The blood-thinning drug Pradaxa made headlines Thursday when a New York Times article by Katie Thomas blew the lid off insider communications. The scandal hit the fan because a federal judge in Illinois released drug company documents revealing that the manufacturer knew about Pradaxa complications, but went out of its way keep them under wraps.

The bottom line: Pradaxa can cause life-threatening hemorrhages if the dose isn’t spot on. It’s not always easy to tell when the dose is correct. As a result, doctors are often flying blind.

Visitors to our website have been asking about the safety of this drugĀ for years. Here are just a few of the questions we have received:

Q. I have recently been diagnosed with Stage III Kidney Disease by a nephrologist. I also have A-Fib [atrial fibrillation] diagnosed by my cardiologist.

My problem is that the cardiologist suggested I take magnesium to help with sleep and my heart. I am reading in your Guide to Home and Herbal Remedies that too much magnesium could cause further damage to my kidneys.

I take Pradaxa (75 mg) twice a day along with propafenone for my heart, valsartan, Estrace and hydrochlorothiazide.

Is there anything else I need to do to keep my kidney disease from getting worse? Otherwise I am in good health.


A. Gayle, although you are taking a reduced dose of Pradaxa (which is appropriate for patients with kidney disease), there is the potential for overdose. Older people often have reduced kidney function and you clearly do. That is why you are walking a tightrope when it comes to dosing. If Pradaxa [dabigatran] builds up in your system you could be at serious risk for bleeding. Symptoms to be especially alert to include:


  • Unusual bruising (bruises that show up without any obvious cause)
  • Nose bleeds
  • Bleeding from gums that is worse than usual
  • Bleeding from a cut that will not stop within a reasonable amount of time
  • Urine that has a pinkish or brownish color
  • Stools that look red, black or tarry
  • Coughing that brings up pink flecks of blood
  • Vomiting blood or vomiting anything that looks like coffee grounds
  • Headaches, dizziness, weakness
  • Unusual joint pain, swelling or discomfort in a joint

Such symptoms are extremely serious and require immediate medical attention.

One final note, Gayle, magnesium can be dangerous if you have kidney disease. Please discuss this with your nephrologist.

Q. I just got back from Ohio helping my Mom who was suffering serious fatigue. She ended up in the hospital from internal bleeding due to an interaction of Celebrex and Pradaxa.

Five different doctors did not mention this combination could be a problem. Why do doctors not have more info about drug interactions?


A. Pat, your mom was lucky she survived her internal bleeding episode. Her doctors should have warned her that taking a drug like Celebrex that can irritate the digestive tract and cause ulcers is quite dangerous in combination with an anti-coagulant like Pradaxa. If an ulcer does occur, it can lead to internal bleeding. Whenever this happens, it is a life-threatening situation. Doctors should be well informed about such interactions and always warn patients what to watch out for. The pharmacist should have caught this potential problem as well.

Q. I was diagnosed with A-fib several months ago. I went to my primary care physician first and he prescribed digoxin for the A-fib and nattokinase for stroke prevention. He then referred me to a cardiologist, who kept me on digoxin but prescribed Pradaxa for stroke prevention.

I have two concerns. One is that every time I watch television for more than an hour, I’m being urged to call an attorney and sue Pradaxa because of possible deadly side effects. The other is cost: Pradaxa is $225.00 a month and my insurance doesn’t cover it. So I’m concerned about both safety and cost.

Is Coumadin [warfarin] a better and much less expensive way to go? How much blood work is required if I take Coumadin? Is there anything else out there that will prevent clots but doesn’t cost so much?


A. You have asked a complex and intriguing question, Bob. Doctors used to primarily rely on warfarin (Coumadin) to prevent blood clots from forming and triggering strokes. Then along came Pradaxa.

One of the big selling points for the new anticoagulant was that unlike warfarin, it did not require frequent blood tests. This “benefit” led doctors to prescribe Pradaxa to over 800,000 patients. Last year alone, Pradaxa earned more than $800,000,000.

But here’s the rub. By monitoring warfarin levels, doctors can adjust the dose to try to avoid under-treatment that might lead to blood clots and strokes or over-treatment that might lead to fatal bleeding episodes. Without a similar test to monitor Pradaxa effectiveness, it is more challenging for physicians to hit the sweet spot. It is estimated that there have been more than 1,000 deaths linked to Pradaxa.

