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Xeljanz
Xeljanz (generic name: tofacitinib) is an oral Janus kinase (JAK) inhibitor used to treat several autoimmune conditions, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), ulcerative colitis (UC), and ankylosing spondylitis. Xeljanz works by targeting specific enzymes in the immune system that are involved in the inflammatory process, helping to reduce symptoms such as pain, swelling, and joint damage in autoimmune disorders.
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Frequently Asked Questions
How long does it take for Xeljanz to work?
Improvements in symptoms may be noticed within 2 weeks, but it may take 3 to 6 months to experience the full benefits of Xeljanz, depending on the condition being treated.
Can I take Xeljanz with other medications for arthritis?
Xeljanz can be taken with non-biologic DMARDs such as methotrexate, but it should not be combined with biologic therapies like Humira or Enbrel due to the increased risk of infections.
What should I do if I miss a dose of Xeljanz?
If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and resume your regular schedule. Do not double up on doses.
Is Xeljanz safe to use during pregnancy?
Xeljanz is not recommended during pregnancy. If you become pregnant while taking Xeljanz, consult your healthcare provider immediately.
How often do I need blood tests while taking Xeljanz?
Regular blood tests are required to monitor your liver function, blood cell counts, and cholesterol levels. Your healthcare provider will determine the frequency of these tests based on your individual health needs.
Comprehensive Drug Guide
How Does Xeljanz Work?
Xeljanz works by inhibiting the activity of Janus kinases (JAK1 and JAK3), enzymes that play a role in signaling pathways responsible for the activation of immune cells. By blocking these enzymes, Xeljanz helps reduce the overactive immune response seen in autoimmune conditions, thereby decreasing inflammation and preventing further joint and tissue damage.
Common Dosages
- 5 mg immediate-release tablets
- 10 mg immediate-release tablets
- 11 mg extended-release tablets
Typical Dosing
- Rheumatoid arthritis and psoriatic arthritis: The typical dose is 5 mg twice daily or 11 mg once daily (extended-release).
- Ulcerative colitis: The typical starting dose is 10 mg twice daily for at least 8 weeks, followed by a maintenance dose of 5 mg or 10 mg twice daily.
- Ankylosing spondylitis: 5 mg twice daily or 11 mg once daily (extended-release).
Typical Dosing
FDA Approved Indications
- Moderate to severe rheumatoid arthritis (RA)
- Active psoriatic arthritis (PsA)
- Moderate to severe ulcerative colitis (UC)
- Ankylosing spondylitis (AS)
Who Shouldn't Take Xeljanz?
- Severe liver impairment
- Active infections such as tuberculosis (TB) or other serious infections
- Known hypersensitivity to tofacitinib or any other components of the formulation
Advice From The Pharmacist
- Take Xeljanz exactly as prescribed, either once or twice daily depending on the formulation. It can be taken with or without food.
- Regular blood tests are required to monitor your liver function, blood counts, and cholesterol levels while taking Xeljanz.
- Inform your healthcare provider if you experience any signs of infection, such as fever, chills, or persistent cough, while taking Xeljanz.
- Avoid live vaccines during treatment with Xeljanz.
Side Effects of Xeljanz
Common Side Effects
- Upper respiratory tract infections
- Headache
- Diarrhea
- High blood pressure
- Increased cholesterol levels
Uncommon/Severe Side Effects
- Increased risk of serious infections such as tuberculosis, pneumonia, or fungal infections
- Blood clots (deep vein thrombosis, pulmonary embolism)
- Liver problems (elevated liver enzymes)
- Cancers such as lymphoma
Risks and Warnings of Xeljanz
- Serious Infections: Xeljanz can increase the risk of serious infections, including tuberculosis, bacterial, fungal, and viral infections. Patients should be screened for TB before starting treatment.
- Blood Clots: Xeljanz has been associated with an increased risk of blood clots in the veins (DVT, PE), particularly in patients who are elderly or have pre-existing risk factors. Monitor for symptoms such as swelling, pain, or difficulty breathing.
- Cancer Risk: Long-term use of Xeljanz may increase the risk of developing certain cancers, including lymphoma and skin cancer. Regular monitoring is recommended.
Interactions with Xeljanz
Common Drug Interactions
- Immunosuppressants: Combining Xeljanz with other immunosuppressive drugs (such as cyclosporine or azathioprine) may increase the risk of infections and other side effects.
- Biologics: Avoid using Xeljanz with biologic medications used for autoimmune conditions, such as Humira (adalimumab) or Enbrel (etanercept), due to the increased risk of infections.
- CYP3A4 inhibitors: Medications that inhibit the enzyme CYP3A4, such as ketoconazole or clarithromycin, can increase the concentration of Xeljanz in the body, potentially increasing the risk of side effects.
Alternatives to Xeljanz
- Humira (adalimumab): A biologic medication used for similar autoimmune conditions, particularly RA, PsA, and UC.
- Enbrel (etanercept): Another biologic used to treat RA, PsA, and AS.
- Remicade (infliximab): An intravenous biologic used to treat autoimmune disorders, including RA, PsA, and UC.
- Methotrexate: A traditional disease-modifying antirheumatic drug (DMARD) used to manage RA and PsA.
