RUXOL

Indications

Ruxolitinib tablets are used by specialists to treat certain bone marrow cancers called myeloproliferative neoplasms, mainly myelofibrosis and polycythaemia vera, and graft-versus-host disease after a stem cell transplant. Ruxolitinib cream is used on the skin for mild to moderate atopic dermatitis (eczema) and for non-segmental vitiligo (white patches of skin) in adults and older children.

How It Works

It blocks enzymes called JAK1 and JAK2 (Janus kinases). These enzymes pass signals that drive blood cell overproduction and inflammation. Blocking them reduces spleen size, relieves symptoms such as tiredness, night sweats and itching, and calms the immune reaction in the skin.

Dosage and Administration

Tablets: taken by mouth, with or without food, at the dose prescribed by the specialist. The dose depends on the condition and on blood counts, especially the platelet count, and is changed according to regular blood tests. Do not change or stop the dose on your own.

Cream: apply a thin layer to the affected skin, usually twice a day, only to the areas and for the length of time the doctor advises. Do not cover large areas of the body and do not use more than the doctor prescribes. Wash hands after use unless the hands are being treated.

Interactions

• Ketoconazole, Itraconazole, Clarithromycin, Ritonavir and Fluconazole can raise ruxolitinib levels; the dose may need to be lowered.
• Rifampicin, Carbamazepine and Phenytoin can lower its effect.
• Live vaccines should be avoided while taking the tablets.
• Grapefruit and grapefruit juice can raise its levels.
• Tell the doctor about all medicines, including herbal products.

Contraindications

• Allergy to ruxolitinib or any ingredient of the product.
• Pregnancy and breastfeeding (tablets).

Side Effects

Tablets: low platelets (easy bruising or bleeding), anaemia (tiredness, breathlessness), low white blood cells, infections including shingles and urine infections, dizziness, headache, raised cholesterol, weight gain and diarrhoea. Rare but serious effects include serious infections, other skin cancers, blood clots and heart problems.

Cream: redness, itching or irritation where applied, acne-like spots and cold-like symptoms.

Get urgent medical help for fever, chills or other signs of infection; unusual bleeding, black stools or blood in vomit; chest pain, breathlessness or swelling of a leg; sudden weakness, confusion, problems with speech or vision; or a painful blistering rash.

Pregnancy and Lactation

Ruxolitinib tablets should not be used in pregnancy; women who can become pregnant should use reliable contraception during treatment. Do not breastfeed while taking the tablets. The cream should only be used in pregnancy if the doctor advises; avoid breastfeeding during cream treatment and for about 4 weeks after the last use, and never apply it to the nipple area.

Precautions and Warnings

• Regular blood tests are needed while taking the tablets.
• Do not stop the tablets suddenly; symptoms can come back quickly. The specialist will reduce the dose gradually if needed.
• The doctor will check for tuberculosis and hepatitis B before treatment.
• Have regular skin checks and protect the skin from the sun.
• Extra care is needed in people over 65, smokers, and those with heart disease, blood clots, kidney or liver disease.
• The cream is for use on the skin only; avoid the eyes, mouth and inside the nose.

Overdose

Taking too many tablets can severely lower blood counts. Seek medical help straight away. If cream is swallowed, contact a doctor.

Therapeutic Class

Janus kinase (JAK) inhibitor (targeted anticancer and immune-modifying medicine).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Do not freeze the cream.