Classification: Kinase Inhibitor
About Ruxolitinib (Jakafi®)
Ruxolitinib is a type of targeted therapy called a kinase inhibitor. This means it works by targeting receptors present on the cancer cells. Ruxolitinib targets Janus Associated Kinases, JAK1 and JAK2, which regulate cytokines and growth factors that are important for blood cell formation and immune function.
How to Take Ruxolitinib
Ruxolitinib comes in a tablet form in multiple dosage strengths. It is typically taken twice a day, with or without food. The exact dose is based on your platelet count. Your blood counts will be monitored closely while on therapy and your dose will be adjusted based on the platelet count. If you miss a dose, do not take an additional dose to make up for the missed dose and take your next dose as scheduled. Do not stop taking this medication abruptly without talking with your provider as the dose may need to be tapered.
The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, ketoconazole, rifampin, St. Johns Wort and many anti-fungal medications. Be sure to tell your healthcare provider about all medications and supplements you take.
Storage and Handling
Store this medication at room temperature in the original container. If you prefer to use a pillbox, discuss this with your oncology pharmacist. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Ruxolitinib is available through select specialty pharmacies. Your oncology team will work with your prescription drug plan to identify an in-network specialty pharmacy for distribution of this medication and shipment to the oncology clinic or directly to your home.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible, commercially (non-government sponsored) insured patients, are also available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Ruxolitinib
Below are some of the possible side effects and suggestions for dealing with them. Be sure to tell your oncology team if you are experiencing any of these problems.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your doctor or nurse before scheduling dental appointments or procedures.
- Ask your doctor or nurse before you, or someone you live with, has any vaccinations.
Low Red Blood Cell Count (Anemia)
Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.
Low Platelet Count (Thrombocytopenia)
Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.
- Do not use a razor (an electric razor is fine).
- Avoid contact sports and activities that can result in injury or bleeding.
- Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, etc. as these can all increase the risk of bleeding. Unless your healthcare team tells you otherwise, you may take acetaminophen (Tylenol).
- Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.
Infections Unrelated to White Blood Cell Count
Taking this medication can make you more susceptible to infections. You should report any symptoms of infection to your healthcare provider right away, including:
- Fever (temperature greater than 100.4), sore throat or cold, shortness of breath, cough, burning or pain with urination.
The following infections have been reported in studies, so you should be aware of these symptoms:
- Herpes zoster: symptoms include a skin rash or blisters that may be painful or itchy, localized to one area.
- Tuberculosis: symptoms include new or worsening cough, weight loss, night sweats, and fever.
- Progressive Multifocal Leukoencephalopathy (PML) is a rare, but very serious brain infection that may develop over several weeks or months. They may include changes in mood or usual behavior, confusion, thinking problems, loss of memory, changes in vision, speech, or walking, and decreased strength or weakness on one side of the body.
Other Side Effects
In studies, patients reported headaches, bruising and dizziness. Please report any of these side effects to your care provider.
Some people who take ruxolitinib have developed certain types of non-melanoma skin cancers. Monitor your skin and notify your care provider of any changes.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.