ruxolitinib phosphate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
ruxolitinib phosphate: clinical details
Prescribing considerations
- Treatment should be initiated by a clinician experienced with anticancer therapies.
- Assess active infection and tuberculosis risk; screen for hepatitis B before treatment.
- Review cardiovascular, thrombotic and malignancy risks, particularly in older people, long-term smokers and those with relevant histories.
- Renal or hepatic impairment and interacting medicines require specialist assessment.
- Avoid abrupt discontinuation where possible because disease symptoms may return and severe events have occurred during interruption, especially with acute illness.
Contraindications and cautions
- Hypersensitivity to ruxolitinib or a formulation excipient
- Pregnancy
- Breastfeeding
- Tablets are unsuitable in rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption because they contain lactose
Monitoring
- Complete blood count with differential before treatment and regularly thereafter
- Clinical signs of bacterial, viral, fungal, mycobacterial and opportunistic infection
- Hepatitis B status and viral load where relevant
- Lipid profile and liver biochemistry
- Treatment response and tolerability
- Skin examination in patients at increased risk of skin cancer
- New neurological or psychiatric features suggestive of progressive multifocal leukoencephalopathy
Clinical pharmacology
Selective JAK1/JAK2 inhibition suppresses cytokine-mediated JAK-STAT signalling. Ruxolitinib is rapidly absorbed and is metabolised mainly by CYP3A4, with CYP2C9 also contributing.
Formulation and product differences
- Tablets contain lactose and are licensed for myelofibrosis, polycythaemia vera and graft-versus-host disease.
- The oral solution is licensed for graft-versus-host disease in people aged 2 years and over, is measured with the supplied syringe and can be administered through specified feeding tubes.
- The oral solution contains propylene glycol and parahydroxybenzoate preservatives, requires refrigerated storage, must not be frozen and has a limited period of use after opening.
ruxolitinib phosphate preparations and strengths
Oral solution
Route: Oral
Strengths: 5 mg/mL
Tablet
Route: Oral
Strengths: 5 mg, 10 mg, 15 mg, 20 mg
ruxolitinib phosphate interactions
Check all prescriptions, non-prescription products and herbal remedies with the specialist team before starting them.
Strong CYP3A4 inhibitors, including clarithromycin, itraconazole, posaconazole, voriconazole and ritonavir-containing treatments
They can substantially increase ruxolitinib exposure and the risk of blood-cell suppression, requiring specialist review and closer monitoring.
Fluconazole and other combined CYP2C9/CYP3A4 inhibitors
They can markedly increase ruxolitinib exposure; concurrent use requires specialist assessment.
Carbamazepine, phenytoin, phenobarbital, rifampicin, rifabutin and St John’s wort
These enzyme inducers may reduce ruxolitinib exposure and alter its effect.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.