idarucizumab
Brand: Praxbind
Prototype Drug
Drug Class: anticoagulant reversal agent
Drug Family: reversal agent
Subclass: humanized monoclonal Fab fragment (dabigatran-specific antidote)
Organ Systems: cardiovascularhematology-oncology
Mechanism of Action
Humanized Fab fragment with 350x higher affinity for dabigatran than thrombin; rapidly neutralizes dabigatran and its acylglucuronide metabolites.
dabigatran and its metabolites
Indications
- reversal of dabigatran anticoagulation for life-threatening bleeding or emergency surgery
Contraindications
- no absolute contraindications
Adverse Effects
Common
- hypersensitivity reactions
- hypocoagulable state
Serious
- thromboembolic events (rebound after reversal)
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | intravascular |
| Metabolism | proteolysis |
| Excretion | renal |
| Half-life | ~47 minutes |
| Onset | immediate IV |
| Peak | immediate |
| Duration | hours |
| Protein Binding | <0% |
| Vd | 0.07 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| dabigatran | specific reversal | beneficial |
Nursing Considerations
- Dose: 2.5 g IV x2 given consecutively (two separate vials) = 5 g total
- Takes effect within minutes
- Monitor coagulation parameters (TT, eCT, aPTT) for reversal confirmation
- Can restart dabigatran 24 hours after idarucizumab if clinically appropriate
- Monitor for hypersensitivity
Clinical Pearls
- REVERSE-AD: complete dabigatran reversal in >98% within 4 hours; median reversal immediate
- Dabigatran can be restarted 24 hours after reversal when thrombosis risk resumes
Safety Profile
Pregnancy insufficient-data
Lactation insufficient-data
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
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