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Ruxolitinib – Uses, Dosage, Side Effects, Interaction

Ruxolitinib - Uses, Dosage, Side Effects, Interaction

Mechanism of Action

The Janus kinase (JAK) family of protein tyrosine kinases comprises JAK1, JAK2, JAK3, and non-receptor tyrosine kinase 2 (TYK2). JAKs play a pivotal role in intracellular signalling pathways of various cytokines and growth factors essential to hematopoiesis, such as interleukin, erythropoietin, and thrombopoietin. JAKs have diverse functions: JAK1 and JAK3 promote lymphocyte differentiation, survival, and function, while JAK2 promotes signal transduction of erythropoietin and thrombopoietin. JAKs are in close proximity to the cytokine and growth factor receptor’s cytoplasmic region. Upon binding of cytokines and growth factors, JAKs are activated, undergoing cross-phosphorylation and tyrosine phosphorylation. This process also reveals selective binding sites for STATs, which are DNA-binding proteins that also bind to the cytoplasmic region of cytokine or growth factor receptors. Activated JAKs and STATs translocate to the nucleus as transcription factors to regulate gene expression of pro-inflammatory cytokines such as IL-6, IL-10, and nuclear factor κB (NF-κB). They also activate downstream pathways that promote erythroid, myeloid, and megakaryocytic development. The molecular pathogenesis of myeloproliferative neoplasms is not fully understood; however, JAK2 is constitutively activated and the JAK-STAT signaling pathway becomes deregulated and aberrant. Ruxolitinib is a selective and potent inhibitor of JAK2 and JAK1, with some affinity against JAK3 and TYK2. Anticancer effects of ruxolitinib are attributed to its inhibition of JAKs and JAK-mediated phosphorylation of STAT3. By downregulating the JAK-STAT pathway, ruxolitinib inhibits myeloproliferative and suppresses the plasma levels of pro-inflammatory cytokines such as IL-6 and TNF-α. Activated JAKs are also implicated in graft-versus-host-disease (GVHD), which is a severe immune complication of allogeneic hematopoietic cell transplantation GVHD is associated with significant morbidity and mortality, especially for patients who do not respond well to corticosteroid therapy. Activated JAKS stimulate T-effector cell responses, leading to increased proliferation of effector T cells and heightened production of pro-inflammatory cytokines. By blocking JAK1 and JAk2, ruxolitinib inhibits donor T-cell expansion and suppresses pro-inflammatory responses. By directly targeting both JAK1 and JAK2 through small-molecule inhibition, ruxolitinib elicits a reduction in splenomegaly and disease-related symptoms in patients with intermediate- or high-risk myelofibrosis while maintaining an acceptable toxicity profile and a low treatment-discontinuation rate.

or

Ruxolitinib phosphate, a selective inhibitor of Janus kinase (JAK) 1 and 2, is an antineoplastic agent. JAK1 and 2 mediate the signaling of cytokines and growth factors that are important for hematopoiesis and immune function. JAK signaling involves the recruitment of signal transducers and activators of transcription (STAT) to cytokine receptors, activation, and subsequent localization of STATs to the nucleus leading to modulation of gene expression. Myelofibrosis is a myeloproliferative neoplasm known to be associated with dysregulated JAK1 and 2 signalings. Ruxolitinib demonstrated dose- and time-dependent inhibition of cytokine-induced phosphorylated STAT3 with maximal inhibition occurring 1-2 hours after single-dose administration (ranging from 5-200 mg) in healthy individuals at all dosage levels.

Ruxolitinib is an antineoplastic agent that inhibits cell proliferation, induces apoptosis of malignant cells, and reduces pro-inflammatory cytokine plasma levels by inhibiting JAK-induced phosphorylation of signal transducer and activator of transcription (STAT). Inhibition of STAT3 phosphorylation, which is used as a marker of JAK activity, by ruxolitinib is achieved at two hours after dosing which returned to near baseline by 10 hours in patients with myelofibrosis and polycythemia vera. In clinical trials, ruxolitinib reduced splenomegaly and improved symptoms of myelofibrosis. In a mouse model of myeloproliferative neoplasms, administration of ruxolitinib was associated with prolonged survival. Ruxolitinib inhibits both mutant and wild-type JAK2; however, JAK2V617F mutation, which is often seen in approximately 50% of patients with myelofibrosis, was shown to reduce ruxolitinib sensitivity, which may also be associated with possible resistance to JAK inhibitor treatment.

Indications

  • Ruxolitinib is indicated for the treatment of the following conditions: – intermediate or high-risk myelofibrosis (MF), including prima1y MF, post-polycythemia vera MF and post-essential thrombocythemia MF in adults. It is also used to treat disease-related splenomegaly or symptoms in adult patients with these conditions. – polycythemia vera (PV) in adults who have had an inadequate response to or are intolerant of hydroxyurea. – steroid-refracto1y acute graft-versus-host disease (GVHD) in adult and pediatric patients 12 years and older. – chronic GVHD in patients aged 12 years and older who have failed one or two lines of systemic therapy. Topical ruxolitinib is indicated for: – the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised patients 12 years of age and older whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. – the treatment of nonsegmental vitiligo in adult and pediatric patients 12 years of age and older.
  • Myelofibrosis (MF): Jakavi is indicated for the treatment of disease-related splenomegaly or symptoms in adult patients with primary myelofibrosis (also known as chronic idiopathic myelofibrosis), post polycythemia vera myelofibrosis or post essential thrombocythaemia myelofibrosis.
  • Polycythaemia vera (PV): Jakavi is indicated for the treatment of adult patients with polycythemia vera who are resistant to or intolerant of hydroxyurea.
  • Graft versus host disease (GvHD): Jakavi is indicated for the treatment of patients aged 12 years and older with acute graft versus host disease or chronic graft versus host disease who have an inadequate response to corticosteroids or other systemic therapies.
  • Ruxolitinib is a small molecule Janus kinase inhibitor that is used in the treatment of intermediate or high-risk myelofibrosis and resistant forms of polycythemia vera and graft-vs-host disease.
  • Treatment of vitiligo.
  • Ruxolitinib is a kinase inhibitor used to treat various types of myelofibrosis, and polycythemia vera in patients who have not responded to or cannot tolerate hydroxyurea, and to treat graft-versus-host disease in cases that are refractory to steroid treatment.
  • Acute Graft-Versus-Host Disease (GVHD)
  • Chronic Graft Versus Host Disease
  • Non-segmental Vitiligo
  • Post Polycythemia Vera Myelofibrosis
  • Post-essential Thrombocythemia Myelofibrosis (Post-ET MF)
  • Primary Myelofibrosis (PMF)
  • High-risk Myelofibrosis
  • Intermediate risk Myelofibrosis
  • Mild Atopic dermatitis
  • Moderate Atopic dermatitis
  • Refractory Polycythemia vera

Use in Cancer

Ruxolitinib phosphate is approved for use in adults to treat:

Ruxolitinib phosphate is also being studied in the treatment of some types of cancer.

