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Xeljanz XR
Xeljanz XR (tofacitinib extended-release) is an oral Janus kinase (JAK) inhibitor used to treat rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ulcerative colitis (UC) in adults. It works by targeting specific enzymes that are involved in the immune response, thereby reducing inflammation and alleviating symptoms of autoimmune conditions. Xeljanz XR is the extended-release form, allowing for once-daily dosing.
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Frequently Asked Questions
How long does Xeljanz XR take to work?
Xeljanz XR may start reducing inflammation within 1-2 weeks, but it may take up to 3-6 months to see the full benefits, depending on the condition being treated.
Can I take Xeljanz XR with other medications for arthritis?
Xeljanz XR should not be combined with other biologics or potent immunosuppressants, but it may be used with non-biologic DMARDs like methotrexate or NSAIDs. Always consult your healthcare provider before combining therapies.
What should I do if I miss a dose of Xeljanz XR?
If you miss a dose, take it as soon as you remember, but skip it if it is almost time for your next dose. Do not double up on doses.
Is Xeljanz XR safe for long-term use?
Xeljanz XR can be used long-term, but regular monitoring is required due to the risks of serious side effects, including infections, cardiovascular issues, and cancer.
Can I get vaccines while taking Xeljanz XR?
You should avoid live vaccines while taking Xeljanz XR due to the potential for weakened immune responses. However, inactivated vaccines are generally safe. Consult your healthcare provider before receiving any vaccines.
Comprehensive Drug Guide
How Does Xeljanz XR Work?
Xeljanz XR works by inhibiting Janus kinases (JAKs), which are enzymes that play a key role in the signaling pathways that lead to inflammation. By blocking these enzymes, Xeljanz XR reduces the immune system's overactivity, which is responsible for the joint inflammation and damage seen in conditions like rheumatoid arthritis and the gastrointestinal inflammation seen in ulcerative colitis.
Common Dosages
- 11 mg extended-release tablets
Typical Dosing
- For rheumatoid arthritis and psoriatic arthritis: The typical dose is 11 mg once daily.
- For ulcerative colitis: The typical dose is 11 mg once daily, although higher initial doses may be used in some cases under the supervision of a healthcare provider.
Typical Dosing
FDA Approved Indications
- Moderate to severe rheumatoid arthritis (RA) in adults who have not responded adequately to methotrexate
- Active psoriatic arthritis (PsA) in adults
- Moderate to severe ulcerative colitis (UC) in adults who have not responded well to other treatments
Who Shouldn't Take Xeljanz XR?
- Severe liver impairment
- Known hypersensitivity to tofacitinib or any component of the formulation
- Active serious infections (e.g., tuberculosis, sepsis)
Advice From The Pharmacist
- Take Xeljanz XR once daily with or without food, and swallow the tablet whole without crushing or chewing it.
- Routine blood tests may be needed to monitor for side effects, such as liver function, white blood cell count, and cholesterol levels.
- Xeljanz XR increases the risk of serious infections, so inform your healthcare provider if you experience symptoms of infection, such as fever or cough.
- Avoid live vaccines while taking Xeljanz XR, as your immune response may be weakened.
- Be aware that Xeljanz XR may increase the risk of blood clots or heart-related issues, particularly in patients with other risk factors like smoking or a history of cardiovascular disease.
Side Effects of Xeljanz XR
Common Side Effects
- Upper respiratory tract infections
- Headache
- Diarrhea
- High blood pressure
- Increased cholesterol levels
Uncommon/Severe Side Effects
- Serious infections (e.g., tuberculosis, fungal infections)
- Blood clots (deep vein thrombosis, pulmonary embolism)
- Increased risk of cancer, including lymphoma
- Liver damage (yellowing of the skin or eyes, dark urine)
- Heart attack or stroke
Risks and Warnings of Xeljanz XR
- Infection Risk: Xeljanz XR can increase the risk of serious infections, including tuberculosis and viral, bacterial, or fungal infections. Patients should be tested for tuberculosis before starting the treatment, and regular monitoring for signs of infection is necessary.
- Cardiovascular Risk: Xeljanz XR may increase the risk of heart attack, stroke, and blood clots. This risk is higher in patients who already have cardiovascular risk factors, such as smoking, high cholesterol, or high blood pressure.
- Cancer Risk: Long-term use of Xeljanz XR has been associated with an increased risk of certain cancers, including lymphoma. Patients should be monitored for signs of abnormal growths or changes in health.
Interactions with Xeljanz XR
Common Drug Interactions
- Biologic therapies: Xeljanz XR should not be used in combination with other biologic agents (e.g., TNF inhibitors) or potent immunosuppressants, such as azathioprine or cyclosporine, due to an increased risk of infections.
- CYP3A4 inhibitors (e.g., ketoconazole, erythromycin): These medications can increase the concentration of Xeljanz XR in the body, leading to a higher risk of side effects.
- CYP3A4 inducers (e.g., rifampin, carbamazepine): These can decrease the effectiveness of Xeljanz XR by speeding up its metabolism.
Alternatives to Xeljanz XR
- Humira (adalimumab): A biologic medication used to treat rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis.
- Enbrel (etanercept): A TNF inhibitor used to treat rheumatoid arthritis and psoriatic arthritis.
- Methotrexate: A disease-modifying antirheumatic drug (DMARD) often used in combination with biologics or JAK inhibitors.
- Stelara (ustekinumab): Another biologic agent used for ulcerative colitis and psoriatic arthritis.
