Nurses Compass
Drug Guide
Ruxolitinib Phosphate
Classification
Therapeutic: Immunosuppressant, JAK inhibitor
Pharmacological: Janus kinase (JAK) inhibitor
FDA Approved Indications
- Myelofibrosis
- Polycythemia vera
- Atopic dermatitis (topical form)
Mechanism of Action
Ruxolitinib inhibits JAK1 and JAK2, enzymes involved in the signaling pathways that regulate hematopoiesis and immune function, thereby reducing inflammation and abnormal cell proliferation.
Dosage and Administration
Adult: Dosage varies by condition; for myelofibrosis, starting dose often 15-20 mg twice daily. For atopic dermatitis, topical apply as directed. Adjust doses based on patient response and tolerability.
Pediatric: Safety and efficacy not established for pediatric patients.
Geriatric: Use caution; start at lower doses due to increased risk of adverse effects.
Renal Impairment: Adjust dosing based on renal function; consult product guidelines.
Hepatic Impairment: Use with caution; no specific dosage adjustment determined.
Pharmacokinetics
Absorption: Oral bioavailability approximately 54%.
Distribution: High plasma protein binding (>90%).
Metabolism: Primarily hepatic via CYP3A4 and to a lesser extent CYP2C9.
Excretion: Renal and fecal routes.
Half Life: Approximately 3 hours.
Contraindications
- Known hypersensitivity to ruxolitinib or any excipients.
Precautions
- Risk of infections, including serious and opportunistic infections; monitor closely.
- Hematologic adverse effects, such as anemia and thrombocytopenia; monitor blood counts.
- Liver function abnormalities; monitor hepatic enzymes.
- Use with caution in concomitant immunosuppressive therapy.
Adverse Reactions - Common
- Anemia (Very common)
- Thrombocytopenia (Very common)
- Elevated liver enzymes (Common)
- Hemorrhage (Uncommon)
Adverse Reactions - Serious
- Infections (including pneumonia, herpes zoster, and systemic infections) (Serious)
- Progressive multifocal leukoencephalopathy (PML) - rare (Rare)
- Malignant transformation or secondary malignancies (Reported but rare)
Drug-Drug Interactions
- strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) increase ruxolitinib levels.
- strong CYP3A4 inducers (e.g., rifampin) decrease effectiveness.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood counts, liver function tests, signs of infection.
Diagnoses:
- Risk for infection
- Impaired skin integrity (topical form)
Implementation: Administer medication as prescribed, monitor for adverse effects, educate patient.
Evaluation: Assess effectiveness, monitor for adverse events, adjust doses accordingly.
Patient/Family Teaching
- Report signs of infection immediately.
- Do not stop medication abruptly.
- Avoid live vaccines during treatment.
- Adhere to monitoring schedules.
Special Considerations
Black Box Warnings:
- Serious infections, including tuberculosis and herpes zoster, which can be fatal.
- Potential for blood clots.
Genetic Factors: Patients with certain genetic predispositions may have altered responses.
Lab Test Interference: May affect some laboratory tests, monitor as necessary.
Overdose Management
Signs/Symptoms: Severe cytopenias, infections.
Treatment: Supportive care, discontinue drug, monitor blood counts and signs of infection.
Storage and Handling
Storage: Store at room temperature 20-25°C (68-77°F).
Stability: Stable for the duration of the shelf life as per manufacturer instructions.