Contraindications

  • active tuberculosis
  • a bad infection
  • cancer or malignancy
  • squamous cell carcinoma
  • anemia
  • decreased blood platelets
  • low levels of a type of white blood cell called neutrophils
  • hardening of the arteries due to plaque buildup
  • obstruction of a blood vessel by a blood clot
  • a blood clot
  • a patient who is producing milk and breastfeeding
  • basal cell carcinoma of the skin
  • malignant lymphoma
  • progressive multifocal leukoencephalopathy, a type of brain infection
  • a type of skin cancer called Merkel cell carcinoma
  • chronic kidney disease stage 3A (moderate)
  • chronic kidney disease stage 3B (moderate)
  • chronic kidney disease stage 4 (severe)
  • chronic kidney disease stage 5 (failure)
  • kidney disease with likely reduction in kidney function
  • Child-Pugh class A liver impairment
  • Child-Pugh class B liver impairment
  • Child-Pugh class C liver impairment

Dosage

Strengths: 5 mg; 10 mg; 15 mg; 20 mg; 25 mg

Myeloproliferative Disorder

  • Doses should be titrated based on safety and efficacy; CBC (complete blood count) and platelet counts should be performed every 2 to 4 weeks until doses are stabilized and then as clinically indicated

Initial Dose Based on Platelet Count:

  • Platelets greater than 200 x 10(9)/L: 20 mg orally twice a day
  • Platelets 100 x 10(9)/L to 200 x 10(9)/L: 15 mg orally twice a day
  • Platelets 50 x 10(9)/L to less than 100 x 10(9)/L: 5 mg orally twice a day

INSUFFICIENT RESPONSE: Failure to achieve a reduction from baseline in either palpable spleen length of 50% or a 35% reduction in spleen volume as measured by computed tomography (CT) or magnetic resonance imaging (MRI); Platelet count greater than 125 × 10(9)/L at 4 weeks and platelet count never below 100 × 10(9)/L; ANC Levels greater than 0.75 × 10(9)/L

For Patients Starting Treatment with a Platelet Count of 100 × 10(9)/L or greater:

  • May increase in 5 mg twice a day increments after the first 4 weeks and then no more frequently than every 2 weeks if the response is insufficient and platelet and neutrophil counts are adequate; MAXIMUM DOSE: 25 mg orally twice a day

For Patients Starting Treatment with a Platelet Count of 50 to less than 100 × 10(9)/L or greater:

  • May increase in 5 mg once a day increments to a maximum of 5 mg twice a day after the first 4 weeks and then no more frequently than every 2 weeks if the response is insufficient and platelet count remains at least 40 × 10(9)/L, platelet count has not fallen by more than 20% in the prior 4 weeks, the ANC is more than 1 × 10(9)/L, and the dose has not been reduced or interrupted for an adverse event or hematological toxicity in the prior 4 weeks.

DOSE MODIFICATIONS FOR HEMATOLOGIC TOXICITY: For Patients Starting Treatment with a Platelet Count of 100 × 10(9)/L or greater:
INTERRUPT treatment for PLATELET COUNTS less than 50 x 10(9)/L or ANC (absolute neutrophil count) less than 0.5 x 10(9)/L: RESTART once platelet count is above 50 x 10(9)/L and ANC above 0.75 x 10(9)/L

  • When restarting, begin with a dose that is at least 5 mg twice a day below the dose at the interruption
  • Maximum Restarting Dose after Interruption for Thrombocytopenia:
  • Platelet Count: Greater than or equal to 125 × 10(9)/L: Restart at no more than 20 mg twice a day
  • Platelet Count 100 to less than 125 × 10(9)/L: Restart at no more than 15 mg twice a day
  • Platelet Count 75 to less than 100 × 10(9)/L: Restart at no more than 10 mg twice a day for at least 2 weeks; if stable, may increase to 15 mg twice a day
  • Platelet Count 50 to less than 75 × 10(9)/L: Restart at no more than 5 mg twice a day for at least 2 weeks; if stable, may increase to 10 mg twice a day

INTERRUPT treatment for ANC below 0.5 × 10(9)/L, restart once ANC recovers to 0.75 × 10(9)/L or greater: Restart at the higher of 5 mg once a day OR 5 mg twice a day below the largest dose in the week prior to the treatment interruption

DOSE REDUCTIONS: To Avoid Dose Interruptions for Thrombocytopenia Among Patients Starting Treatment with a Platelet Count of 100 x 10(9)/L or greater, consider the following:
If the Dose at the time of Thrombocytopenia is 25 mg twice a day:

  • Reduce the dose to 20 mg twice a day for a platelet count of 100 to less than 125 x 10(9)/L
  • Reduce the dose to 10 mg twice a day for a platelet count of 75 to less than 100 x 10(9)/L
  • Reduce the dose to 5 mg twice a day for a platelet count of 50 to less than 75 x 10(9)/L

If the Dose at the time of Thrombocytopenia is 20 mg twice a day:

  • Reduce the dose to 15 mg twice a day for a platelet count of 100 to less than 125 x 10(9)/L
  • Reduce the dose to 10 mg twice a day for a platelet count of 75 to less than 100 x 10(9)/L
  • Reduce the dose to 5 mg twice a day for a platelet count of 50 to less than 75 x 10(9)/L

If the Dose at the time of Thrombocytopenia is 15 mg twice a day:

  • Reduce the dose to 10 mg twice a day if the platelet count is 75 to less than 100 x 10(9)/L
  • Reduce the dose to 5 mg twice a day if the platelet count is 50 to less than 75 x 10(9)/L

If the Dose at the time of Thrombocytopenia is 10 mg twice a day:

  • Reduce the dose to 5 mg twice a day if the platelet count is 50 to less than 75 x 10(9)/L

DOSE MODIFICATIONS FOR HEMATOLOGIC TOXICITY: For Patients Starting Treatment with a Platelet Count of 50 to less than 100 × 10(9)/L or greater:

INTERRUPT treatment for PLATELET COUNTS less than 25 x 10(9)/L or ANC less than 0.5 x 10(9)/L
RESTART once platelet count is above 35 x 10(9)/L and ANC above 0.75 x 10(9)/L

  • Restart at the higher of 5 mg once a day or 5 mg twice a day below the largest dose in the week prior to the decrease in platelet count below 25 x 10(9)/L or ANC below 0.5 x 10(9)/L that led to dose interruption

REDUCE dose for PLATELET COUNTS less than 35 x 10(9)/L:

  • Platelet Count less than 25 x 10(9)/L: Interrupt dosing
  • Platelet Count 25 to less than 35 x 10(9)/L AND the platelet count decline is less than 20% during the prior 4 weeks: Decrease by 5 mg once a day; for patients on 5 mg once a day, maintain this dose
  • Platelet Count 25 to less than 35 x 10(9)/L AND the platelet count decline is 20% or greater during prior 4 weeks: Decrease by 5 mg twice a day; for patients on 5 mg twice a day, decrease to 5 mg once a day; for patients on 5 mg once a day, maintain this dose

DOSE MODIFICATION FOR BLEEDING:

  • Interrupt treatment for bleeding requiring intervention regardless of current platelet count
  • Once bleeding event resolves, consider resuming at prior dose if the underlying cause of bleeding has been controlled
  • If the bleeding event has resolved but the underlying cause persists, consider resuming treatment with at a lower dose
  • Based on limited clinical data, long-term maintenance at 5 mg twice a day has not shown benefit; this dose should be limited to patients for whom the benefits outweigh the potential risks.
  • Discontinue therapy if there is no spleen size reduction or symptom improvement after 6 months of therapy.
  • For the treatment of intermediate or high-risk myelofibrosis (MF), including primary MF, post-polycythemia vera MF, and post-essential thrombocythemia MF.

