Ruxolitinib (Oral) interactions

Food & lifestyle

• grapefruit juice

  Moderate

  Metabolism

  Grapefruit juice may increase the plasma concentrations of ruxolitinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.

  What to do: Patients treated with ruxolitinib should avoid consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract. Ruxolitinib may be administered with or without food.

  1 source

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):

Conditions

Conditions in which Ruxolitinib (Oral) needs care, as documented in this source.

• Cardiovascular Diseases

  Major

  In a major safety study of a Janus kinase (JAK) inhibitor, tofacitinib, in rheumatoid arthritis patients 50 years and older with at least 1 cardiovascular risk factor, higher rates of all-cause mortality (including sudden cardiovascular death) and major adverse cardiovascular events (MACE) (defined as cardiovascular death, myocardial infarction, and stroke) were observed with the JAK inhibitor when compared with tumor necrosis factor (TNF) blockers; patients who are current or past smokers are at additional increased risk. Based on a shared mechanism of action, this risk should be considered for other JAK inhibitors, including baricitinib, upadacitinib, ruxolitinib, fedratinib, and pacritinib. Before starting or continuing therapy, the benefits and risks for the individual patient should be considered, especially in patients with other cardiovascular risk factors and patients who are current or past smokers. Patients should be informed about the symptoms of serious cardiovascular events and what to do if they occur. Tofacitinib, baricitinib, and upadacitinib are indicated for patients with inadequate response or intolerance to 1 or more TNF blockers, but should be discontinued in patients who have experienced a myocardial infarction or stroke. The dosage recommended for tofacitinib should not be exceeded; for the treatment of ulcerative colitis, tofacitinib should be used at the lowest effective dose and for the shortest duration needed to achieve and/or maintain therapeutic response.

  7 sources

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):
  2. "Product Information. Olumiant (baricitinib)." Lilly, Eli and Company (2018):
  3. "Product Information. Rinvoq (upadacitinib)." AbbVie US LLC (2019):
  4. "Product Information. Inrebic (fedratinib)." Celgene Corporation (2019):
  5. "Product Information. Vonjo (pacritinib)." CTI BioPharma Corp. (2022):
  6. "Product Information. Xeljanz (tofacitinib)." Pfizer U.S. Pharmaceuticals Group (2021):
  7. "Product Information. Inrebic (fedratinib)." Bristol-Myers Squibb (2022):

• Neoplasms

  Major

  Malignancies (including lymphomas and solid tumors) have been reported in patients treated with tofacitinib and other Janus kinase (JAK) inhibitors used to treat inflammatory conditions; lymphomas and other malignancies have been seen in patients treated with baricitinib or upadacitinib. Patients who are current or past smokers are at additional increased risk of malignancies. Based on a shared mechanism of action, this risk should be considered for other JAK inhibitors, including ruxolitinib, pacritinib, and fedratinib. Before starting or continuing therapy, the benefits and risks for the individual patient should be considered, especially in patients with a known malignancy (other than successfully treated nonmelanoma skin cancer), patients who develop a malignancy during therapy, and patients who are current or past smokers. Periodic skin examination is recommended for patients who are at increased risk for skin cancer.

  7 sources

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):
  2. "Product Information. Olumiant (baricitinib)." Lilly, Eli and Company (2018):
  3. "Product Information. Rinvoq (upadacitinib)." AbbVie US LLC (2019):
  4. "Product Information. Inrebic (fedratinib)." Celgene Corporation (2019):
  5. "Product Information. Vonjo (pacritinib)." CTI BioPharma Corp. (2022):
  6. "Product Information. Xeljanz (tofacitinib)." Pfizer U.S. Pharmaceuticals Group (2021):
  7. "Product Information. Inrebic (fedratinib)." Bristol-Myers Squibb (2022):

• Thrombosis

  Major

  Thrombosis (including deep venous thrombosis, pulmonary embolism, and arterial thrombosis) has occurred in patients treated for inflammatory conditions with Janus kinase (JAK) inhibitors, including baricitinib, tofacitinib, and upadacitinib; many of these adverse events were serious and some resulted in death. Based on a shared mechanism of action, this risk should be considered for other JAK inhibitors, including ruxolitinib, fedratinib, and pacritinib. Baricitinib, pacritinib, tofacitinib, and upadacitinib should be avoided in patients who may be at increased risk of thrombosis; for the treatment of ulcerative colitis, tofacitinib should be used at the lowest effective dose and for the shortest duration needed to achieve/maintain therapeutic response. If symptoms of thrombosis occur, baricitinib, pacritinib, tofacitinib, and upadacitinib should be discontinued and patients should be evaluated promptly and treated appropriately.

