Pradaxa Interactions: Other Medications, Alcohol, and More
Pradaxa (dabigatran) is a prescription drug that’s used to treat and help prevent blood clots. This drug can interact with other medications. For example, Pradaxa can interact with ibuprofen (Advil) and ketoconazole.
Pradaxa is used in adults to:
- help prevent blood clots and stroke in people with atrial fibrillation (AFib)
- treat deep vein thrombosis (DVT) or pulmonary embolism (PE)
- help prevent further DVT or PE
- help prevent DVT and PE in people having hip replacement surgery
Pradaxa is used in certain children to:
- treat venous thromboembolism (VTE)
- help prevent further VTE
Pradaxa contains the active ingredient dabigatran. (An active ingredient is what makes a drug work.) The medication comes as a capsule that you swallow. It also comes as pellets that can be swallowed with soft food such as apple sauce or with apple juice. The pellets are only prescribed for children.
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Pradaxa’s possible interactions. And for more information about Pradaxa, including details about its uses, see this article.
Boxed warnings
This drug has boxed warnings about the increased risk of blood clots if you stop taking Pradaxa and blood clots in or around your spinal column. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.
Risk of blood clots if you stop taking Pradaxa: If you stop taking Pradaxa before you’re supposed to, your risk of blood clots may increase. If you have atrial fibrillation (AFib), stopping Pradaxa may increase your risk of stroke. You should not stop taking Pradaxa, even just for a few days, unless your doctor recommends this. If you do stop Pradaxa, your doctor may prescribe a different medication to help prevent blood clots.
Risk of blood clots in or around your spinal column: If you have a spinal procedure while taking Pradaxa, you may have a risk of developing blood clots in or around your spinal column. These type of blood clot are called spinal and epidural hematomas. They can cause long-lasting or even permanent paralysis.
Spinal procedures include epidural or spinal injection (used to administer anesthesia or pain relief) and lumbar puncture (used to collect a sample of cerebrospinal fluid).
If you need one of these procedures while taking Pradaxa, your doctor will monitor you for symptoms of spinal or epidural hematomas. Tell your doctor right away if you have numbness, weakness or tingling (especially in your legs or feet), back pain, or loss of control bladder or bowel control. Your doctor will treat you right away if needed.
To learn more about these warnings, talk with your doctor.
Are there other interactions with Pradaxa?
Pradaxa may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Pradaxa.
Does Pradaxa interact with supplements?
Before you start taking Pradaxa, talk with your doctor and pharmacist about any herbs or vitamins and supplements you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Pradaxa interactions with herbs
Pradaxa can interact with St. John’s wort, an herbal supplement used to ease symptoms of depression and other conditions. St. John’s wort can cause Pradaxa to not work as well as expected.
Be sure to check with your doctor or pharmacist before taking herbs while taking Pradaxa.
Pradaxa interactions with vitamins
There are currently no reports of Pradaxa interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Pradaxa.
Does Pradaxa interact with food?
There are currently no reports of Pradaxa oral capsule interacting with food. However, there are reports of Pradaxa oral pellets interacting with certain foods. Note that Pradaxa oral pellets are only prescribed for children.
Pradaxa oral pellets should only be given with apple juice, apple sauce, mashed carrots, or mashed banana. You should not mix Pradaxa oral pellets with milk, milk products, or soft foods containing milk products.
If you have questions about eating certain foods during your treatment with Pradaxa, talk with your doctor. They can recommend if there are any foods to avoid while taking Pradaxa.
Does Pradaxa interact with vaccines?
There are currently no reports of Pradaxa interacting with vaccines. If you have questions about getting certain vaccines during your Pradaxa treatment, talk with your doctor.
Does Pradaxa interact with lab tests?
There are currently no reports of Pradaxa interacting with lab tests. If you have questions about having certain lab tests during your treatment with Pradaxa, talk with the healthcare professional ordering the test.
Does Pradaxa interact with cannabis or CBD?
Cannabis(commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Pradaxa. Taking cannabis or cannabis products with Pradaxa can increase the level of Pradaxa in your body. This can raise your risk of Pradaxa side effects*, such as bleeding.
Before you start treatment with Pradaxa, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
*To learn more about Pradaxa’s side effects, see this article.
