What to know about Xeljanz
Xeljanz can reduce swelling and pain in the joints. However, it also weakens the immune system, which can leave people susceptible to infections.
Continue reading this article to learn more about Xeljanz, including when doctors prescribe it, the dosage, side effects, warnings, and interactions with other medications that can occur.
What is it?
In 2012, The Food and Drug Administration (FDA) approved tofacitinib, which is the active ingredient in Xeljanz, to treat moderate to severe rheumatoid arthritis (RA) in people who cannot tolerate methotrexate.
The FDA had also approved Xeljanz to treat moderate to severe ulcerative colitis.
However, in 2019, the FDA approved an updated boxed warning, stating that a safety trial "finds risk of blood clots in the lungs and death with higher dose of tofacitinib (Xeljanz, Xeljanz XR)" in people with RA.
How does it work?
A doctor may prescribe Xeljanz for RA, psoriatic arthritis, and ulcerative colitis.
Xeljanz acts as a Janus kinase (JAK) inhibitor. It prevents inflammatory enzymes called cytokine from stimulating the body's immune response.
Cytokines include various substances, such as tumor necrosis factor (TNF), interleukins, and transforming growth factor (TGF), that play critical roles in RA and other immune-mediated inflammatory diseases.
When a cytokine binds to a JAK receptor, it begins a chain of chemical reactions that cause systemic, or widespread, inflammation.
JAK inhibitors, such as Xeljanz, block JAK receptors from signaling other immune responses.
Xeljanz treats chronic inflammatory disorders that include RA, psoriatic arthritis, and ulcerative colitis.
How to take and dosage
Xeljanz comes in two varieties, which are a regular tablet or an extended release (XR) tablet. People can take Xeljanz tablets whole, with or without food.
- Xeljanz regular: 5 milligrams (mg) twice daily
- Xeljanz XR: 11 mg once daily
Adults with ulcerative colitis will take 10 mg of regular Xeljanz twice daily for at least 8 weeks. After this period, their doctor will reevaluate their symptoms.
Depending on how the person responds to the treatment, a doctor may recommend reducing the dosage to 5 mg twice daily.
People can take Xeljanz in combination with disease modifying drugs, such as methotrexate or azathioprine. However, they will take half the regular dose of Xeljanz.
People who have kidney or liver damage may have more difficulty metabolizing Xeljanz. This means that they will have higher concentrations of the medication in their blood. Doctors will prescribe lower doses for people who have moderate to severe kidney or liver damage because of this fact.
Doctors may interrupt the treatment if a person develops the following conditions:
- low red blood cell counts, known as anemia
- low white blood cell counts, known as neutropenia
- low lymphocyte counts, known as lymphopenia
- severe infections
In pregnancy, some evidence suggests a link between Xeljanz and miscarriage, preterm labor, and low birth weight. However, there is currently not enough data to establish a clear link between Xeljanz and adverse birth effects.
The National Institutes of Health (NIH) have an ongoing pregnancy exposure registry to monitor pregnancy outcomes in women who are taking Xeljanz or Xeljanz XR. Women taking Xeljanz can enroll in the pregnancy registry by calling the toll-free number 1-977-311-8972.
Side effects of Xeljanz may include headaches, swollen lymph nodes, and excessive sweating.
Xeljanz can cause a variety of side effects, such as:
- upper respiratory tract infections
- swollen lymph nodes
- high blood pressure
- shortness of breath
- chest or back pain
- coughing up blood
- excessive sweating
- clammy or blue-colored skin
Although Xeljanz can help treat immune system-related inflammatory disorders, it can cause adverse effects in specific populations, as follows:
Xeljanz affects the immune system, which can leave people vulnerable to infections.
People who have low lymphocyte counts should not take Xeljanz. An individual who experiences frequent severe infections can take Xeljanz, but they should carefully consider the costs and benefits of this treatment option with their doctor.
In 2019, the FDA released a safety announcement citing a clinical trial that found an increased rate of blood clots in the lungs, or pulmonary embolism, in people with RA who were taking 10 mg of Xeljanz and Xeljanz XR twice daily.
These risks may also apply to people with ulcerative colitis.
As a result, the FDA has approved 10 mg twice daily to treat ulcerative colitis only in certain people who experience severe side effects with other medicines. This dose is not approved for RA or psoriatic arthritis.
Xeljanz may interact with specific medications, including:
- moderate to strong CP3A4 inhibitors, such as ketoconazole
- strong CP3A4 inducers, such as rifampin
- strong CYP2C19 inhibitors, such as fluconazole
- immunosuppressive drugs, such as azathioprine, cyclosporine, and tacrolimus
People must inform their doctors of any current medications they are taking before starting Xeljanz.
Private insurance companies usually cover the cost of Xeljanz.
Xeljanz has no generic alternatives at this time. The cost of Xeljanz varies, depending on an individual's insurance. Private insurance companies can cover most of the cost, if not the entire cost.
People who do not have insurance can get more information and apply for financial assistance at the Xeljanz website here.
Xeljanz is a prescription medication that doctors give to treat inflammatory conditions, such as RA, psoriatic arthritis, and ulcerative colitis.
Xeljanz acts as a JAK inhibitor and lowers the body's immune response. This action can help control inflammation, but it can also leave the body vulnerable to severe infections.