Ruxolitinib

What is Ruxolitinib for?

Ruxolitinib is commonly used for treatment of myelofibrosis, polycythemia vera and graft-versus-host disease (GVHD). It works by blocking a group of enzymes which are involved in the production and growth of blood cells.

How should I take or use Ruxolitinib?

Ruxolitinib is taken orally at the same time twice a day. You may take this medication with or without food. Do not chew or crush the medication.

Do not stop taking your medication without checking with your healthcare professional.

If possible, handle the medication yourself. If a family member or caregiver needs to give the medication, do wash their hands before and after handling the medication.

What should I do if I forget to take or use Ruxolitinib?

If you forget to take a dose, skip the missed dose and take your next dose at the usual time. Do not take two doses to make up for the missed dose.

What precautions should I take when taking or using Ruxolitinib?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication
• You are pregnant, planning to become pregnant, or breastfeeding:
  • This medication can cause serious harm to an unborn child.
  • It is unknown if Ruxolitinib passes into breast milk. It is recommended to discontinue breastfeeding during treatment and for 2 weeks after the last dose
• You have high cholesterol or triglycerides (fat in the blood), liver or kidney problems
• If you have an current infection
• If you have a history of smoking, or heart attack, other heart problems, stroke, or blood clot
• You are taking any other medications, including supplements, traditional medications and herbal remedies

What food or medication should I avoid when I take or use Ruxolitinib?

Avoid grapefruit, starfruit, pomelo, pomegranate and their juices for the duration of your treatment as these may interact with Ruxolitinib and increase the risk of side-effects.

What are some common side effects of Ruxolitinib?

• Dizziness or headache
  • Take painkillers such as paracetamol for your headache. Inform your doctor if symptoms persist or worsen
  • Avoid activities such as drive or operate machinery if you feel dizzy
• Feeling tired or lack of energy
  • Try to pace yourself and plan your day ahead so you have time to rest
• Loose and frequent stools (diarrhoea)
  • Reduce consumption of foods high in fibre such as raw fruits and vegetables which cause softer and more frequent stools
  • Have foods such as porridge or soups which are gentler on the stomach
  • Ensure you are drinking sufficient fluid (at least 2 litres or 8 cups of water or fluids a day)
  • Avoid spicy and/or fried food
  • Avoid alcohol
  • Avoid coffee, tea, milk, and dairy products.
  • Take antidiarrheal medicine as instructed to manage your diarrhoea. Inform your doctor if the antidiarrhoeal medicine does not help with your diarrhoea.
• Increase cholesterol level
  • Your doctor will monitor your cholesterol level before you start ruxolitinib and during the treatment
• Temporary decrease in blood cell counts
  • This may put you at higher risk of infections, bleeding or bruising and feeling tired
  • Reduce your risk of getting an infection by:
    • Maintaining good hand hygiene. Wash your hands often during the day especially before you eat or after using the toilet.
    • Avoid crowded spaces and wear a mask to protect yourself
    • Eating freshly cooked food. Avoid raw meats, vegetables, eggs, half-cooked or uncooked food
  • Brush teeth gently with a soft bristle toothbrush to prevent gum bleeding
  • Be careful when handling sharp objects such as scissors or knives

What are some rare but serious side effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

Other serious side effects include:

• Infections
  • Signs of an infection include:
    • Fever (temperature over 38°C)
    • Chills
    • Severe sore throat
    • Cough with thick or green phlegm
    • Cloudy or foul smelling urine
    • Painful, tender, or swollen red skin wounds or sores
• Unusual bleeding
  • Signs of unusual bleeding
    • Bruising without a cause or bruise that worsens
    • Dark (black or red), sticky stools
    • Coughing out blood
    • Vomit that looks like coffee grounds
    • Passing blood in the urine
    • Bleeding that you cannot stop
• Blood clots or blockage in your blood vessels
  • Signs of a blood clot include:
    • Calf swelling and tenderness
    • Sudden onset of cough
    • Shortness of breath
  • Increased risk of heart attack or stroke. Signs include:
    • Chest discomfort/pain
    • Weakness in one part or on one side of your body
    • Difficulty in speaking or thinking
• Liver problems:
  • Signs of liver problems include:
    • Dark or tea-coloured urine
    • Pale or light-coloured stools
    • Yellowing of skin or eyes
    • Severe loss of appetite
    • Abdominal pain
    • Nausea or vomiting that does not go away
• Any new or changing skin lesion or growth, change in colour or size of a mole

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

How should I store Ruxolitinib?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children.

How do I throw away Ruxolitinib safely?

Pack this medication into a black trash bag and seal it tightly before throwing it into the rubbish chute or bin.