosing
The equivalent dosing when switching from Pradaxa (dabigatran) 150 mg twice daily to Eliquis (apixaban) is 5 mg twice daily for most patients. This standard dose of apixaban is appropriate based on the comparative pharmacological profiles of these direct oral anticoagulants (DOACs) as outlined in clinical guidelines 1.
Dosing Considerations
Standard Dosing
- Apixaban 5 mg twice daily is the standard dose equivalent to dabigatran 150 mg twice daily for patients with atrial fibrillation 1
Dose Reduction Criteria
Reduce to apixaban 2.5 mg twice daily if the patient has at least 2 of the following:
- Age ≥80 years
- Body weight ≤60 kg
- Serum creatinine ≥1.5 mg/dL (133 μmol/L) 1
Switching Process
- Discontinue dabigatran
- Start apixaban when the next dose of dabigatran would have been due
- This approach minimizes the risk of both thrombosis and bleeding
- No overlap period is needed between the medications
Comparative Efficacy and Safety
Efficacy
- Both dabigatran 150 mg BID and apixaban 5 mg BID provide effective stroke prevention in atrial fibrillation
- Dabigatran 150 mg BID showed a 35% reduction in stroke and systemic embolism compared to warfarin 1
- Apixaban showed a 21% reduction in stroke or systemic embolism compared to warfarin 1
Safety Profile
- Apixaban may offer a more favorable bleeding profile:
Special Considerations
Renal Function
- Dabigatran is 80% renally excreted vs. apixaban's 27% renal excretion 1
- For patients with moderate renal impairment (CrCl 30-50 mL/min), apixaban may be preferred due to less renal dependence for clearance 1
Bleeding Risk
- For patients with prior gastrointestinal bleeding or high bleeding risk, apixaban may be preferred as it's associated with lower bleeding risk compared to dabigatran 150 mg BID 1, 2
Age Considerations
- In patients ≥80 years, consider dose reduction criteria for apixaban 1
Clinical Pearls
- No bridging anticoagulation is required when switching between DOACs
- Ensure good medication adherence with twice-daily dosing for both medications
- Monitor for any signs of bleeding during the transition period
- Apixaban has a shorter half-life (9-14 hours) compared to dabigatran (12-17 hours) 1
By following these guidelines, you can safely transition your patient from Pradaxa 150 mg BID to the appropriate dose of Eliquis while maintaining effective anticoagulation.