Common questions about Pradaxa and interactions
Find answers to some frequently asked questions about Pradaxa and possible interactions.
Is there an interaction between Pradaxa and coffee?
No. There’s no known interaction between Pradaxa and coffee. It should be safe to drink coffee while taking Pradaxa.
If you have questions about taking Pradaxa with coffee, talk with your doctor or pharmacist.
Is it safe to take Tylenol with Pradaxa?
Yes, it should be safe to take acetaminophen (Tylenol) with Pradaxa. There is no known interaction between these drugs.
Pradaxa is used to treat and help prevent blood clots in adults and certain children. Tylenol is used to relieve pain and reduce fever in adults and certain children.
Tylenol can interact with some pain relievers. For example, it can interact with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin). For more information about this interaction, see the section above called “Drug interactions explained.”
Tylenol is not an NSAID. It’s considered safe to take Tylenol and Pradaxa together.
If you have other questions about taking Tylenol or other pain relievers with Pradaxa, talk with your doctor or pharmacist.
When should I avoid Pradaxa?
Certain health conditions or other factors could raise your risk of harm if you take Pradaxa. In such cases, your doctor may not prescribe Pradaxa for you. These are known as contraindications. The list below includes contraindications of Pradaxa.
If you have active bleeding: If you currently have any active bleeding, such as bleeding in your stomach or intestines, your doctor will likely not prescribe Pradaxa. This is because Pradaxa could make the bleeding worse. You can ask your doctor about other treatments that may be better options for you.
If you have a mechanical heart valve: If you’ve had heart valve replacement surgery and you’ve had a mechanical (artificial) heart valve fitted, your doctor likely will not prescribe Pradaxa for you. Instead, they’ll likely prescribe a different blood thinner drug called warfarin (Jantoven). This is because Pradaxa is less effective than warfarin for preventing blood clots in this situation. It’s also more likely than warfarin to cause bleeding in this situation.
If you’ve had an allergic reaction: If you’ve had a serious allergic reaction to Pradaxa or any of its ingredients, your doctor likely will not prescribe Pradaxa for you. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
Before you start taking Pradaxa, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Pradaxa is safe for you to take.
Does Pradaxa interact with other drugs?
Before you start taking Pradaxa, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Pradaxa interacts with herbs or vitamins and supplements, see the “Are there other interactions with Pradaxa?” section below.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Pradaxa. Keep in mind that this table does not include all drugs that may interact with Pradaxa. For more information about some of these interactions, see the “Drug interactions explained” section below.
| Drug group or drug name | Drug examples | What can happen |
| nonsteroidal anti-inflammatory drugs (NSAIDs) | • aspirin • ibuprofen (Advil, Motrin) • naproxen (Aleve, Naprosyn) | can increase the risk of bleeding |
| antiplatelets | • clopidogrel (Plavix) • dipyridamole (Persantine) • ticagrelor (Brilinta) | can increase the risk of bleeding |
| other anticoagulants | • apixaban (Eliquis) •dalteparin (Fragmin) • heparin • warfarin (Jantoven) | can increase the risk of bleeding |
| selective serotonin reuptake inhibitors (SSRIs) | • citalopram (Celexa) • fluoxetine (Prozac) • paroxetine (Paxil) | can increase the risk of bleeding |
| certain antiarrhythmics | • amiodarone (Pacerone) • dronedarone (Multaq) • quinidine | can increase the risk of side effects from Pradaxa |
| certain antibiotics | • clarithromycin • erythromycin (Erytab, others) | can increase the risk of side effects from Pradaxa |
| certain antifungals | • itraconazole (Sporanox) • ketoconazole | can increase the risk of side effects from Pradaxa |
| certain seizure medications | • carbamazepine (Tegretol, others) • phenobarbital (Sezaby) • phenytoin (Dilantin) | can make Pradaxa less effective |
| rifampin (Rifadin, Rimactane) | – | can make Pradaxa less effective |
| verapamil (Verelan) | – | can increase the risk of side effects from Pradaxa |
Does Pradaxa interact with alcohol?
Pradaxa is not known to interact with alcohol. But drinking alcohol during your Pradaxa treatment may increase your risk of bleeding, which is a possible side effect* of Pradaxa.
