Xeljanz Xr

— THERAPEUTIC CATEGORIES —
  • Arthritis/rheumatic disorders
  • Colorectal disorders

Xeljanz Xr Generic Name & Formulations

General Description

Tofacitinib 11mg, 22mg; ext-rel tabs.

Pharmacological Class

Janus kinase (JAK) inhibitor.

How Supplied

Tabs 5mg—28, 60; 10mg—28, 60, 180; XR tabs 11mg—14, 30; 22mg—30; Oral soln—240mL (w. dosing syringe)

Manufacturer

Generic Availability

NO

Xeljanz Xr Indications

Indications

Moderately to severely active rheumatoid arthritis (RA), active psoriatic arthritis (PsA), or active ankylosing spondylitis (AS) in adults who have had an inadequate response or intolerance to 1 or more TNF blockers.

Limitations of Use

Not recommended in combination with other biologic DMARDs, or potent immunosuppressants (eg, azathioprine, cyclosporine).

Xeljanz Xr Dosage and Administration

Adult

Swallow whole. 11mg once daily. Switching from immediate-rel to XR tabs: start XR tab the day following the last immediate-rel 5mg dose. Moderate to severe renal impairment (hemodialysis: give after session) or moderate hepatic impairment; concomitant strong CYP3A4 inhibitors, or drugs that result in both moderate CYP3A4 and strong CYP2C19 inhibition: reduce to immediate-rel 5mg once daily. Other dose adjustments: see full labeling.

Children

Not established.

Xeljanz Xr Contraindications

Not Applicable

Xeljanz Xr Boxed Warnings

Boxed Warning

Serious infections. Mortality. Malignancy. Major adverse cardiovascular events (MACE). Thrombosis.

Xeljanz Xr Warnings/Precautions

Warnings/Precautions

XR tabs are not interchangeable or substitutable with oral soln. Increased risk of serious or fatal infections (eg, TB, bacterial, viral, invasive fungal, or other opportunistic pathogens) esp. with 10mg twice daily dose (in UC treatment). Avoid in active, serious, or localized infections. Chronic, recurrent, or history of serious or opportunistic infections. Travel to, or residence in, areas with endemic TB or mycoses. Conditions that predispose to infection. Test/treat latent TB infection prior to and per applicable guidelines during therapy. Monitor closely if new infection, active TB (even if initial latent test is negative), reactivation of herpes virus or hepatitis occurs; interrupt treatment if serious or opportunistic infection, or sepsis develops. Screen for viral hepatitis (eg, Hep B or C) prior to initiation. History of chronic lung disease or in those who develop interstitial lung disease. RA patients age ≥50yrs with ≥1 CV risk factor on 5mg or 10mg twice daily dose: increased rate of all-cause mortality (including sudden CV death), MACE (CV death, MI, stroke), or thrombosis. Discontinue in those with previous MI or stroke, or with symptoms of thrombosis. Avoid in those with increased risk for thrombosis. RA patients on 5mg or 10mg twice daily: increased rate of malignancies (esp. lymphomas, lung cancers). Consider benefits/risks prior to or continuing therapy (esp. smokers, with other CV risk factors, or with a known malignancy). GI perforation risk (eg, history of diverticulitis). Discontinue and evaluate if serious hypersensitivity reaction occurs. Monitor lymphocytes at baseline, then every 3 months; neutrophils and hemoglobin at baseline, after 4–8 weeks, then every 3 months thereafter. Do not initiate therapy if lymphocytes <500cells/mm3, ANC <1000cells/mm3, or hemoglobin <9g/dL. Severe hepatic impairment: not recommended. Routinely monitor liver enzymes; interrupt therapy if drug-induced liver injury suspected. Monitor lipids 4–8 weeks following initiation. Perform periodic skin exam in those with skin cancer risk. Update immunizations based on current guidelines prior to initiation. XR tabs: pre-existing severe GI narrowing. Diabetes. Elderly. Pregnancy: females of reproductive potential should consider prevention. Nursing mothers: not recommended (during and for ≥18hrs [tabs/oral soln] or ≥36hrs [XR tabs] after last dose).

Xeljanz Xr Pharmacokinetics

See Literature

Xeljanz Xr Interactions

Interactions

Concomitant live vaccines, biologic DMARDs, biologics for UC, or potent immunosuppressants (eg, azathioprine, cyclosporine, tacrolimus): not recommended. Potentiated by strong CYP3A4 inhibitors (eg, ketoconazole), or drugs that result in both moderate CYP3A4 and strong CYP2C19 (eg, fluconazole) inhibition; adjust dose. Antagonized by strong CYP3A4 inducers (eg, rifampin); avoid concomitant use. Caution with NSAIDs.

Xeljanz Xr Adverse Reactions

Adverse Reactions

Upper respiratory tract infections, headache, diarrhea, nasopharyngitis, elevated cholesterol, increased blood CPK, rash, herpes zoster; serious or opportunistic infections, TB, malignancies, thrombosis, cytopenias, liver enzyme or lipid elevations, non-melanoma skin cancer, hypersensitivity reactions.

Xeljanz Xr Clinical Trials

See Literature

Xeljanz Xr Note

Not Applicable

Xeljanz Xr Patient Counseling

See Literature

Xeljanz Xr Generic Name & Formulations

General Description

Tofacitinib 11mg, 22mg; ext-rel tabs.

