Xeljanz XR (Tofacitinib) 11 Mg
Xeljanz 11 mg XR
Xeljanz (pronounced as Zel-janz)
Tofacitinib (pronounced as Toe-fa-sit-in-ib)
About Xeljanz XR 11 mg
What is Xeljanz?
The active ingredient of Xeljanz is tofacitinib. Xeljanz has been used to treat rheumatoid arthritis, psoriatic arthritis and ulcerative colitis. in patients who have experienced inadequate or intolerance to one or more DMARD agents.
How does Xeljanz work?
Essentially these medications reduce the body’s over-active inflammatory responses. In these auto-immune, or rheumatic, conditions the body often attacks and harms itself either by an over-active immune state and/or the body misdirecting itself. The cytokine pathway is one of the main signaling mechanism of the body’s immune response. Xeljanz inhibits the Janus Kinase (JAK) enzyme, which acts in the JAK-STAT signaling pathway involved in certain cytokine inflammatory responses.
How to use Xeljanz?
Be aware that it is not recommended to use Xeljanz in combination with other biological DMARDS or strong immunosuppressants such as cyclosporine or azathioprine. The exception is that it may be combined with methotrexate when used for rheumatoid arthritis, but studies show that it is equally effective when used by itself also.
Xeljanz XR dosing is dependent on many factors. One of the main factors affecting the dosing and possibly even discontinuing therapy is dependent upon the patient’s immune status and presence of any active infections. Note patients should never initiate Xeljanz if they have an active chronic or localized infection. As Xeljanz is designed to depress the body’s immune system from attacking itself, it can consequently make it more difficult to fight actual threats that are present or may arise. In fact, taking Xeljanz XR can increase a person’s risk of acquiring certain infections such as pneumonia, fungal infections and thrush, cellulitis, and other viral and bacterial infections. Furthermore, it can activate latent infections such as herpes and tuberculosis.
Dosing in Rheumatoid Arthritis
- Xeljanz 5 mg should be taken once daily
Dosing in Psoriatic Arthritis
- Xeljanz 5 mg should be taken twice daily
Dosing in Ulcerative Colitis
- Xeljanz 11 mg XR should be taken twice daily for 8 weeks, then 5 mg twice daily for maintenance
Do not double the dose, just skip the dose and take next dose at the scheduled time.
How does Xeljanz dosing change when there is a serious infection or patient is immuno-compromised?
Cytopenia are good indicators of an individual’s immune health. As such, absolute neutrophil count (ANC), hemoglobin levels, and lymphocyte count are used to dictate and dose Xeljanz XR.
For ANC levels 500-1000 cells/mm3 stop Xeljanz XR and resume only when ANC >1000 persistently.
When hemoglobin values are abnormal stop Xeljanz XR until they normalize.
Stop Xeljanz XR if lymphocyte count is less than 500 cells/mm3
Does Xeljanz dosing change when kidneys are impaired?
Yes, Xeljanz is metabolized by the kidneys, as such renal impairment may require dose adjustments. For moderate to severe (Creatinine Clearance CLcr = 15-60 ml/min) renal insufficiency the following doses should be adjusted accordingly:
Xeljanz 11 mg XR should be 5 mg once daily
Xeljanz 10 mg twice daily should be 5 mg twice daily
Xeljanz 5 mg twice daily should be 5 mg once daily
Does Xeljanz dosing change when the liver is impaired?
Yes, Xeljanz is metabolized by the liver, as such hepatic impairment may require dose adjustments. If there is severe hepatic impairment, Xeljanz should be discontinued until liver function is restored. For moderate hepatic impairment:
only Xeljanz 5mg once daily can be considered.
Xeljanz has shown to interact with Ketoconazole and Fluconazole and can increase plasma levels of Xeljanz and may require dose adjustment. Concomitant use of strong immunosuppressants such as Tacrolimus, Cyclosporine, and Azathioprim and Xeljanz is not well studied and is commonly believed that this could result in excessive immunosuppression resulting in infections and thus strongly discouraged. Xeljanz has not been studied when used with biologics such as TNF antagonists, and Interleukin antagonist and thus is not practiced. Rifampin can decrease levels of Xeljanz and thus reduce efficacy and may require dose adjustments.
Xeljanz does decrease the body’s immune capacity and as such can result in many side effects. Here we discuss some serious and more common side effects, but this is by no mean a complete account of this drugs side effect profile. A detailed resource highlighting several research articles that study these side effects are outlined by RX-Files.
The most common side effect of Xeljanz is resulting serious infections. The most common serious infections observed are pneumonia, cellulitis, nasopharyngitis, bronchitis, herpes zoster, and urinary tract infections; in long term exposure diverticulitis, gastroenteritis, and appendicitis were also reported. Cases of Tuberculosis have also been reported.
Patients using Xeljanz must be closely monitored for any infections and should follow up with their doctor immediately upon discovering any infection whatsoever.
Malignancy can also arise while using Xeljanz, however, the rate of occurrence is low, less than 0.4% in the first 0-12 months of use. This risk can then increase to 3% in longer term use. The most common types of malignancy’s reported were lung and breast cancer, then gastric, colorectal, renal cell, and prostate cancer, followed by lymphoma and malignant melanoma. Non-malignant melanoma is observed more in patients treated with 10 mg twice daily versus 5 mg twice daily.
Post-marketing adverse reactions reported thrombotic events including deep vein thrombosis, pulmonary embolism, and arterial thrombosis.
Is Xeljanz a special drug?
Xeljanz XR is a novel approach to treating rheumatoid arthritis and associated types of disease. It is the first oral kinase inhibitor; and one of the first of its kind oral biologic for rheumatoid arthritis. It provides a much-needed supplement or alternative to methotrexate.
It has also shown some potentially beneficial application in some auto-immune dermatological diseases such as alopecia areata, atopic dermatitis, and even repigmentation in vitligo. In fact, JAK inhibitors may play an important role in dermatology treatments.
Can I buy Xeljanz in Canada?
As Xeljanz is a first of its kind medication and still very new (there is no generic alternative) the cost of this medication is still very high. Xeljanz is very expensive in the USA at more than $4000 for a bottle of 30 tablets. With the use of Xeljanz manufacturer coupons, patient assist cards, Xeljanz discounts cards, or certain Xeljanz promos patients may be able to find Xeljanz cheaper.
The easiest way for Americans to save on name brand Xeljanz is to buy from Canada. In Canada, Americans can fill their prescription for Xeljanz at half the price. From Canada Cloud Pharmacy you have the peace of mind that you will receive actual brand name Xeljanz manufactured by Pfizer, as we only buy and ship from Canada. If you purchase Xeljanz from other online Canadian Pharmacies they may ship it from another country like India, Turkey, Singapore, or Mauritius, the list goes on. When shipped from a non-Canadian location the safety and efficacy of Xeljanz may be compromised as these countries do not follow the strict requirements that health authorities like the FDA and Health Canada follow here in North America.
Buy Xeljanz XR 11 mg XR from Canada
Information contained here on this page is for informational purpose only. Always speak with your Doctor about the usage of your medication.