Idarucizumab is the antidote to dabigatran. Perhaps the hardest thing about it is saying its name. Eye-da-roo-ciz-oo-mab or praxbind until to comes off label. It is a humanised monoclonal antibody fragment (Fab) that binds to dabigatran with very high affinity (340x fold more than dabigatran binds to thrombin).

Reversal of patients on Dabigatran (pradaxa):

  • Dose = 5 grams as a bolus injection
  • Comes as 2 vials of 2.5 grams

Adverse reactions:

  • Nil significant
  • Patients may have hypersensitivity
  • Caution if the patient has hereditary fructose intolerance (contains sorbitol)
  • Proteinuria lasts for 24 hours post dosing

Length of action

  • Immediately effective and lasts for 12 hours
  • Half life is 47 minutes
  • Eliminated in the urine and therefore reduced if renal impairment is present
toxicology library antidote 700 1

Toxicology Library


Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.

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