Why am I prescribed Tofacitinib/Xeljanz?

• Xeljanz is a medicine that contains the active substance Tofacitinib. It is used to treat adults with moderate to severe rheumatoid arthritis. Tofacitinib can reduce the symptoms and slow the progress of rheumatoid arthritis. It may reduce the inflammation in your joints and decrease pain, swelling and stiffness.

When do I take Tofacitinib?

• The recommended dose is 5 mg twice a day. Try to take your tablet at the same time every day (one tablet in the morning and one tablet in the evening).
• You can take XELJANZ with or without food
• Tofacitinib is not a painkiller. If you are on painkillers you can continue to take these as well, unless your doctor advises otherwise.

What should I do if I forget to take a dose?

• If you forget a dose just take the next dose as usual. Do not take a double dose to make up for a forgotten tablet.

What are the possible side-effects?

Like all medicines, this medicine can cause side effects, although not everybody gets them. Some may be serious and need medical attention.

The most common side effects of Tofacitinib are upper respiratory tract infections, headache, diarrhoea, and nasopharyngitis.

Possible side effects:

• If you develop shingles (a painful blistering rash) contact your doctor for review

Signs of serious infections include

• fever and chills
• cough
• skin blisters

Signs of stomach problems include

• fever
• stomach or abdominal pain
• blood in the stool
• unexplained changes in bowel habits

All patients are tested for tuberculosis and hepatitis B and C before starting on Tofacitinib.
Tofacitinib has been associated with increased cholesterol levels in some patients, and should be periodically monitored. If your cholesterol level becomes too high, it is possible you may need to start taking a medication to lower it.
A rare complication seen with Tofacitinib use in clinical trials was bowel perforation, or a hole in the bowel wall. If you have a history or diverticulitis or develop abdominal pain or bloody bowel movements while taking Tofacitinib, you should notify your doctor immediately.

Do I need any special checks while on Tofacitinib?

• Your doctor should perform blood tests before you start taking XELJANZ, monthly for the first 3 months and then every 3 months, to determine if you have a low white blood cell (neutrophil or lymphocyte) count, or a low red blood cell count (anaemia).
• You should not receive XELJANZ if your white blood cell (neutrophil or lymphocyte) count or red blood cell count is too low. If needed, your doctor may interrupt your XELJANZ treatment to reduce the risk of infection (white blood cell counts) or anaemia (red blood cell counts).
• Your doctor may also perform other tests, for example to check your blood cholesterol levels or monitor the health of your liver.
• Your doctor should test your cholesterol levels 8 weeks after you start receiving XELJANZ. Your doctor should perform liver tests periodically.

Can I take other medicines along with Tofacitinib?

• Most drugs can be taken safely. However, if you are to start any new drugs you should tell the doctor that you are taking Tofacitinib. Do not take 'over-the-counter' or herbal preparations without discussing this first with your pharmacist.

Is tofacitinib safe to use in pregnancy or breastfeeding?

• You should not take Tofacitinib if you are pregnant or breastfeeding. While taking Tofacitinib use of appropriate contraception is advised.

References:

https://www.webmd.com/drugs/2/drug-162865/xeljanz-oral/details

http://www.cuh.hse.ie/Our-Services/Our-Specialities-A-Z-/Rheumatology/Patient-Medication-Information/Tofacitinib-PT-Information-Sheet.pdf

https://www.medicines.org.uk/emc/product/2500/smpc

https://www.versusarthritis.org/about-arthritis/treatments/drugs/tofacitinib/

https://www.xeljanz.com

https://medlineplus.gov/druginfo/meds/a613025.html

https://www.hpra.ie/docs/default-source/default-document-library/important-safety-information---xeljanz-(tofacitinib)1d0c0c2697826eee9b55ff00008c97d0.pdf?sfvrsn=0