Ruxolitinib

Ruxolitinib is a janus kinase (jak) inhibitor medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Myelofibrosis, including primary myelofibrosis, post-polycythaemia vera myelofibrosis, and post-essential thrombocythaemia myelofibrosis, when treatment is appropriate.
• Polycythaemia vera in patients who have had an inadequate response to, or cannot tolerate, hydroxyurea.
• Steroid-refractory or steroid-dependent graft-versus-host disease in selected patients, according to specialist prescribing.
• Topical treatment of mild to moderate atopic dermatitis in appropriate non-immunocompromised patients when other topical treatments are not suitable or have not worked adequately.
• Topical treatment of non-segmental vitiligo in appropriate patients.

Dosage depends on the condition being treated, the dosage form, blood counts, liver and kidney function, other medicines, and response to treatment. Ruxolitinib tablets are usually taken regularly as prescribed and require blood-test monitoring; the dose may need adjustment or interruption if blood counts fall or side effects occur. Ruxolitinib cream is applied as a thin layer only to the affected skin areas as directed, avoiding the eyes, mouth, and mucous membranes. Do not start, change, or stop ruxolitinib without the prescribing doctor’s advice.

• Common effects with tablets: anaemia, low platelet count, low white blood cell count, bruising, bleeding, dizziness, headache, weight gain, raised cholesterol, and increased liver enzymes.
• Common effects with cream: application-site acne, redness, itching, burning, irritation, or folliculitis.
• Infections may occur, including upper respiratory infections, urinary tract infections, herpes zoster, tuberculosis, hepatitis B reactivation, and other serious infections.
• Serious possible effects include severe low blood counts, serious bleeding, severe infection, blood clots, major cardiovascular events, and certain cancers including skin cancers, particularly in higher-risk patients.
• Seek urgent medical help for fever, persistent cough, shortness of breath, unusual bleeding or bruising, chest pain, sudden leg swelling, severe weakness, or signs of an allergic reaction.

Use Ruxolitinib with caution in patients with current or past serious infections, tuberculosis, hepatitis B or C, HIV, low blood counts, liver or kidney impairment, a history of blood clots, heart disease risk factors, smoking history, previous cancer, or a history of skin cancer. Blood counts and other tests may be needed before and during tablet treatment. Skin examination may be advised, especially with long-term use or risk factors for skin cancer. Avoid live vaccines during treatment unless the doctor advises otherwise. Use this medicine only under the guidance of a registered doctor or pharmacist.

• Strong CYP3A4 inhibitors such as ketoconazole, itraconazole, clarithromycin, posaconazole, voriconazole, and some HIV antivirals may increase ruxolitinib levels and side effects.
• Fluconazole can increase exposure; dose adjustment or avoidance may be needed depending on the situation.
• Strong CYP3A4 inducers such as rifampicin, carbamazepine, phenytoin, phenobarbital, and St John’s wort may reduce effectiveness.
• Other immunosuppressants or medicines that lower blood counts may increase the risk of infection or blood-cell problems.
• Live vaccines should generally be avoided during treatment because immune response may be reduced and infection risk may increase.
• Grapefruit or grapefruit juice may affect CYP3A4 metabolism; ask the doctor or pharmacist whether it should be avoided.

• Do not use ruxolitinib if there is a known allergy or serious hypersensitivity to ruxolitinib or any ingredient in the product.
• Ruxolitinib cream must not be used in the eyes, mouth, or vagina, and should not be applied to infected skin unless a doctor specifically advises treatment.
• Ruxolitinib should not be started in patients with an active serious infection unless the prescribing specialist decides the benefit clearly outweighs the risk.

Ruxolitinib should be used during pregnancy only if the potential benefit justifies the potential risk to the unborn baby. Women who are pregnant, planning pregnancy, or may become pregnant should discuss risks and alternatives with their doctor. Breastfeeding is not recommended during treatment and for a period after the last dose because of the potential risk to the infant; follow the prescriber’s advice for the specific product and dosage form.

Store at room temperature away from excessive heat, moisture, and direct light. Keep tablets in the original container and keep cream tightly closed when not in use. Keep all medicines out of the reach of children and do not use after the expiry date.