Graft Versus Host Disease

  • Monitor complete blood counts (CBC), including platelet count and ANC, and bilirubin prior to
    initiating therapy, every 2 to 4 weeks until doses are stabilized, and then as indicated clinically: Acute Graft-Versus-Host Disease (GVHD): Initial dose: 5 mg orally 2 times a day
  • Dose titration: Consider increasing the dose to 10 mg orally 2 times a day after at least 3 days if the ANC (absolute neutrophil count) and platelet counts are not decreased by 50% or more relative to the first day of dosing
  • Duration of therapy: Consider tapering after 6 months for those with response who have stopped therapeutic doses of corticosteroids; taper by 1 dose level every 8 weeks (see comments); if signs or symptoms of GVHD recur during or after the taper, consider retreatment
  • Chronic GVHD: Initial dose: 10 mg orally 2 times a day
  • Duration of therapy: Consider tapering after 6 months for those with response who have stopped therapeutic doses of corticosteroids; taper by 1 dose level every 8 weeks (see comments); if signs or symptoms of GVHD recur during or after the taper, consider retreatment
  • The dose level decreases from 10 mg twice a day to 5 mg once a day.
  • See the Dose Adjustment section for dose modification guidance for adverse reactions.
  • For the treatment of steroid-refractory acute GVHD and treatment of chronic GVHD after the failure of 1 or 2 lines of systemic therapy.

Polycythemia Vera

  • Doses should be titrated based on safety and efficacy; CBC and platelet counts should be performed every 2 to 4 weeks until doses are stabilized and then as clinically indicated
  • Initial dose: 10 mg orally twice a day
  • The dose may be titrated based on safety and efficacy

INSUFFICIENT RESPONSE: Consider dose increases in patients with inadequate efficacy as demonstrated by one or more of the following: Continued need for phlebotomy; WBC greater than the upper limit of normal range; Platelet count greater than the upper limit of normal range; Palpable spleen that is reduced by less than 25% from baseline; Platelet count greater than or equal to 140 × 10(9)/L;. Hb (hemoglobin) greater than or equal to 12 g/dL; ANC greater than or equal to 1.5 × 10(9)/L
DOSE INCREASES: Increased dose in 5 mg twice a day increments to a MAXIMUM of 25 mg twice a day; doses should not be increased during the first 4 weeks of therapy and not more frequently than every two weeks

DOSE REDUCTIONS: Dose reductions should be considered for Hb and platelet count decreases:

  • Hb greater than or equal to 12 g/dL AND platelet count greater than or equal to 100 × 10(9)/L: No change needed
  • Hb 10 to less than 12 g/dL AND platelet count 75 to less than 100 × 10(9)/L: Dose reductions should be considered with the goal of avoiding dose interruptions for anemia and thrombocytopenia
  • Hb 8 to less than 10 g/dL OR platelet count 50 to less than 75 × 10(9)/L: Reduce dose by 5 mg twice a day; for patients on 5 mg twice a day, decrease the dose to 5 mg once a day
  • Hb less than 8 g/dL OR platelet count less than 50 × 10(9)/L OR ANC less than 1 x 10(9)/L: Interrupt dosing.

RESTARTING THERAPY:  After recovery of the hematologic parameter(s) to acceptable levels, dosing may be restarted. Restarted doses may be titrated, but the maximum total daily dose should not exceed 5 mg less than the dose that resulted in the dose interruption (One exception: following phlebotomy-associated anemia, the maximal total daily dose allowed would not be limited). Use the most severe category of a patient’s Hb, platelet count, or ANC abnormality to determine the corresponding MAXIMUM restarting dose:

  • Hb 8 to less than 10 g/dL OR platelet count 50 to less than 75 × 10(9)/L OR ANC 1 to less than 1.5 × 10(9)/L: MAXIMUM restarting dose: 5 mg twice a day or no more than 5 mg twice a day less than the dose which resulted in dose interruption
  • Hb 10 to less than 12 g/dL OR platelet count 75 to less than 100 × 10(9)/L OR ANC 1.5 to less than 2 × 10(9)/L: MAXIMUM restarting dose: 10 mg twice day or no more than 5 mg twice a day less than the dose which resulted in dose interruption
  • Hb greater than or equal to 12 g/dL OR platelet count greater than or equal to 100 × 10(9)/L OR ANC greater than or equal to 2 × 10(9)/L: MAXIMUM restarting dose: 15 mg twice a day or no more than 5 mg twice a day less than the dose which resulted in dose interruption
  • Dose should be continued for at least 2 weeks, if stable may increase dose by 5 mg twice a day
  • For treatment of polycythemia vera (PV) in adults who have had an inadequate response to or are intolerant of hydroxyurea.

Graft Versus Host Disease

12 years or older:

Monitor complete blood counts (CBC), including platelet count and ANC, and bilirubin prior to
initiating therapy, every 2 to 4 weeks until doses are stabilized, and then as indicated clinically:

  • Acute Graft-Versus-Host Disease (GVHD): Initial dose: 5 mg orally 2 times a day
  • Dose titration: Consider increasing the dose to 10 mg orally 2 times a day after at least 3 days if the ANC (absolute neutrophil count) and platelet counts are not decreased by 50% or more relative to the first day of dosing
  • Duration of therapy: Consider tapering after 6 months for those with response who have stopped therapeutic doses of corticosteroids; taper by 1 dose level every 8 weeks (see comments); if signs or symptoms of GVHD recur during or after the taper, consider retreatment
  • Chronic GVHD: Initial dose: 10 mg orally 2 times a day
  • Duration of therapy: Consider tapering after 6 months for those with response who have stopped therapeutic doses of corticosteroids; taper by 1 dose level every 8 weeks (see comments); if signs or symptoms of GVHD recur during or after the taper, consider retreatment
  • The dose level decreases from 10 mg twice a day to 5 mg once a day.
  • See the Dose Adjustment section for dose modification guidance for adverse reactions.
  • For the treatment of steroid-refractory acute GVHD and treatment of chronic GVHD after the failure of 1 or 2 lines of systemic therapy in pediatric patients 12 years or older.