If you have questions about consuming alcohol while taking Pradaxa, talk with your doctor or pharmacist.
* To learn more about Pradaxa’s side effects, see this article.
Drug interactions explained
Learn more about certain drug interactions that can occur with Pradaxa.
Interaction with NSAIDs
Pradaxa can interact with NSAIDs, which are used to reduce inflammation (swelling) and relieve pain.
Examples of NSAID medications include:
- aspirin
- celecoxib (Celebrex)
- ibuprofen (Advil, Motrin)
- naproxen (Aleve, Naprosyn)
Some NSAIDs are available over the counter (OTC). And many OTC pain medications contain NSAIDs among their active ingredients. (An active ingredient is what makes a drug work.)
What could happen?
Pradaxa and NSAIDs can both increase your risk of bleeding. So taking these drugs together can raise your risk of this side effect*. The risk is higher if you take an NSAID for long periods of time, for example for arthritis.
If you have kidney problems, you may have a higher risk of bleeding if you take Pradaxa with an NSAID.
*To learn more about Pradaxa’s side effects, see this article.
What you can do
You should not take Pradaxa with an NSAID unless this has been recommended by your doctor. While taking Pradaxa, talk with your doctor before taking OTC pain relievers that contain an NSAID, such as ibuprofen or aspirin. Be sure to check the ingredients of OTC medications before taking them with Pradaxa. You can also ask your pharmacist for advice.
If you take Pradaxa and an NSAID together, tell your doctor right away if you have any unusual bleeding. This may include bruising easily, nosebleeds, bleeding gums, and taking longer than usual to stop bleeding after an injury.
See your doctor right away if you have symptoms of more serious bleeding. These can include having blood in your urine or stool, passing black or tar-like stools, coughing up blood, or vomiting blood or a substance that looks like coffee grounds.
If you have questions about taking Pradaxa with an NSAID, talk with your doctor or pharmacist.
Interaction with SSRIs
Pradaxa can interact with SSRIs, which are a type of antidepressant. They’re used to treat depression and anxiety disorders.
Examples of SSRI medications:
- citalopram (Celexa)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
What could happen?#
Pradaxa and SSRIs can both increase your risk of bleeding. So taking these drugs together can raise your risk of this side effect*.
If you have kidney problems, you may have a higher risk of bleeding if you take Pradaxa with an SSRI.
*To learn more about Pradaxa’s side effects, see this article.
What you can do#
If you take Pradaxa with an SSRI, tell your doctor right away if you have any unusual bleeding. This may include bruising easily, nosebleeds, bleeding gums, and taking longer than usual to stop bleeding after an injury.
See your doctor right away if you have symptoms of more serious bleeding. These can include having blood in your urine or stool, passing black or tar-like stools, coughing up blood, or vomiting blood or a substance that looks like coffee grounds.
If you have questions about taking Pradaxa with an SSRI, talk with your doctor or pharmacist.
Interaction with certain antiarrhythmics
Pradaxa can interact with certain antiarrhythmics, which are drugs used to treat irregular heart rhythms.
Examples of antiarrhythmic medications that can interact with Pradaxa:
- amiodarone (Pacerone)
- dronedarone (Multaq)
- quinidine
What could happen?
The antiarrhythmics listed above block the action of a protein in your body called P-glycoprotein (P-gp). P-gp is involved in transporting Pradaxa in your body. Taking Pradaxa with an antiarrhythmic that blocks P-gp can make Pradaxa build up in your body. This can raise your risk of Pradaxa side effects*, such as bleeding.
If you have kidney problems, you may have a higher risk of side effects if you take Pradaxa with one of these antiarrhythmics.*
* To learn more about Pradaxa’s side effects, see this article.
What you can do
If you have kidney problems, your doctor may avoid prescribing Pradaxa with the antiarrhythmics listed above. Or your doctor may prescribe a dosage of Pradaxa that’s lower than usual. You should not take a higher dose of either medication than your doctor prescribes.
If you take Pradaxa and one of these antiarrhythmics together, tell your doctor right away if you have any unusual bleeding. This may include bruising easily, nosebleeds, bleeding gums, and taking longer than usual to stop bleeding after an injury.