The current scandal surrounding the drug is all about internal documents at Boehringer Ingelheim (the manufacturer of Pradaxa). A researcher at the company seemingly suggested that careful blood monitoring would allow physicians to adjust the dose of Pradaxa so it could prevent strokes without leading to hemorrhage. But this would have upset the marketing advantage over warfarin or other new anticoagulants. In other words, Pradaxa wasn’t supposed to need testing. That was its big selling point.

The unanswered question is whether marketing trumped patient safety. That is the crux of the thousands of lawsuits that are now pending. Did the drug company reveal the complexity and dangers of taking Pradaxa?

We’re not lawyers, so we will not dabble our toes in that water. But we would like to hear about your experience with Pradaxa or other anticoagulants. Share your story below in the comment section.


  • Bleeding, hemorrhage
  • Heartburn, reflux, indigestion, digestive distress, abdominal discomfort, gastritis
  • Rash, itching, allergic reactions, anaphylaxis
  • Blood disorders


  • Never stop Pradaxa without medical supervision!
  • Never stop Pradaxa suddenly. Doing so can trigger a rebound hypercoagulable state that could lead to blood clots and an increased risk of stroke
  • If Pradaxa must be stopped for a reason other than life-threatening hemorrhage, a physician will need to substitute another anticoagulant and make the hand off cautiously to prevent either bleeding or blood clots from forming

Again, please share your own story with Pradaxa or any other anticoagulant so that others can benefit from your experience.

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  1. Barb

    I think we are all used to test these drugs and if they don’t work oh well. I am so upset that these drug companies and doctors can push this stuff on the market without really knowing how it is going to work on all people. The lack of blood tests while on Pradaxa is a game of chance.

    I keep telling my doctor he needs to know my blood range and check here and there but he said “we have a lot of drugs we don’t test people on” I’m like what? So here I am on Pradaxa and my voice is very weak and he keeps saying its not from the Pradaxa. Then he tells me Warifin is more dangerous. What are we to do. If you have blood clots you have to be on something.

  2. Barb

    I have been on Pradaxa for one month and I have hoarseness and voice change. I am very afraid of this drug but have had two episodes of blood clots in legs. I was on 325mg of asprin then was put on Pradaxa. All I hear are bad things about this drug. Every day I take it I am a nervous wreck. Now the doctor is saying the hoarseness is from a viral infection but I don’t think so. When taking the Pradaxa I always feel a burning in my throat. Now after one month my voice is almost gone.

  3. Eileen
    North Shore

    My husband was told he had Atrial Fibrillation and was put on Praxada. I used to have to run to catch up with him walking Now he shuffles along as though he had feet made of wooden blocks. He is always tired. He is 79. He was so fit and looked so good before he was put on Praxada. He showed no symptons of having anything wrong with him. He only went to get his driver’s licence renewed.

  4. Carlene

    I have atrial fib and have had for 17 years. Cardiologist put me on Pradaxa three months ago and I have noticed progressive joint pain. Fingers, elbows, knees and feet only. Hands so sore I have to gently and slowly form a fist to get mobility back. Feet so sore (only after period of inactivity) I plod like blocks of wood and not feet. I am 59, not overweight, fit and healthy. Dr refuses to believe Pradaxa is related to my joint pain. I can’t fit my rings on my fingers now. Blood test results for arthritis are negative. Xray negative. What can I do ?

  5. Barb K.

    Does anyone take omega 7 with pradaxa. Is it safe? Where do u get machine for home blood test when on warfarin?

  6. ed

    the primary non medical issue with pradaxa is cost. the patent expires in 2017 so expect generic availability. xaralto is another blood thinner that works using a different mechanism also very expensive and not formulary for medicare except as tier 3 or 4.
    most people don’t know that the major advantage of warfarin is that it can be reversed almost immediately with large doses on vitamin K

    • Carlene

      I take salmon oil caps with my pradaxa. Dr says its not a problem.

  7. ron
    aurora, ohio

    All this information is from 2014. I think it should be updated with more recent information.