Renal Dose Adjustments

  • Mild Renal Impairment (CrCl 60 mL/min or greater): No adjustment recommended

Moderate or Severe Renal Impairment (CrCl 15 to less than 60 mL/min):

  • MF: Platelet Count greater than 150 x 10(9)/L: No adjustment recommended
  • MF: Platelet Count: 100 to 150 x 10(9)/L: Initial dose: 10 mg twice a day
  • MF: Platelet Count: 50 to less than 100 x 10(9)/L: Initial dose: 5 mg once a day
  • MF: Platelets less than 50 x 10(9)/L: Avoid use
  • MF: ESRD (CrCl less than 15 mL/min) not on dialysis: Avoid use
  • MF: ESRD on dialysis: See Dialysis

Moderate or Severe Renal Impairment (CrCl 15 to less than 60 mL/min):

  • PV: Initial dose: 5 mg twice a day
  • PV: ESRD (CrCl less than 15 mL/min) not on dialysis: Avoid use
  • PV: ESRD on dialysis: See Dialysis

Moderate or Severe Renal Impairment (CrCl 15 to less than 60 mL/min):

  • Acute GVHD: Initial dose: 5 mg once a day
  • Chronic GVHD: Initial dose: 5 mg twice a day
  • GVHD (acute or chronic) (CrCl less than 15 mL/min) not on dialysis: Avoid the use
  • GVHD (acute or chronic): ESRD on dialysis: See Dialysis

Liver Dose Adjustments

Mild, Moderate, or Severe Hepatic Impairment (Child-Pugh Class A, B, C):

  • MF: Platelet Count greater than 150 x 10(9)/L: No adjustment recommended
  • MF: Platelet Count: 100 to 150 x 10(9)/L: Initial dose: 10 mg twice a day
  • MF: Platelet Count: 50 to less than 100 x 10(9)/L: Initial dose: 5 mg once a day
  • MF: Platelets less than 50 x 10(9)/L: Avoid use

Mild, Moderate, or Severe Hepatic Impairment (Child-Pugh Class A, B, C):

  • PV: Initial dose: 5 mg twice a day

Acute GVHD:

  • Mild, Moderate, or Severe Hepatic Impairment (based on NCI criteria without liver GVHD): No adjustment is recommended
  • Stage 1, 2, or 3 Liver Acute GVHD: No adjustment recommended
  • Stage 4 Liver Acute GVHD: Initial dose: 5 mg once a day

Chronic GVHD:

  • Mild, Moderate or Severe Hepatic Impairment (based on NCI criteria without liver GVHD): No adjustment is recommended
  • Score 1 or 2 Liver Chronic GVHD: No adjustment recommended
  • Score 3 Liver Chronic GVHD: Monitor blood counts more frequently for toxicity and modify dosage for adverse reactions if they occur

Dose Adjustments

DRUG INTERACTIONS:

  • Avoid concomitant use of Ruxolitinib with Fluconazole at doses greater than 200 mg/day
  • Modify the dose of Ruxolitinib when used with Strong CYP450 3A4 Inhibitors or Fluconazole less than 200 mg/day
  • MF: Initial dose with platelets 100 x 10(9)/L or greater: 10 mg twice a day
  • MF: Initial dose with platelets 50 to less than 100 x 10(9)/L: 5 mg once a day
  • PV: Initial dose: 5 mg twice a day

MF OR PV ON STABLE RUXOLITINIB (adding strong CYP450 3A4 inhibitor or fluconazole dose less than 200 mg/day):

  • A dose greater than or equal to 10 mg twice a day: Decrease dose by 50% (rounded to closest tablet strength)
  • Stable on 5 mg twice a day: Reduce to 5 mg once a day
  • Stable on 5 mg once a day: Avoid the use of strong CYP450 3A4 inhibitor or fluconazole or interrupt ruxolitinib for the duration of strong CYP450 3A4 inhibitor or fluconazole use

ACUTE GVHD: With fluconazole 200 mg/day or less: Initial dose: 5 mg once a day
CHRONIC GVHD: With fluconazole 200 mg/day or less: Initial dose: 5 mg twice a day
ACUTE OR CHRONIC GVHD: With CYP450 3A4 Inhibitors: Monitor blood counts more frequently for toxicity and modify the ruxolitinib dosage for adverse reactions if they occur
GVHD: DOSE MODIFICATIONS for ADVERSE REACTIONS

Dose Level Reductions for Patients with GVHD:

  • A dose of 10 mg twice a day should be reduced to 5 mg twice a day
  • A dose of 5 mg twice a day should be reduced to 5 mg once a day
  • Patients unable to tolerate 5 mg once a day should have treatment interrupted until their clinical and/or laboratory parameters recover

DOSE MODIFICATION for Patients with ACUTE GVHD:

  • Clinically significant thrombocytopenia after supportive measures: Reduce dose by 1 level; when platelets recover to previous values, dosing may return to prior dose level
  • ANC less than 1 × 10(9) considered related to therapy: Hold for up to 14 days; resume at 1 dose level lower upon recovery
  • Total Bilirubin Elevation, no liver GVHD:
  • Total bilirubin elevated 3 to 5 × ULN (times upper limit of normal), continue at 1 dose level lower until recovery
  • Total bilirubin elevated greater than 5 to less than 10 × ULN, hold for up to 14 days until bilirubin is 1.5 or less than ULN, resume at current dose upon recovery
  • Total bilirubin greater than 10 × ULN, hold for up to 14 days until bilirubin is 1.5 or less than ULN, resume at 1 dose level lower upon recovery
  • Total Bilirubin Elevation, liver GVHD: Total bilirubin greater than 3 × ULN, continue at 1 dose level lower until recovery

DOSE MODIFICATION for Patients with CHRONIC GVHD:

  • Platelet count less than 20 × 10(9)/L: Reduce by 1 dose level; if resolved within 7 days, may return to initial dose level, if not resolved within 7 days, maintain at 1 dose level lower
  • ANC less than 0.75 × 10(9)/L (considered related to therapy): Reduce by 1 dose level, resume at initial dose level upon recovery
  • ANC less than 0.5 × 10(9)/L (considered related to therapy): Hold for up to 14 days, resume at 1 dose level lower upon recovery; may resume initial dose level when ANC greater than 1 × 10(9)/L
  • Total bilirubin elevated 3 to 5 × ULN: Continue at 1 dose level lower until recovery; if resolved within 14 days, then increase by 1 dose level, if not resolved within 14 days, then maintain the decreased dose level
  • Total bilirubin elevated greater than 5 to less than 10 × ULN: Hold for up to 14 days until resolved; resume at current dose upon recovery, if not resolved within 14 days, resume at 1 dose level lower upon recovery
  • Total bilirubin greater than 10 × ULN: Hold for up to 14 days until resolved, resume at 1 dose level lower upon recovery, if not resolved within 14 days, discontinue
  • Other Adverse Reactions: Grade 3: Continue at 1 dose level lower until recovery
  • Other Adverse Reactions: Grade 4: Discontinue

Therapy Discontinuation:

  • MF or PV: When discontinuing therapy for reasons other than thrombocytopenia, a gradual tapering should be considered, for example by 5 mg twice daily each week.
  • Acute or Chronic GVHD: Consider tapering therapy after 6 months in patients with response who have discontinued therapeutic doses of corticosteroids; taper by 1 dose level approximately every 8 weeks (10 mg twice daily to 5 mg once daily). If GVHD signs or symptoms recur during or after the taper, consider retreatment

Administration advice:

  • Take orally without regard to meals
  • For a missed dose, the patient should not take an additional dose but should take the next usual scheduled dose
  • Suspend 1 table in approximately 40 mL of water; stir for approximately 10 minutes
  • Administer suspension using an appropriate syringe within 6 hours of the tablet being dispersed; rinse with 75 mL of water after administration
  • The effect of tube-feeding preparations on drug exposure has not been evaluated
  • Perform pretreatment complete blood count (CBC) and monitor CBCs every 2 to 4 weeks until doses are stabilized, and then as clinically indicated
  • Perform periodic skin examinations
  • Assess lipid parameters approximately 8¬ to 12 weeks following initiation of therapy; monitor accordingly
  • Patients should be advised to read the FDA-approved patient labeling (Patient Information).
  • Patients should be aware of potential adverse events including thrombocytopenia, anemia, neutropenia, infections, and increased cholesterol.
  • Patients should be advised to continue therapy as prescribed and talk with their healthcare provider prior to discontinuation.
  • Patients should be aware that drug interactions may require dose modifications and they should discuss all medication use with their healthcare provider.

