Ruxolitinib

Ruxolitinib is a type of targeted cancer drug. It is also known by its brand name, Jakavi.

You have it as a treatment for some  myeloproliferative neoplasms such as:

  • myelofibrosis
  • polycythaemia vera

You might also have ruxolitinib as part of a clinical trial Open a glossary item for another type of myeloproliferative neoplasm.

How ruxolitinib works

Ruxolitinib is a type of targeted cancer drug called a cancer growth blocker.  A cancer growth blocker blocks the growth factors  Open a glossary itemthat trigger the cancer cells to divide and grow. Ruxolitinib works by blocking a gene that is important in the production of blood cells. This gene is called JAK2.

You have a blood test to check for the JAK2 gene change before you start treatment.

How you have ruxolitinib

You have ruxolitinib as tablets, usually twice a day. The amount (dose) might change depending on the results of your blood tests. Your doctor will tell you if you need to change the dose.

You can take them with or without food, at the same time each day.

You must take tablets according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have ruxolitinib

You have ruxolitinib for as long as it works, and the side effects are not too bad.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better.

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

The side effects are different for people having ruxolitinib for myelofibrosis and people having ruxolitinib for polycythaemia vera.

Side effects (myelofibrosis)

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Urinary tract infections (UTIs)

Tell your doctor or nurse if you think you might have a urinary tract infection. You might find it difficult to pass urine, want to go with some urgency or are going more often. There may be pain or burning when you go. You may see blood in your urine, or your urine might smell bad or look cloudy.

Low levels of red blood cells (anaemia)

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Other bleeding

Ruxolitinib can cause bleeding from anywhere in your body. This is usually mild. Signs of bleeding from other parts of the body include blood in your urine or poo (stool), black stool, vomiting or coughing up blood, headaches, dizziness or feeling weak.

Contact your doctor or nurse straight away if you have any signs of bleeding.

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.

Weight gain

You may gain weight while having this treatment. You may be able to control it with diet and exercise. Tell your doctor or nurse if you are finding it difficult to control your weight.

High blood cholesterol

Cholesterol is a fatty substance which helps cells in the body to work normally. When the cholesterol level is too high it could have an effect on your heart. You usually have blood tests to check your cholesterol levels.

Headaches and dizziness

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

You might have headaches or feel dizzy because of high blood pressure. Your nurse will check your blood pressure regularly.

Liver changes

You might have liver changes while taking this drug. You have regular blood tests to check for any changes in the way your liver is working.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

  • lung infection due to inflammation of the air sacs in the lungs (pneumonia)
  • shingles (herpes zoster) which is an infection of the nerve and skin around that nerve
  • sepsis - a severe infection can happen due to the effects of the treatment on the bone marrow
  • wind (flatulence)

Side effects (polycythaemia vera)

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Low levels of red blood cells (anaemia)

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Ruxolitinib can cause bleeding from anywhere in your body. This is usually mild. Signs of bleeding from other parts of the body include blood in your urine or poo (stool), black stool, vomiting or coughing up blood, headaches, dizziness or feeling weak.

Contact your doctor or nurse straight away if you have any signs of bleeding.

High cholesterol and other fats in the blood

Cholesterol is a fatty substance which helps cells in the body to work normally. When the cholesterol level is too high it could have an effect on your heart. You usually have blood tests to check your cholesterol and other fat levels in the blood.

Liver changes

You might have liver changes while taking this drug. You have regular blood tests to check for any changes in the way your liver is working.

High blood pressure

Tell your doctor or nurse if you have headaches, dizziness, nose bleeds, blurred or double vision or shortness of breath. Your nurse will check your blood pressure regularly.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

  • urinary tract infections (UTIs) - you might find it difficult to pass urine, want to go with some urgency or are going more often
  • shingles (herpes zoster) which is an infection of the nerve and skin around that nerve
  • weight gain
  • constipation

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Ruxolitinib contains lactose (milk sugar). If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

Loss of fertility

It is not known whether this treatment affects fertility. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Pregnancy and contraception

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

Last reviewed: 
23 Jun 2020
Next review due: 
23 Jun 2023
  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination

    Public Health England

    First published: March 2013 and regularly updated on the Gov.UK website

  • Electronic Medicines Compendium 
    Accessed April 2020

  • Cancer Research UK Clinical Trials Database

    Accessed April 2020

  • Ruxolitinib for treating disease-related splenomegaly or symptoms in adults with myelofibrosis

    National Institute for Health and Care Excellence, March 2016

  • Ruxolitinib for treating polycythaemia vera (terminated appraisal)

    National Institute for Health and Care Excellence, 2015

  • Ruxolitinib (Jakavi) - The treatment of adult patients with polycythaemia vera (PV) who are resistant to or intolerant of hydroxyurea (HU)

    Scottish Medicines Consortium, December 2019

     

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