I have been trying unsuccessfully to find information online to my question.
Does anybody know if a patient currently taking Jakafi can be prescribed Paxlovid in case of a Covid infection?
My husband had intermediate Myelofibrosis. So far the Jakafi has done wonders. We went through a lot of dose adjustments. Anywhere from 5 mg to 20 mg and are now settled at 15 mg. With Jakafi All symptoms disappeared and he put on a lot of weight. We are hoping this miracle continues for you long time. With all the Covid restrictions lifted and people returning to normal lives it is of course more difficult for the wonderful people in this forum.
I think for many of us the world was shattered when news came out that the vaccines are not as effective for MPN patients. Then came the pills I hope that we are getting some good news on those. Thank you and stay well!
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It's a complex question and your Dr needs to be very up to date for good advice since it's all very new
You are correct that Rux (Jakafi) can reduce vax response.
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Here is some info on Pax:
I agree I can't find info on Rux vs Pax. Assuming the worst case:
Paxlovid is actually a two part med in separate pills, the first two fancy words in this quote below. Two considerations I've read:
-If you can stop the regular medicine for the period that you take Pax, it can help. The article here suggests 8 days of stoppage. **But this is a complex decision that only your Dr can help you decide** I don't know whether stopping Rux is reasonable.
-Using an alternate MF med for the time period. But then do we know which one is for sure ok?
-The ritonavir part of it makes most the trouble as seen here. It makes the active part, nirmatrelvirn, last longer in the body. I've read an idea to get more frequent doing of the active part without the prolonging part to reduce interaction risk. I think this is still more concept than practice.
So some things you might discuss with your Dr.
There may be members who have more specific info.
<<Ritonavir-boosted nirmatrelvir has significant and complex drug-drug interactions, primarily due to the ritonavir component of the combination.>>.
Thank you I had suspected that there would not be a simple answer. I was hoping that the so called “Covid Pill” was an option which it seems to be with proper guidance from the hematologist with some dose adjustments. Best to seems to contact Doctor the moment he contracts Covid which hopefully will never happen. Thank you EP😀
Applies to: Paxlovid (nirmatrelvir / ritonavir), Jakafi (ruxolitinib)
Ritonavir may increase the blood levels and effects of ruxolitinib. This can increase the risk of side effects that affect your bone marrow function, resulting in low numbers of different types of blood cells. You may be more likely to develop anemia, bleeding problems, or infections. Contact your doctor if you experience potential signs and symptoms of these conditions such as paleness, fatigue, dizziness, fainting, unusual bleeding or bruising, fever, chills, sore throat, body aches, or other flu-like symptoms. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
ADJUST DOSE: Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of ruxolitinib, which is primarily metabolized by the isoenzyme. In healthy subjects, administration of a single 10 mg dose of ruxolitinib following pretreatment with the potent CYP450 3A4 inhibitor ketoconazole (200 mg twice daily for four days) resulted in a 33% increase in ruxolitinib peak plasma concentration (Cmax) and a 91% increase in systemic exposure (AUC) compared to administration of ruxolitinib alone. The half-life was also prolonged from 3.7 to 6.0 hours in the presence of ketoconazole. The change in the pharmacodynamic marker, pSTAT3 inhibition, was consistent with the corresponding ruxolitinib AUC following concurrent administration with ketoconazole.
MANAGEMENT: Indication specific dose modifications should be made when ruxolitinib is coadministered with strong CYP450 3A4 inhibitors. Ruxolitinib 10 mg twice a day is the recommended starting dose for patients with myelofibrosis (MF) coadministered strong CYP450 3A4 inhibitors when the platelet count is at least 100 X 10(9)/L and 5 mg once a day when the platelet counts is at least 50 X 10(9)/L and less than 100 x 10(9)/L. The recommended starting dose for patients with Polycythemia vera (PV) coadministered potent CYP450 3A4 inhibitors is ruxolitinib 5 mg twice a day. For patients with MF or PV who are stabilized on ruxolitinib 10 mg twice a day or greater and starting a potent CYP450 3A4 inhibitor, the ruxolitinib dose should be reduced by 50% (rounded up to the closest available tablet strength). For patients with MF or PV stabilized on a dose of 5 mg twice a day and starting fluconazole (at a dose of 200 mg per day or less), the ruxolitinib dose should be reduced to 5 mg once a day. For patients with MF or PV stabilized on ruxolitinib 5 mg once a day, concomitant use of strong CYP450 3A4 inhibitors should be avoided or ruxolitinib therapy interrupted for the duration of strong CYP450 3A4 inhibitor use. For patients with for acute graft versus host disease (GVHD) coadministered strong CYP450 3A4 inhibitors, the ruxolitinib dose should be reduced to 5 mg once a day with concomitant ketoconazole use; however, no dose adjustments are necessary with other potent CYP450 3A4 inhibitors. For patients with GVHD receiving itraconazole, blood counts should be monitored more frequently for toxicity and ruxolitinib dose adjustments made, if necessary. Additional dosage modifications should be made with careful monitoring of safety and efficacy.
ritonavir food
Applies to: Paxlovid (nirmatrelvir / ritonavir)
ADJUST DOSING INTERVAL: Administration with food may modestly affect the bioavailability of ritonavir from the various available formulations. When the oral solution was given under nonfasting conditions, peak ritonavir concentrations decreased 23% and the extent of absorption decreased 7% relative to fasting conditions. Dilution of the oral solution (within one hour of dosing) with 240 mL of chocolate milk or a nutritional supplement (Advera or Ensure) did not significantly affect the extent and rate of ritonavir absorption. When a single 100 mg dose of the tablet was administered with a high-fat meal (907 kcal; 52% fat, 15% protein, 33% carbohydrates), approximately 20% decreases in mean peak concentration (Cmax) and systemic exposure (AUC) were observed relative to administration after fasting. Similar decreases in Cmax and AUC were reported when the tablet was administered with a moderate-fat meal. In contrast, the extent of absorption of ritonavir from the soft gelatin capsule formulation was 13% higher when administered with a meal (615 KCal; 14.5% fat, 9% protein, and 76% carbohydrate) relative to fasting.
MANAGEMENT: Ritonavir should be taken with meals to enhance gastrointestinal
ruxolitinib food
Applies to: Jakafi (ruxolitinib)
GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of ruxolitinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.
MANAGEMENT: Patients treated with ruxolitinib should avoid consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract. Ruxolitinib may be administered with or without food. tolerability
Whow thank you Hunter. That is a lot of information but from what I can read is that in case of the so called “Covid Pill” we are in a totally different circumstance.m than the general population.It is probably best as Maze suggested to have a Plan for the case he contracts Covid on hand with the hematologist Many thanks!!! Our GP told us that he can prescribe it without problem but I thought I better check as it is all so new.
Hi, I have PV but take Rux, at the moment 15 mg twice a day. So far it seems to suit me although I have gained weight which is unwanted in my case.
My MPN consultant has advised me to obviously do my best to avoid getting covid but also live my life. If/when I get covid to contact him immediately. This has reassured me and eased the worry.
Perhaps you could discuss with your haematologist what your plan would be.
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