Side Effects

The Most Common

  • dizziness
  • headache
  • tiredness
  • shortness of breath
  • weight gain
  • gas
  • diarrhea
  • constipation
  • nausea
  • rash
  • muscle or joint pain
  • swelling of the arms, legs or other parts of the body
  • unusual or heavy bleeding or bruising
  • fever, sore throat, chills, cough, chest pain, night sweats, frequent, painful, urgent urination, and other signs of infection
  • burning, tingling, itching, or skin sensitivity on one side of the body or face with painful rash or blisters appearing several days later.
  • new sores, bumps, or discoloration or other changes to the skin
  • pale skin, tiredness, or shortness of breath (especially while exercising)
  • difficulty moving or keeping your balance, weakness of the legs or arms that keeps getting worse, difficulty understanding or speaking, loss of memory, vision problems, or changes in personality
  • swelling, pain, tenderness, warmth or redness in one or both legs
  • shortness of breath
  • difficulty breathing
  • pain in the chest, arms, back, neck, jaw, or stomach
  • breaking out in cold sweat
  • nausea or vomiting
  • lightheadedness
  • slow or difficult speech
  • numbness or weakness of the face, arm, or leg on one side of your body

More common

  • Black, tarry stools
  • bladder pain
  • bleeding gums
  • blood in the urine or stools
  • blurred vision
  • bruising
  • chest tightness
  • chills
  • cloudy urine
  • collection of blood under the skin
  • cough
  • coughing up blood
  • deep, dark purple bruise
  • difficult, burning, or painful urination
  • difficulty in breathing or swallowing
  • dizziness
  • fever
  • frequent urge to urinate
  • headache
  • hoarseness
  • increased menstrual flow or vaginal bleeding
  • itching, pain, redness, or swelling
  • large, flat, blue or purplish patches in the skin
  • lower back or side pain
  • nervousness
  • nosebleeds
  • painful or difficult urination
  • pale skin
  • paralysis
  • pinpoint red spots on the skin
  • pounding in the ears
  • prolonged bleeding from cuts
  • pus in the urine
  • red or dark brown urine
  • small, red or purple spots on the skin
  • slow or fast heartbeat
  • sore throat
  • swelling
  • tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over the affected area
  • trouble breathing
  • ulcers, sores, or white spots in the mouth
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Rare

  • Painful blisters on the trunk of the body
  • Anxiety
  • chest pain
  • fainting
  • pain, redness, or swelling in the arm or leg
  • pains in the chest, groin, or legs, especially calves of the legs
  • persistent non-healing sore
  • pink growth
  • reddish patch or irritated area
  • severe headaches of sudden onset
  • sudden loss of coordination
  • sudden onset of slurred speech
  • sudden vision changes
  • shiny bump
  • a white, yellow, or waxy scar-like area

Drug Interaction

Pregnancy and Lactation

AU TGA pregnancy category: C
US FDA pregnancy category: N

Pregnancy

When pregnant rats and rabbits were administered ruxolitinib during the period of organogenesis adverse developmental outcomes occurred at doses associated with maternal toxicity (see Data). There are no studies on the use of Jakafi in pregnant women to inform drug-associated risks. The background risk of major birth defects and miscarriage for the indicated populations is unknown. Adverse outcomes in pregnancy occur regardless of the health of the mother or the use of medications. The background risk in the U.S. general population of major birth defects is 2% to 4% and miscarriage is 15% to 20% of clinically recognized pregnancies.

Lactation

No information is available on the clinical use of ruxolitinib during breastfeeding. Because ruxolitinib is 97% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during ruxolitinib therapy and for 2 weeks after the last dose.

Why is this medication prescribed?

Ruxolitinib is used to treat myelofibrosis (a cancer of the bone marrow in which the bone marrow is replaced by scar tissue and causes decreased blood cell production). It is also used to treat polycythemia vera (PV; a slow growing cancer of the blood in which the bone marrow makes too many red blood cells) in people who were not able to be treated successfully with hydroxyurea. Ruxolitinib is also used to treat acute graft versus host disease (aGVHD; a complication of hematopoietic stem-cell transplant [HSCT; a procedure that replaces diseased bone marrow with healthy bone marrow] that usually develops within the first months after HSCT) in adults and children 12 years of age and older who were treated unsuccessfully with steroid medications. It is also used to treat chronic GVHD (cGVHD; a complication of HSCT that usually develops at least 3 months after HSCT) in adults and children 12 years of age and older who were treated unsuccessfully with 1 or 2 other treatments. Ruxolitinib is in a class of medications called kinase inhibitors. It works to treat myelofibrosis and PV by blocking the signals that cause cancer cells to multiply. This helps to stop the spread of cancer cells. It works to treat GVHD by blocking the signals of the cells that cause GVHD.

How should this medicine be used?

Ruxolitinib comes as a tablet to take by mouth. It is usually taken with or without food two times a day. Take ruxolitinib at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ruxolitinib exactly as directed. Do not take more or less of it, or take it more often than prescribed by your doctor.

If you are being treated for myelofibrosis or PV your doctor may start you on a low dose of ruxolitinib for the first four weeks of treatment, and gradually increase your dose after that time, not more than once every 2 weeks. If you are being treated for acute GVHD your doctor may start you on a low dose of ruxolitinib and may increase your dose after at least 3 days of therapy. If you are being treated for acute or chronic GVHD your doctor may gradually lower your dose of ruxolitinib after at least 6 months of therapy.

Swallow the tablets whole; do not chew or crush them.

If you can not have food by mouth and have a nasogastric (NG) tube, your doctor may tell you to take ruxolitinib through the nasogastric (NG) tube. Your doctor or pharmacist will explain how to prepare ruxolitinib to give through an NG tube.

Your doctor will order blood tests before and during your treatment to see how you are affected by this medication. Your doctor may increase or decrease your dose of ruxolitinib during your treatment, or may tell you to stop taking ruxolitinib for awhile. This depends on how well the medication works for you, your lab test results, and if you experience side effects. Talk to your doctor about how you are feeling during your treatment. Continue to take ruxolitinib even if you feel well. Do not stop taking ruxolitinib without talking to your doctor. If your doctor decides to stop your treatment with ruxolitinib, your doctor may decrease your dose gradually. Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

What special precautions should I follow?