  8. Tony

    an additional note….my doctor mentioned that given all the negative interactions we now know about Coumadin, that most likely if Coumadin were just this year coming out, the FDA probably would not approve it…..

  9. Tony
    Dallas, TX

    I had in 1993 open heart surgery and repaired a mitral valve at the Cleveland Clinic, and I also had afib… I was put on Coumadin/Wafarin…..that went on ok until 2014 and worsened into the end of 2015 when I experienced horrible nose bleeds with emergency room trips to the hospital, and…..the last of which led to three sequential nasal surgeries. With my consultation with my cardiologist, we discussed the negative impact of Coumadin with my dietary supplements, with eating salads, with other ingredients, even a glass of wine.

    So we switched to Pradaxa first for a 75 mg dose to see how I handled it, which was fine, then went to 150 mg tablets twice a day. Results, no more nose bleeds, no interaction with dietary supplements, but I watch my diet carefully with the great support of my wife and am more sensible about myself, and I lost 15 pounds and do three times a week 30 minutes of treadmill and other things. A couple glasses of wine, or a couple glasses of vodka tonic … problem.

    I read all the comment above and one common thread is that if one is used to blood testing (I had coaguchex)…and regularly changing the wafarin dosage….and now I do wonder how they know if anything is happening other than a visible negative event. Well so far I have no negative events so knock on wood….so for me Pradaxa is a God-send….my difference and one I will watch is that I have afib and take meds for that, I do not have an artificial valve, my surgery was a mitral valve repair using then new technology, but I have to watch my sugar (medformin) and cholesterol (Crestor) and fenofibrate. But I do believe in taking high antioxidant supplements such as tumeric, fucoidan, plus D3 and vitamin B-12 mixes, and CoQ10.

    So far it works for me. Next is how we adjust when we have a teeth cleaning, if at all, as besides amoxillin prior to and after dental work, the issue is do you stop Pradaxa…..

    • ed

      alcohol and afib meds are a dangerous combination depending on the meds
      just saying…

  10. Mary

    my husband was taken off coumadin and put on Pradaxa. He developed hoarseness, a cough, difficulty swallowing necessitating a swallow test, which showed he had narrowing of the esophagus. He is now scheduled for an endoscopy and possible stretching of the esophagus. He also has anal fungus and itching. after reading some of the comments, I wonder if the anal problem is related to Pradaxa too.Not one of his doctors made the connection between Pradaxa and his symptoms. I guess we have to self-monitor all drugs side effects in the future.

  11. Judy

    My husband has been taking pradaxa for 4 years now he needs a prostate biopsy dr wants to take him off for three days before and 2 or 3 days after is this safe

    • Ann

      My Sister was on Pradaxa and had to have a biopsy. The hospital said they stopped her Pradaxa prior to performing the biopsy. She died from internal bleeding 5 days later.

    • ed

      depends on what the med was prescribed to treat. I stopped pradaxa after 3 months of no afib symptoms (after cardioversion) and had to start it up again before a repeat cardioversion. I was off the med for about 5 months with no apparent ill effects. the half life of pradaxa appears to be in the 4 day range based on internet research

  12. Cal

    I have had PE”S and DVT . On Warfarin, as of 12/2005. Couldn’t get correct dose levels were always off the wall. 2 years of Falling, losing balance, many pelvic and rib fractures. MRI results, I now have Sciatic issues. 2 bulging discs and a vertical free floating lumbar disc, Surgery is out of the question. After many neuro visits, several doctors later. One felt it was my medication. I cut the prozac from 80 mg to 40 mg and thought I was doing fine. Medicated for years before my PE episode with Prozac from 80 mg dose to 40 then to 20 mg, symptoms decreased, but I still have episodes of balancing issues, tripping, falling, bruising is a common occurrence to the point of wearing ankle braces. I was placed on Pradaxa 150mg BID, I thought I have been doing okay. I still have been taking prozac generic. I was told I have peripheral neuropathy both legs. Past 2 years, falling continues, off balance episodes, now difficulty after 15 minutes of sitting, standing, even lying down, when I try to get onto my feet. I have pain in both legs and feet, and can barely walk straight. Muscle fatique, occasional spasms in calves,as well as restless legs. Aching from neck down, both arms fingers, legs and feet, numbness and tingling. I feel like an elderly woman. I also have had episodes of anal burning and itching, gas, occasional diarrhea, minor incontinent of urine and feces, vomiting and heartburn. At times I feel like a walking medical zombie. I have recently stopped the generic prozac. Hoping this would help. I am being scheduled for PT next week. for lumbar pain, muscles are sore and tender at times. After reading this web sight. I am considering to see my doctor about getting off of this hopefully get back to normal. I risk a stroke without it, but can’t live like a stumbling fool either. Not much choice falling I can bleed out!!!