See your doctor right away if you have symptoms of more serious bleeding. These can include having blood in your urine or stool, passing black or tar-like stools, coughing up blood, or vomiting blood or a substance that looks like coffee grounds.
If you have questions about taking Pradaxa with an antiarrhythmic, talk with your doctor or pharmacist
Does my health history affect whether I should take Pradaxa?
Certain medical conditions or other health factors may raise the risk of interactions with Pradaxa. Before taking Pradaxa, talk with your doctor about your health history. They’ll determine whether Pradaxa is right for you.
Health conditions or other factors that might interact with Pradaxa include:
Heart valve replacement: If you’ve had heart valve replacement surgery, your doctor likely will not prescribe Pradaxa for you. If you received a mechanical (artificial) heart valve, this is a Pradaxa contraindication. For more information, see the section above, called “When should I avoid Pradaxa?”. If you received a bioprosthetic heart valve, Pradaxa is not recommended for you. The drug hasn’t been studied in people with this type of replacement heart valve. Ask your doctor about other treatment options.
Active bleeding or bleeding problems: Pradaxa increases your risk of bleeding. If you have bleeding problems, your doctor likely will not prescribe Pradaxa for you. And active bleeding is a Pradaxa contraindication. For more information, see the section above, called “When should I avoid Pradaxa?” You can talk with your doctor about other treatments that may be a better option for you.
Stomach ulcer: If you have an active or recently healed ulcer in your stomach or intestines, taking Pradaxa may raise your risk of bleeding in your stomach or intestines. Talk with your doctor about whether Pradaxa is right for you.
Kidney problems: If you have kidney problems, you may have a raised risk of bleeding with Pradaxa. Your doctor may prescribe a dosage of Pradaxa that’s lower than usual. But if you have severe kidney problems, such as chronic kidney disease, your doctor may not prescribe Pradaxa. You can talk with your doctor about other treatments that may be a better option for you.
Triple-positive antiphospholipid syndrome: If you have triple-positive antiphospholipid syndrome (a blood disorder that raises your risk of blood clots), your doctor likely will not prescribe Pradaxa. This is because in people with this blood disorder, Pradaxa may be less effective for preventing blood clots than another medication called warfarin (Jantoven).
Planned surgery, medical or dental procedure: If you are due to have surgery or a medical or dental procedure, talk with your doctor beforehand. Your doctor may recommend temporarily stopping Pradaxa a few days before the surgery or procedure to lower your risk of bleeding. Talk with your doctor about when to stop Pradaxa and when to restart it again after the surgery or procedure.
Pregnancy: It’s not known whether Pradaxa is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Pradaxa.
Breastfeeding: It’s not known whether it’s safe to take Pradaxa while breastfeeding. Breastfeeding is not recommended during treatment with this drug. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to Pradaxa or any of its ingredients, your doctor will likely not prescribe Pradaxa. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
How can I prevent interactions?
Taking certain steps can help you avoid interactions with Pradaxa. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- Whether you drink alcohol or use cannabis.
- Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
- What to do if you start taking a new drug during your Pradaxa treatment.
It’s also important to understand Pradaxa’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Pradaxa, ask your pharmacist to print a copy for you.)
If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Taking Pradaxa exactly as prescribed can also help prevent interactions.
What should I ask my doctor?
If you still have questions about Pradaxa and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- Does my risk of interactions depend on my dosage of Pradaxa?
- Do other drugs that could treat my condition have similar interactions?
- Should I let you know if I make lifestyle changes, such as to my diet or exercise routine?
To learn more about Pradaxa, see these articles:
Thank you for detailing the interactions of Pradaxa! It’s crucial for those on this medication to understand the potential risks with other drugs and substances. This information can really help in managing and minimizing any adverse effects. Keep up the great work in spreading awareness on such important health topics!
Thanks for this informative post! It’s crucial to be aware of drug interactions when taking medications like Pradaxa. This detailed breakdown on how it interacts with other medications and substances like alcohol is really helpful. It would be great to see some real-world examples or experiences from others who have managed these interactions. Keep up the great work!
Great post! It’s crucial to understand potential interactions when taking Pradaxa. Knowing how other medications and alcohol can affect its efficacy and safety can make a significant difference in managing health outcomes. Thank you for shedding light on this important topic!