Before taking ruxolitinib,

  • tell your doctor and pharmacist if you are allergic to ruxolitinib, any other medications, or any of the ingredients in ruxolitinib. Ask your pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antifungal medications including itraconazole (Sporanox), ketoconazole, and voriconazole (Vfend); carbamazepine (Carbatrol, Equetro, Tegretol, others); clarithromycin; efavirenz (Sustiva, in Atripla, Symfi); erythromycin (E.E.S, Eryc, Ery-tab); fluconazole (Diflucan); HIV protease inhibitors including indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra, Viekira Pak), and saquinavir (Invirase); nefazodone; nevirapine (Viramune); phenytoin (Dilantin, Phenytek); pioglitazone (Actos, in Oseni, Duetact); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate, Rifater); and telaprevir (Incivik). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with ruxolitinib, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
  • tell your doctor what herbal products you are taking, especially St. John’s wort.
  • tell your doctor if you have anemia, an infection, if you are on dialysis, or if you were recently around someone who has tuberculosis (TB, a severe lung infection) or visited or lived where TB is common. Also tell your doctor if you are a current or past smoker; if you have or have ever had TB; high cholesterol or triglycerides; a blood clot, heart attack, stroke, or other heart problems; skin cancer; herpes zoster (shingles); hepatitis B or other liver disease; or kidney disease.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking ruxolitinib, call your doctor. You should not breast-feed while taking ruxolitinib and for 2 weeks after your final dose.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

Skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Frequently Asked Questions