  13. Don
    United states

    I was on warfarin and had problems with it,was put on Pradaxa five or more years ago, my musclesin my legs are gone and the rest of my muscles have weakened drastically,I worry about what to do. Guess I will talk to my cardiologist and explain what is going on and I want to do something else.

    • Lynn

      What did you find out? My mother has been on it for 7 years and can not move her legs.

  14. Frank C.
    burbank ca.

    Hi, I had A-fib and I had a cardio version and I am now back to normal. However the doctor wants me to stay on pradaxa. I have been back to normal now for six months now..question? should I stay on pradaxa and how safe is it to stop Thanks, Frank

  15. Nancy F.
    Raleigh NC

    I have Afib and am very impressed with extensive research I have done on the long-term effectiveness of Nattokinase as a blood thinner! Yet, I find almost no info endorsing it in general medical sources. Asking your medical provider is laughable. They look at you like they have just been hit in the head with a board.

    It’s a Japanese enzyme successfully used for centuries for lowering blood pressure and thinning blood to prevent clots. So, it hasn’t had clinical trials! Lots of meds that have trials are prescribed and end up killing people. Would you please publicize some reliable information about this. WebMD is a good starting place, You can do your public a great service by revealing this enzyme.

    • Carlene

      What is a cardio version ? Didmit stop your irregular heart beats ?

  16. Mamoon

    I am very depressed with the information.

  17. marie b.
    st paul mn

    Just started Pradaxa Monday. Day 1 – 3 headache, mostly gone day 4. Day 3 and though today, day 5, swollen painful knees and my right leg is more swollen than my left. Itching here and there also. Day 1-2 only took one 150 capsule. Day 3-4 took two capsules each day. Day 5 I took only one capsule. I already dislike Pradaxa. I have to use an anticoagulant ‘cuz I have had 2 pulmonary embolisms and 1 dvt. Changed from warfarin because of side effects. the side effects of which could cost me my job because I could not think right, memory problems. Made so many errors… looks like Pradaxa ain’t much better.

  18. fbl

    dhs, I am probably not the best source as I seem to have problems with a lot of meds. I can say that Xarelto caused me excruciating pain in my thighs and calves and in fact the muscles wasted terribly. It also caused me the runs which I still have problems with today 2 1/2 years later. I only took the med for about two months.
    My family Dr. did acupuncture and my muscles are almost filled out again but I still have gnawing achy pain and weird feelings of bubbles in the leg muscles.
    The diarrhea is still a problem and it has taken three different remedies to keep it almost in check.
    What I have successfully done for blood thinning is take nattokinase, serraptase and cayenne capsules 2X a day. I also take 1200 iu of vitamin E, mixed tocopherols and tocotrienols, daily as well as Omega 3 (in cod liver oil and krill oil. I do NOT take aspirin or any other blood thinner of blood pressure med.
    These natural remedies have worked for me and I have had no more heart attacks or strokes since I’ve been doing this regimen-about 2 1/2 years.

  19. dhs

    I would be curious how this person, or others, have fared switching from Pradaxa to Xarelto as I am about to do so at Doctors recommendation?

  20. Wendy B.

    I was diagnosed with A Fib on April 4, 2008 and have been on warfarin ever since. When Pradaxa first came on the scene the main thing I didn’t like was the lack of frequent testing of the blood. Recently my blood became quite thin but because I have an INR test once a month my doctor was able to adjust the dosage of warfarin and check it regularly until it got back to normal. The other neat thing is that warfarin costs me a little over $30 per month. A pharmacist has told me that Pradaxa and some of the other new anticoagulants are extremely expensive. As my sister says, I am vindicated for refusing to change to Pradaxa.