  7 sources

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):
  2. "Product Information. Olumiant (baricitinib)." Lilly, Eli and Company (2018):
  3. "Product Information. Rinvoq (upadacitinib)." AbbVie US LLC (2019):
  4. "Product Information. Inrebic (fedratinib)." Celgene Corporation (2019):
  5. "Product Information. Vonjo (pacritinib)." CTI BioPharma Corp. (2022):
  6. "Product Information. Xeljanz (tofacitinib)." Pfizer U.S. Pharmaceuticals Group (2021):
  7. "Product Information. Inrebic (fedratinib)." Bristol-Myers Squibb (2022):

• Hepatic Insufficiency

  Moderate

  A dose reduction of ruxolitinib is recommended for patients with hepatic impairment, particularly those patients with myelofibrosis with a platelet count between 50 X 109/L and 150 X 109/L. Close monitoring is recommended.

  1 source

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):

• Hepatitis B

  Moderate

  Hepatitis B viral load (HBV-DNA titer) increases, with or without associated elevations in alanine aminotransferase and aspartate aminotransferase, have been reported in patients with chronic HBV infections taking ruxolitinib. The effect of ruxolitinib on viral replication in patients with chronic HBV infection is unknown. Care and close monitoring is recommended and patients with chronic HBV infection should be treated and monitored according to clinical guidelines.

  1 source

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):

• Hyperlipidemias

  Moderate

  The use of ruxolitinib may increase total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides. It is recommended to assess lipid parameters approximately 8-12 weeks following initiation of therapy and to monitor and treat per clinical guidelines for the management of hyperlipidemia. Care should be exercised when using this agent in patients with lipids disorders.

  1 source

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):

• Infections

  Moderate

  Serious bacterial, mycobacterial, fungal and viral infections have been reported in patients receiving ruxolitinib. It is recommended to delay starting therapy with ruxolitinib until serious active infections have resolved. Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment. Treatment should be interrupted if a patient develops a serious infection, an opportunistic infection, or sepsis and appropriate therapy should be instituted according to clinical guidelines. Prompt management of signs and symptoms of infection is advisable.

  1 source

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):

• Kidney Diseases

  Moderate

  A dose reduction of ruxolitinib is recommended for patients with moderate or severe renal impairment, particularly those patients with myelofibrosis with a platelet count between 50 X 10^9/L and 150 X 10^9/L; and in patients presenting with end stage renal disease on dialysis. Ruxolitinib is not removed by dialysis; however, the removal of some active metabolites by dialysis cannot be ruled out.

  1 source

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):

• Leukoencephalopathy, Progressive Multifocal

  Moderate

  The use of ruxolitinib may increase the risk of progressive multifocal leukoencephalopathy (PML). Healthcare professionals should monitor patients for any new sign or symptom suggestive of PML. Withhold therapy dosing immediately and perform an appropriate diagnostic evaluation at the first sign or symptom suggestive of PML.

  1 source

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):

• Lung Diseases

  Moderate

  The use of certain multikinase inhibitors has been associated with pulmonary toxicity. Serious cases of interstitial lung disease (ILD), including fatal cases and interstitial pneumonitis or pulmonary fibrosis have been reported. Caution is recommended when using these agents in patients with a history of interstitial pneumonitis or pulmonary fibrosis or those patients presenting with acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever pending diagnostic evaluation. If ILD is confirmed, permanently discontinue these agents and institute appropriate measures. Immediately withhold treatment in patients diagnosed with ILD/pneumonitis and permanently discontinue therapy if no other potential causes of ILD/pneumonitis have been identified.

  7 sources

  1. "Product Information. Vandetanib (vandetanib)." Astra-Zeneca Pharmaceuticals (2011):
  2. "Product Information. Zelboraf (vemurafenib)." Genentech (2011):
  3. "Product Information. Xalkori (crizotinib)." Pfizer U.S. Pharmaceuticals Group (2011):
  4. "Product Information. Mekinist (trametinib)." GlaxoSmithKline (2013):
  5. "Product Information. Zykadia (ceritinib)." Novartis Pharmaceuticals (2014):
  6. "Product Information. Zydelig (idelalisib)." Gilead Sciences (2014):
  7. "Product Information. Alecensa (alectinib)." Genentech (2015):

• Pancytopenia

  Moderate

  The use of ruxolitinib can cause thrombocytopenia, anemia, and neutropenia. It is recommended to manage thrombocytopenia by reducing the dose, temporarily interrupting treatment with ruxolitinib, or as clinically appropriate. Perform a pre-treatment complete blood count (CBC) and monitor CBCs every 2 to 4 weeks until doses are stabilized, and then as clinically indicated. Close monitoring is recommended.

  1 source

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):

• Tuberculosis

  Moderate

  Before initiating ruxolitinib, patients should be screened for latent or active tuberculosis infection. Prior to initiating therapy with ruxolitinib patients should be evaluated for tuberculosis risk factors, and those at higher risk should be tested for latent infection. Patients should be closely monitored for any signs and symptoms of tuberculosis, including those patients who tested negative for latent tuberculosis infection before initiating therapy. Patients with latent tuberculosis should be treated with standard therapy before initiation of treatment and should be closely screened for whether initiating anti-tuberculosis therapy is appropriate.

  1 source

  1. "Product Information. Jakafi (ruxolitinib)." Incyte Corporation (2011):