Mechanism of ActionThe Janus kinase (JAK) family of protein tyrosine kinases comprises JAK1, JAK2, JAK3, and non-receptor tyrosine kinase 2 (TYK2). JAKs play a pivotal role in intracellular signalling pathways of various cytokines and growth factors essential to hematopoiesis, such as interleukin, erythropoietin, and thrombopoietin. JAKs have diverse functions: JAK1 and JAK3 promote lymphocyte differentiation, survival, and function, while JAK2 promotes signal transduction of erythropoietin and thrombopoietin. JAKs are in close proximity to the cytokine and growth factor receptor’s cytoplasmic region. Upon binding of cytokines and growth factors, JAKs are activated, undergoing cross-phosphorylation and tyrosine phosphorylation. This process also reveals selective binding sites for STATs, which are DNA-binding proteins that also bind to the cytoplasmic region of cytokine or growth factor receptors. Activated JAKs and STATs translocate to the nucleus as transcription factors to regulate gene expression of pro-inflammatory cytokines such as IL-6, IL-10, and nuclear factor κB (NF-κB). They also activate downstream pathways that promote erythroid, myeloid, and megakaryocytic development. The molecular pathogenesis of myeloproliferative neoplasms is not fully understood; however, JAK2 is constitutively activated and the JAK-STAT signaling pathway becomes deregulated and aberrant. Ruxolitinib is a selective and potent inhibitor of JAK2 and JAK1, with some affinity against JAK3 and TYK2. Anticancer effects of ruxolitinib are attributed to its inhibition of JAKs and JAK-mediated phosphorylation of STAT3. By downregulating the JAK-STAT pathway, ruxolitinib inhibits myeloproliferative and suppresses the plasma levels of pro-inflammatory cytokines such as IL-6 and TNF-α. Activated JAKs are also implicated in graft-versus-host-disease (GVHD), which is a severe immune complication of allogeneic hematopoietic cell transplantation GVHD is associated with significant morbidity and mortality, especially for patients who do not respond well to corticosteroid therapy. Activated JAKS stimulate T-effector cell responses, leading to increased proliferation of effector T cells and heightened production of pro-inflammatory cytokines. By blocking JAK1 and JAk2, ruxolitinib inhibits donor T-cell expansion and suppresses pro-inflammatory responses. By directly targeting both JAK1 and JAK2 through small-molecule inhibition, ruxolitinib elicits a reduction in splenomegaly and disease-related symptoms in patients with intermediate- or high-risk myelofibrosis while maintaining an acceptable toxicity profile and a low treatment-discontinuation rate.orRuxolitinib phosphate, a selective inhibitor of Janus kinase (JAK) 1 and 2, is an antineoplastic agent. JAK1 and 2 mediate the signaling of cytokines and growth factors that are important for hematopoiesis and immune function. JAK signaling involves the recruitment of signal transducers and activators of transcription (STAT) to cytokine receptors, activation, and subsequent localization of STATs to the nucleus leading to modulation of gene expression. Myelofibrosis is a myeloproliferative neoplasm known to be associated with dysregulated JAK1 and 2 signalings. Ruxolitinib demonstrated dose- and time-dependent inhibition of cytokine-induced phosphorylated STAT3 with maximal inhibition occurring 1-2 hours after single-dose administration (ranging from 5-200 mg) in healthy individuals at all dosage levels.Ruxolitinib is an antineoplastic agent that inhibits cell proliferation, induces apoptosis of malignant cells, and reduces pro-inflammatory cytokine plasma levels by inhibiting JAK-induced phosphorylation of signal transducer and activator of transcription (STAT). Inhibition of STAT3 phosphorylation, which is used as a marker of JAK activity, by ruxolitinib is achieved at two hours after dosing which returned to near baseline by 10 hours in patients with myelofibrosis and polycythemia vera. In clinical trials, ruxolitinib reduced splenomegaly and improved symptoms of myelofibrosis. In a mouse model of myeloproliferative neoplasms, administration of ruxolitinib was associated with prolonged survival. Ruxolitinib inhibits both mutant and wild-type JAK2; however, JAK2V617F mutation, which is often seen in approximately 50% of patients with myelofibrosis, was shown to reduce ruxolitinib sensitivity, which may also be associated with possible resistance to JAK inhibitor treatment.IndicationsRuxolitinib is indicated for the treatment of the following conditions: - intermediate or high-risk myelofibrosis (MF), including prima1y MF, post-polycythemia vera MF and post-essential thrombocythemia MF in adults. It is also used to treat disease-related splenomegaly or symptoms in adult patients with these conditions. - polycythemia vera (PV) in adults who have had an inadequate response to or are intolerant of hydroxyurea. - steroid-refracto1y acute graft-versus-host disease (GVHD) in adult and pediatric patients 12 years and older. - chronic GVHD in patients aged 12 years and older who have failed one or two lines of systemic therapy. Topical ruxolitinib is indicated for: - the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised patients 12 years of age and older whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. - the treatment of nonsegmental vitiligo in adult and pediatric patients 12 years of age and older. Myelofibrosis (MF): Jakavi is indicated for the treatment of disease-related splenomegaly or symptoms in adult patients with primary myelofibrosis (also known as chronic idiopathic myelofibrosis), post polycythemia vera myelofibrosis or post essential thrombocythaemia myelofibrosis. Polycythaemia vera (PV): Jakavi is indicated for the treatment of adult patients with polycythemia vera who are resistant to or intolerant of hydroxyurea. Graft versus host disease (GvHD): Jakavi is indicated for the treatment of patients aged 12 years and older with acute graft versus host disease or chronic graft versus host disease who have an inadequate response to corticosteroids or other systemic therapies. Ruxolitinib is a small molecule Janus kinase inhibitor that is used in the treatment of intermediate or high-risk myelofibrosis and resistant forms of polycythemia vera and graft-vs-host disease. Treatment of vitiligo. Ruxolitinib is a kinase inhibitor used to treat various types of myelofibrosis, and polycythemia vera in patients who have not responded to or cannot tolerate hydroxyurea, and to treat graft-versus-host disease in cases that are refractory to steroid treatment. Acute Graft-Versus-Host Disease (GVHD) Chronic Graft Versus Host Disease Non-segmental Vitiligo Post Polycythemia Vera Myelofibrosis Post-essential Thrombocythemia Myelofibrosis (Post-ET MF) Primary Myelofibrosis (PMF) High-risk Myelofibrosis Intermediate risk Myelofibrosis Mild Atopic dermatitis Moderate Atopic dermatitis Refractory Polycythemia veraUse in Cancer Ruxolitinib phosphate is approved for use in adults to treat:Myelofibrosis (a bone marrow disease) that is an intermediate risk or high risk, including the following types:Primary myelofibrosis. Post-polycythemia vera myelofibrosis. Post-essential thrombocythemia myelofibrosis.Polycythemia vera in patients who cannot be treated with or have not gotten better with hydroxyurea.Ruxolitinib phosphate is also being studied in the treatment of some types of cancer.Contraindicationsactive tuberculosis a bad infection cancer or malignancy squamous cell carcinoma anemia decreased blood platelets low levels of a type of white blood cell called neutrophils hardening of the arteries due to plaque buildup obstruction of a blood vessel by a blood clot a blood clot a patient who is producing milk and breastfeeding basal cell carcinoma of the skin malignant lymphoma progressive multifocal leukoencephalopathy, a type of brain infection a type of skin cancer called Merkel cell carcinoma chronic kidney disease stage 3A (moderate) chronic kidney disease stage 3B (moderate) chronic kidney disease stage 4 (severe) chronic kidney disease stage 5 (failure) kidney disease with likely reduction in kidney function Child-Pugh class A liver impairment Child-Pugh class B liver impairment Child-Pugh class C liver impairmentDosage Strengths: 5 mg; 10 mg; 15 mg; 20 mg; 25 mg Myeloproliferative DisorderDoses should be titrated based on safety and efficacy; CBC (complete blood count) and platelet counts should be performed every 2 to 4 weeks until doses are stabilized and then as clinically indicatedInitial Dose Based on Platelet Count:Platelets greater than 200 x 10(9)/L: 20 mg orally twice a day Platelets 100 x 10(9)/L to 200 x 10(9)/L: 15 mg orally twice a day Platelets 50 x 10(9)/L to less than 100 x 10(9)/L: 5 mg orally twice a dayINSUFFICIENT RESPONSE: Failure to achieve a reduction from baseline in either palpable spleen length of 50% or a 35% reduction in spleen volume as measured by computed tomography (CT) or magnetic resonance imaging (MRI); Platelet count greater than 125 × 10(9)/L at 4 weeks and platelet count never below 100 × 10(9)/L; ANC Levels greater than 0.75 × 10(9)/L For Patients Starting Treatment with a Platelet Count of 100 × 10(9)/L or greater:May increase in 5 mg twice a day increments after the first 4 weeks and then no more frequently than every 2 weeks if the response is insufficient and platelet and neutrophil counts are adequate; MAXIMUM DOSE: 25 mg orally twice a dayFor Patients Starting Treatment with a Platelet Count of 50 to less than 100 × 10(9)/L or greater:May increase in 5 mg once a day increments to a maximum of 5 mg twice a day after the first 4 weeks and then no more frequently than every 2 weeks if the response is insufficient and platelet count remains at least 40 × 10(9)/L, platelet count has not fallen by more than 20% in the prior 4 weeks, the ANC is more than 1 × 10(9)/L, and the dose has not been reduced or interrupted for an adverse event or hematological toxicity in the prior 4 weeks.DOSE MODIFICATIONS FOR HEMATOLOGIC TOXICITY: For Patients Starting Treatment with a Platelet Count of 100 × 10(9)/L or greater: INTERRUPT treatment for PLATELET COUNTS less than 50 x 10(9)/L or ANC (absolute neutrophil count) less than 0.5 x 10(9)/L: RESTART once platelet count is above 50 x 10(9)/L and ANC above 0.75 x 10(9)/LWhen restarting, begin with a dose