  21. Don

    Because Pradaxa and Xarelto work similarly, would the same concerns about Pradaxa be applicable to Xarelto? I switched from warfarin to Xarelto one year ago because my INR was behaving like a yo-yo after years of great stability. However, my doctor orders blood work every six months to monitor renal function.

  22. fbl

    During an auto accident, the shoulder harness damaged my heart. To prevent clots I was given a number of different meds (and shots in the belly)that did not work. The last one, Xarelto, has caused me serious problems. Destroyed muscles, muscle pain and diarrhea were the worst.
    My family Dr. did a series of acupunctures which did bring most of my calf muscle back but now two years later I still have problems with the diarrhea.
    I have been taking nattokinase, vitamin E, cayenne and gingko biloba and the blood is fine. I finally had to get ablation to get rid of the A-fibs and tachycardia. My family Dr. did IV chelation therapy for the “widow maker” artery that got damaged. It is still fine eight years later.


    My husband was diagnosed with A Fib at 90 when he was in very good health despite surviving two cancer episodes. The cardiologist put him on Pradaxa and within two months he hemorrhaged severely and required blood to restore him to normal levels. They found no reason for the hemorrhage. Three months later, they put him back on Pradaxa and, yes, the same hemorrhage–worse this time. There was no sign of bruising or any of the warnings posted above. Just a sudden episode of diarrhea.
    I would add a warning sign of my own: when the person being treated becomes pale and fatigues more easily, it is a sign to get a blood test quickly. We had attributed it to “old age.” Every time we think old age is going on, so far, we discover that the incipient frailty has a direct and treatable cause. No more blood thinner for us. Just baby aspirin. He will be 93 in May, still doing chores, working, driving. Blessed.

  24. DF

    Have your drs review MTHFR and other genetic variants that a naturapath can help with.

  25. ladygray4

    I was put on Pradaxa + aspirin for stroke prevention for Afib. After a couple of weeks, I was concerned about bruises that appeared out of nowhere, but the cardiologist’s office just brushed it off as “just something I’d have to deal with.” Guess I’m strange for not wanting to walk around looking like I got beat up daily.
    And this was AFTER the cardiologist gave me a choice of which treatment option to choose; after I chose, she tried to guilt me into another one – then WHY did you give me a choice?
    I was 58 years old when I started going to her; she talked down to me as if I were 88.
    I no longer go to that quack!!!

  26. J.L.

    I am on warfarin. I have a home monitor. I am lucky enough to be covered by insurance as the monitor and the testing strips are costly. Research has shown that more frequent testing generates more time in appropriate testing-range (fewer strokes, fewer hemorrhages). The research also encourages patients to home-test once a week. I test, on average, every ten days. I am rarely more than 0.2 out of range. I adjust my dose myself when need, which is very rare.
    Some doctors would rather not have the patient adjust their own dose. My doctor is okay with it. I report my INR via a telephone call to an automated system. The company then reports the result to the doctor. It takes 5 minutes. No drive to the lab. No venous blood draw; it’s just a quick finger stick. And in-range for long periods of time. (P.S. Patients get training with the device. It takes a little time to become proficient in its use.)

  27. GH

    My husband switched from Coumadin to Pradaxa because he was tired of the continual blood withdrawal to test for coagulation with the coumadin. Although he was 84, his doctors did not prevent him from switching. After 4 months on this new drug, he had a stroke and died. This surely does not prevent strokes without being monitored. The artery leading into the heart from below, was so clogged up the doctors could not open it up.
    I certainly would not recommend this as a treatment for atrial fibrillation, which he had.

  28. MSS

    Ten years ago I suffered a severe year-long episode of anal bleeding and itching (pruritis ani). Symptoms abated when we bought a new clothes washer and changed our laundry detergent. However, my anal area remained sensitive to irritants, especially acidic foods. I recently was diagnosed with atrial flutter, and was I prescribed Pradaxa as a blood thinner. Within a month I had anal itching and bleeding worse than I had ever had before. I gave my cardiologist the choice of letting me quit Pradaxa cold or letting me taper off. He had me taper off over 4 days. Within 2 weeks the symptoms were gone.

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