Understanding Pradaxa Side Effects

Pradaxa (Dabigatran Etexilate) is a blood thinner used to prevent strokes in people with atrial fibrillation and to treat blood clots. Like all anticoagulants, it comes with side effects — some mild and manageable, others serious enough to require immediate medical attention.

This guide covers what to expect when taking Pradaxa, which side effects are common, which are rare but dangerous, and when you should call your doctor right away.

What Is Pradaxa?

Pradaxa is a direct thrombin inhibitor — a type of anticoagulant that works by blocking thrombin, a protein your body uses to form blood clots. It's manufactured by Boehringer Ingelheim and is available in 75 mg, 110 mg, and 150 mg capsules. For a full overview, see our guide on what Pradaxa is and how it's used.

Common Side Effects

The most frequently reported side effects of Pradaxa are related to the digestive system. These are generally mild to moderate and may improve over time as your body adjusts to the medication:

• Dyspepsia (heartburn/indigestion) — This is the most common complaint, affecting a significant number of patients. It often feels like burning or discomfort in the upper stomach.
• Abdominal pain — Stomach pain or cramping, especially after taking the medication.
• Gastritis-like symptoms — Including acid reflux (GERD) and esophageal irritation.
• Nausea — Some patients feel queasy, particularly when starting the medication.
• Minor bleeding — Easy bruising, nosebleeds, bleeding from cuts that takes longer to stop, and bleeding gums are expected with any blood thinner.
• Epigastric discomfort — A general feeling of discomfort in the upper abdomen.

These side effects are the reason some patients switch from Pradaxa to other blood thinners. If stomach issues are bothersome, talk to your doctor — but don't stop taking Pradaxa on your own.

Serious Side Effects

While less common, Pradaxa can cause serious side effects that need immediate medical attention:

Major Bleeding

As a blood thinner, Pradaxa's primary serious risk is uncontrolled bleeding. Watch for:

• Blood in your urine (pink, red, or brown)
• Bloody or black, tarry stools
• Vomiting blood or material that looks like coffee grounds
• Coughing up blood
• Unexpected or prolonged bleeding from wounds
• Severe or unusual headache
• Dizziness, weakness, or feeling faint

If you experience any of these symptoms, seek emergency medical care immediately. Pradaxa has a reversal agent called Praxbind (Idarucizumab) that doctors can use in emergencies to reverse its blood-thinning effects.

Spinal or Epidural Blood Clots

Pradaxa carries a boxed warning about spinal/epidural hematomas in patients receiving spinal injections or epidural anesthesia. This is a rare but potentially devastating complication that can cause permanent paralysis. Tell any doctor or anesthesiologist that you take Pradaxa before any spinal procedure.

Increased Stroke Risk if Stopped Suddenly

Pradaxa also has a boxed warning about premature discontinuation. Stopping Pradaxa suddenly — without your doctor's guidance — increases your risk of blood clots and stroke. If you need to stop taking it, your doctor will likely bridge you to another anticoagulant.

Serious Allergic Reactions

Rarely, patients may experience anaphylaxis or other severe allergic reactions. Seek emergency care if you develop hives, difficulty breathing, or swelling of the face, lips, tongue, or throat.

Specific Populations at Higher Risk

Certain groups of patients may experience more pronounced side effects or need closer monitoring:

• Elderly patients (75 and older) — Higher risk of bleeding complications. No dose adjustment is required, but doctors should monitor more closely.
• Patients with kidney problems — Pradaxa is cleared through the kidneys. Reduced kidney function means the drug stays in your system longer, increasing bleeding risk. Patients with a CrCl of 15–30 mL/min take a reduced dose (75 mg twice daily). Pradaxa is not recommended for patients with CrCl below 15 mL/min.
• Pregnant or breastfeeding women — Limited data is available. Pradaxa may cause fetal harm and is generally not recommended during pregnancy or breastfeeding.
• Patients taking other blood-thinning medications — Combining Pradaxa with other anticoagulants, Aspirin, Clopidogrel, or NSAIDs like Ibuprofen increases bleeding risk significantly. Check our drug interactions guide for details.

How to Manage Common Side Effects

If you're experiencing mild side effects, these strategies may help:

• Take Pradaxa with food — While it can be taken with or without food, taking it with a meal may reduce stomach upset.
• Swallow capsules whole — Never break, chew, or open Pradaxa capsules. This can increase the amount of drug absorbed by up to 75%, worsening side effects.
• Stay consistent with timing — Take your doses at the same times each day. This helps maintain steady drug levels and reduces fluctuations that might worsen symptoms.
• Avoid alcohol — Alcohol increases your risk of bleeding and can worsen stomach irritation.
• Talk to your doctor about antacids — Some acid-reducing medications may help with dyspepsia, but check with your doctor first since some can affect drug absorption.
• Report minor bleeding patterns — While small bruises and occasional nosebleeds are normal, keep your doctor informed so they can monitor trends.

When to Call Your Doctor

Contact your healthcare provider if you experience:

• Side effects that are persistent or worsening
• Any signs of unusual bleeding
• Dark or bloody stools
• Severe stomach pain that doesn't resolve
• A planned surgery or dental procedure (you may need to temporarily stop Pradaxa)

Call 911 or go to the emergency room if you have:

• Signs of major bleeding (vomiting blood, bloody urine, severe headache with confusion)
• Signs of stroke (sudden numbness, confusion, trouble speaking, severe headache)
• Difficulty breathing or signs of allergic reaction

Final Thoughts

Most people tolerate Pradaxa well, and the benefits of stroke and clot prevention typically outweigh the risks. The most common complaints — stomach upset and minor bleeding — are manageable for most patients.

The key is knowing what to watch for and maintaining open communication with your doctor. Never stop taking Pradaxa without medical guidance, and always report new or worsening symptoms promptly.

If cost is a barrier to staying on your medication, check out our guide on how to save money on Pradaxa. And if you need help finding it at a pharmacy, search Medfinder to check availability near you.