Home Drug Guide Tofacitinib Citrate

Drug Guide

Generic Name

Tofacitinib Citrate

Brand Names Xeljanz, Xeljanz XR

Classification

Therapeutic: Immunosuppressant, Disease-modifying Antirheumatic Drug (DMARD)

Pharmacological: Janus kinase (JAK) inhibitor

FDA Approved Indications

  • Moderate to severe rheumatoid arthritis in adults
  • Active psoriatic arthritis in adults
  • Ulcerative colitis in adults

Mechanism of Action

Tofacitinib inhibits Janus kinase enzymes (primarily JAK1 and JAK3), which are involved in the inflammatory process by interfering with the JAK-STAT signaling pathway, leading to reduced cytokine activity and immune response.

Dosage and Administration

Adult: Typically 5 mg twice daily; dosage may be adjusted based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; adjust dose based on renal and hepatic function.

Renal Impairment: Adjustment may be needed; consult specific guidance.

Hepatic Impairment: Use caution; dose adjustment may be necessary, especially in severe impairment.

Pharmacokinetics

Absorption: Rapidly absorbed with peak concentrations within 0.5 to 1 hour.

Distribution: Vd approximately 87 L; approximately 40% bound to plasma proteins.

Metabolism: Primarily metabolized by hepatic CYP3A4 and to a lesser extent by CYP2C19.

Excretion: Excreted primarily in feces (~70%) and urine (~30%).

Half Life: Approximately 3 hours.

Contraindications

  • Active infections including tuberculosis
  • Known hypersensitivity to tofacitinib or components.

Precautions

  • Screen for latent TB before initiation; monitor for infections during therapy.
  • Use caution in patients with hepatic impairment, blood dyscrasias, or recent live vaccines.
  • Risk of thrombosis; use cautiously in patients with risk factors for blood clots.

Adverse Reactions - Common

  • Upper respiratory infections (Frequent)
  • Nasopharyngitis (Frequent)
  • Increased cholesterol levels (Less frequent)

Adverse Reactions - Serious

  • Serious infections (e.g., bacterial, viral, fungal) (Less frequent)
  • Blood clots (thrombosis) (Rare)
  • Gastrointestinal perforation (Rare)
  • Liver enzyme elevations (Less frequent)

Drug-Drug Interactions

  • May decrease effectiveness of vaccines; avoid live vaccines during treatment.
  • CYP3A4 inhibitors (e.g., ketoconazole) may increase tofacitinib levels; dose adjustment needed.

Drug-Food Interactions

  • No significant interactions established.

Drug-Herb Interactions

  • Limited data; use caution with herbal supplements that affect immune function or CYP enzymes.

Nursing Implications

Assessment: Monitor for signs of infection, blood counts, liver function, lipid profile, and blood clots.

Diagnoses:

  • Impaired immune response related to immunosuppressive therapy.
  • Risk for infection.

Implementation: Educate patient on signs of infection, importance of regular blood tests, and avoiding live vaccines.

Evaluation: Assess efficacy in symptom control and monitor for adverse effects.

Patient/Family Teaching

  • Report signs of infection immediately.
  • Adhere to scheduled lab tests.
  • Inform about potential side effects, including increased infection risk and lipid changes.

Special Considerations

Black Box Warnings:

  • Serious infections, including tuberculosis and invasive fungal infections; Malignancy and thrombosis risk.

Genetic Factors: No specific genetic testing required.

Lab Test Interference: May alter lipid profiles, blood counts, liver enzymes, and infection markers.

Overdose Management

Signs/Symptoms: Nausea, vomiting, diarrhea, dizziness, increased risk of infection.

Treatment: Supportive care; no specific antidote. Consider activated charcoal if ingestion is recent; monitor and provide symptomatic treatment.

Storage and Handling

Storage: Store at room temperature, 20–25°C (68–77°F); protect from moisture.

Stability: Stable under recommended storage conditions for the duration of the labeled shelf life.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.