Pharmacological Class

Janus kinase (JAK) inhibitor.

See Also

How Supplied

Tabs 5mg—28, 60; 10mg—28, 60, 180; XR tabs 11mg—14, 30; 22mg—30

Manufacturer

Generic Availability

NO

Xeljanz Xr Indications

Indications

Moderately to severely active ulcerative colitis (UC) in adults who have had an inadequate response or intolerance to 1 or more TNF blockers.

Limitations of Use

Not recommended in combination with biological therapies for UC or potent immunosuppressants (eg, azathioprine, cyclosporine).

Xeljanz Xr Dosage and Administration

Adult

Use lowest effective dose for shortest duration. Swallow whole. 22mg once daily for ≥8wks, then 11mg once daily. May continue 22mg once daily dose for up to max 16wks if needed; limit to those with loss of response. Discontinue after 16wks if inadequate response with 22mg once daily. Switching from immediate-rel to XR tabs: start 11mg XR tab the day following the last immediate-rel 5mg dose; or the 22mg XR tab the day following the last immediate-rel 10mg dose. Moderate to severe renal impairment (hemodialysis: give after session) or moderate hepatic impairment; concomitant strong CYP3A4 inhibitors, or drugs that result in both moderate CYP3A4 and strong CYP2C19 inhibition: reduce 22mg once daily to 11mg once daily, or 11mg once daily to immediate-rel 5mg once daily. Other dose adjustments: see full labeling.

Children

Not established.

Xeljanz Xr Contraindications

Not Applicable

Xeljanz Xr Boxed Warnings

Boxed Warning

Serious infections. Mortality. Malignancy. Major adverse cardiovascular events (MACE). Thrombosis.

Xeljanz Xr Warnings/Precautions

Warnings/Precautions

XR tabs are not interchangeable or substitutable with oral soln. Increased risk of serious or fatal infections (eg, TB, bacterial, viral, invasive fungal, or other opportunistic pathogens) esp. with 10mg twice daily dose (in UC treatment). Avoid in active, serious, or localized infections. Chronic, recurrent, or history of serious or opportunistic infections. Travel to, or residence in, areas with endemic TB or mycoses. Conditions that predispose to infection. Test/treat latent TB infection prior to and per applicable guidelines during therapy. Monitor closely if new infection, active TB (even if initial latent test is negative), reactivation of herpes virus or hepatitis occurs; interrupt treatment if serious or opportunistic infection, or sepsis develops. Screen for viral hepatitis (eg, Hep B or C) prior to initiation. History of chronic lung disease or in those who develop interstitial lung disease. RA patients age ≥50yrs with ≥1 CV risk factor on 5mg or 10mg twice daily dose: increased rate of all-cause mortality (including sudden CV death), MACE (CV death, MI, stroke), or thrombosis. Discontinue in those with previous MI or stroke, or with symptoms of thrombosis. Avoid in those with increased risk for thrombosis. RA patients on 5mg or 10mg twice daily: increased rate of malignancies (esp. lymphomas, lung cancers). Consider benefits/risks prior to or continuing therapy (esp. smokers, with other CV risk factors, or with a known malignancy). GI perforation risk (eg, history of diverticulitis). Discontinue and evaluate if serious hypersensitivity reaction occurs. Monitor lymphocytes at baseline, then every 3 months; neutrophils and hemoglobin at baseline, after 4–8 weeks, then every 3 months thereafter. Do not initiate therapy if lymphocytes <500cells/mm3, ANC <1000cells/mm3, or hemoglobin <9g/dL. Severe hepatic impairment: not recommended. Routinely monitor liver enzymes; interrupt therapy if drug-induced liver injury suspected. Monitor lipids 4–8 weeks following initiation. Perform periodic skin exam in those with skin cancer risk. Update immunizations based on current guidelines prior to initiation. XR tabs: pre-existing severe GI narrowing. Diabetes. Elderly. Pregnancy: females of reproductive potential should consider prevention. Nursing mothers: not recommended (during and for ≥18hrs [tabs/oral soln] or ≥36hrs [XR tabs] after last dose).

Xeljanz Xr Pharmacokinetics

See Literature

Xeljanz Xr Interactions

Interactions

Concomitant live vaccines, biologic DMARDs, biologics for UC, or potent immunosuppressants (eg, azathioprine, cyclosporine, tacrolimus): not recommended. Potentiated by strong CYP3A4 inhibitors (eg, ketoconazole), or drugs that result in both moderate CYP3A4 and strong CYP2C19 (eg, fluconazole) inhibition; adjust dose. Antagonized by strong CYP3A4 inducers (eg, rifampin); avoid concomitant use. Caution with NSAIDs.

Xeljanz Xr Adverse Reactions

Adverse Reactions

Upper respiratory tract infections, headache, diarrhea, nasopharyngitis, elevated cholesterol, increased blood CPK, rash, herpes zoster; serious or opportunistic infections, TB, malignancies, thrombosis, cytopenias, liver enzyme or lipid elevations, non-melanoma skin cancer, hypersensitivity reactions.

Xeljanz Xr Clinical Trials

See Literature

Xeljanz Xr Note

Not Applicable

Xeljanz Xr Patient Counseling

See Literature