that is at least 5 mg twice a day below the dose at the interruption Maximum Restarting Dose after Interruption for Thrombocytopenia: Platelet Count: Greater than or equal to 125 × 10(9)/L: Restart at no more than 20 mg twice a day Platelet Count 100 to less than 125 × 10(9)/L: Restart at no more than 15 mg twice a day Platelet Count 75 to less than 100 × 10(9)/L: Restart at no more than 10 mg twice a day for at least 2 weeks; if stable, may increase to 15 mg twice a day Platelet Count 50 to less than 75 × 10(9)/L: Restart at no more than 5 mg twice a day for at least 2 weeks; if stable, may increase to 10 mg twice a dayINTERRUPT treatment for ANC below 0.5 × 10(9)/L, restart once ANC recovers to 0.75 × 10(9)/L or greater: Restart at the higher of 5 mg once a day OR 5 mg twice a day below the largest dose in the week prior to the treatment interruption DOSE REDUCTIONS: To Avoid Dose Interruptions for Thrombocytopenia Among Patients Starting Treatment with a Platelet Count of 100 x 10(9)/L or greater, consider the following: If the Dose at the time of Thrombocytopenia is 25 mg twice a day:Reduce the dose to 20 mg twice a day for a platelet count of 100 to less than 125 x 10(9)/L Reduce the dose to 10 mg twice a day for a platelet count of 75 to less than 100 x 10(9)/L Reduce the dose to 5 mg twice a day for a platelet count of 50 to less than 75 x 10(9)/LIf the Dose at the time of Thrombocytopenia is 20 mg twice a day:Reduce the dose to 15 mg twice a day for a platelet count of 100 to less than 125 x 10(9)/L Reduce the dose to 10 mg twice a day for a platelet count of 75 to less than 100 x 10(9)/L Reduce the dose to 5 mg twice a day for a platelet count of 50 to less than 75 x 10(9)/LIf the Dose at the time of Thrombocytopenia is 15 mg twice a day:Reduce the dose to 10 mg twice a day if the platelet count is 75 to less than 100 x 10(9)/L Reduce the dose to 5 mg twice a day if the platelet count is 50 to less than 75 x 10(9)/LIf the Dose at the time of Thrombocytopenia is 10 mg twice a day:Reduce the dose to 5 mg twice a day if the platelet count is 50 to less than 75 x 10(9)/LDOSE MODIFICATIONS FOR HEMATOLOGIC TOXICITY: For Patients Starting Treatment with a Platelet Count of 50 to less than 100 × 10(9)/L or greater: INTERRUPT treatment for PLATELET COUNTS less than 25 x 10(9)/L or ANC less than 0.5 x 10(9)/L RESTART once platelet count is above 35 x 10(9)/L and ANC above 0.75 x 10(9)/LRestart at the higher of 5 mg once a day or 5 mg twice a day below the largest dose in the week prior to the decrease in platelet count below 25 x 10(9)/L or ANC below 0.5 x 10(9)/L that led to dose interruptionREDUCE dose for PLATELET COUNTS less than 35 x 10(9)/L:Platelet Count less than 25 x 10(9)/L: Interrupt dosing Platelet Count 25 to less than 35 x 10(9)/L AND the platelet count decline is less than 20% during the prior 4 weeks: Decrease by 5 mg once a day; for patients on 5 mg once a day, maintain this dose Platelet Count 25 to less than 35 x 10(9)/L AND the platelet count decline is 20% or greater during prior 4 weeks: Decrease by 5 mg twice a day; for patients on 5 mg twice a day, decrease to 5 mg once a day; for patients on 5 mg once a day, maintain this doseDOSE MODIFICATION FOR BLEEDING:Interrupt treatment for bleeding requiring intervention regardless of current platelet count Once bleeding event resolves, consider resuming at prior dose if the underlying cause of bleeding has been controlled If the bleeding event has resolved but the underlying cause persists, consider resuming treatment with at a lower dose Based on limited clinical data, long-term maintenance at 5 mg twice a day has not shown benefit; this dose should be limited to patients for whom the benefits outweigh the potential risks. Discontinue therapy if there is no spleen size reduction or symptom improvement after 6 months of therapy. For the treatment of intermediate or high-risk myelofibrosis (MF), including primary MF, post-polycythemia vera MF, and post-essential thrombocythemia MF.Graft Versus Host DiseaseMonitor complete blood counts (CBC), including platelet count and ANC, and bilirubin prior to initiating therapy, every 2 to 4 weeks until doses are stabilized, and then as indicated clinically: Acute Graft-Versus-Host Disease (GVHD): Initial dose: 5 mg orally 2 times a day Dose titration: Consider increasing the dose to 10 mg orally 2 times a day after at least 3 days if the ANC (absolute neutrophil count) and platelet counts are not decreased by 50% or more relative to the first day of dosing Duration of therapy: Consider tapering after 6 months for those with response who have stopped therapeutic doses of corticosteroids; taper by 1 dose level every 8 weeks (see comments); if signs or symptoms of GVHD recur during or after the taper, consider retreatment Chronic GVHD: Initial dose: 10 mg orally 2 times a day Duration of therapy: Consider tapering after 6 months for those with response who have stopped therapeutic doses of corticosteroids; taper by 1 dose level every 8 weeks (see comments); if signs or symptoms of GVHD recur during or after the taper, consider retreatment The dose level decreases from 10 mg twice a day to 5 mg once a day. See the Dose Adjustment section for dose modification guidance for adverse reactions. For the treatment of steroid-refractory acute GVHD and treatment of chronic GVHD after the failure of 1 or 2 lines of systemic therapy.Polycythemia VeraDoses should be titrated based on safety and efficacy; CBC and platelet counts should be performed every 2 to 4 weeks until doses are stabilized and then as clinically indicated Initial dose: 10 mg orally twice a day The dose may be titrated based on safety and efficacyINSUFFICIENT RESPONSE: Consider dose increases in patients with inadequate efficacy as demonstrated by one or more of the following: Continued need for phlebotomy; WBC greater than the upper limit of normal range; Platelet count greater than the upper limit of normal range; Palpable spleen that is reduced by less than 25% from baseline; Platelet count greater than or equal to 140 × 10(9)/L;. Hb (hemoglobin) greater than or equal to 12 g/dL; ANC greater than or equal to 1.5 × 10(9)/L DOSE INCREASES: Increased dose in 5 mg twice a day increments to a MAXIMUM of 25 mg twice a day; doses should not be increased during the first 4 weeks of therapy and not more frequently than every two weeks DOSE REDUCTIONS: Dose reductions should be considered for Hb and platelet count decreases:Hb greater than or equal to 12 g/dL AND platelet count greater than or equal to 100 × 10(9)/L: No change needed Hb 10 to less than 12 g/dL AND platelet count 75 to less than 100 × 10(9)/L: Dose reductions should be considered with the goal of avoiding dose interruptions for anemia and thrombocytopenia Hb 8 to less than 10 g/dL OR platelet count 50 to less than 75 × 10(9)/L: Reduce dose by 5 mg twice a day; for patients on 5 mg twice a day, decrease the dose to 5 mg once a day Hb less than 8 g/dL OR platelet count less than 50 × 10(9)/L OR ANC less than 1 x 10(9)/L: Interrupt dosing.RESTARTING THERAPY:  After recovery of the hematologic parameter(s) to acceptable levels, dosing may be restarted. Restarted doses may be titrated, but the maximum total daily dose should not exceed 5 mg less than the dose that resulted in the dose interruption (One exception: following phlebotomy-associated anemia, the maximal total daily dose allowed would not be limited). Use the most severe category of a patient's Hb, platelet count, or ANC abnormality to determine the corresponding MAXIMUM restarting dose:Hb 8 to less than 10 g/dL OR platelet count 50 to less than 75 × 10(9)/L OR ANC 1 to less than 1.5 × 10(9)/L: MAXIMUM restarting dose: 5 mg twice a day or no more than 5 mg twice a day less than the dose which resulted in dose interruption Hb 10 to less than 12 g/dL OR platelet count 75 to less than 100 × 10(9)/L OR ANC 1.5 to less than 2 × 10(9)/L: MAXIMUM restarting dose: 10 mg twice day or no more than 5 mg twice a day less than the dose which resulted in dose interruption Hb greater than or equal to 12 g/dL OR platelet count greater than or equal to 100 × 10(9)/L OR ANC greater than or equal to 2 × 10(9)/L: MAXIMUM restarting dose: 15 mg twice a day or no more than 5 mg twice a day less than the dose which resulted in dose interruption Dose should be continued for at least 2 weeks, if stable may increase dose by 5 mg twice a day For treatment of polycythemia vera (PV) in adults who have had an inadequate response to or are intolerant of hydroxyurea.Graft Versus Host Disease 12 years or older:Monitor complete blood counts (CBC), including platelet count and ANC, and bilirubin prior to initiating therapy, every 2 to 4 weeks until doses are stabilized, and then as indicated clinically:Acute Graft-Versus-Host Disease (GVHD): Initial dose: 5 mg orally 2 times a day Dose titration: Consider increasing the dose to 10 mg orally 2 times a day after at least 3 days if the ANC (absolute neutrophil count) and platelet counts are not decreased by 50% or more relative to the first day of dosing Duration of therapy: Consider tapering after 6 months for those with response who have stopped therapeutic doses of corticosteroids; taper by 1 dose level every 8 weeks (see comments); if signs or symptoms of GVHD recur during or after the taper, consider retreatment Chronic GVHD: Initial dose: 10 mg orally 2 times a day Duration of therapy: Consider tapering after 6 months for those with response who have stopped therapeutic doses of corticosteroids; taper by 1 dose level every 8 weeks (see comments); if signs or symptoms of GVHD recur during or after the taper, consider retreatment The dose level decreases from 10 mg twice a day to 5 mg once a day. See the Dose Adjustment section for dose modification guidance for adverse reactions. For the treatment of steroid-refractory acute GVHD and treatment of chronic GVHD after the failure of 1 or 2 lines of systemic therapy in pediatric patients 12 years or older.Renal Dose AdjustmentsMild Renal Impairment (CrCl 60 mL/min or greater): No adjustment recommendedModerate or Severe Renal Impairment (CrCl 15 to less than 60 mL/min):MF: Platelet Count greater than 150 x 10(9)/L: No adjustment recommended MF: Platelet Count: 100 to 150 x 10(9)/L: Initial dose: 10 mg twice a day MF: Platelet Count: 50 to less than 100 x 10(9)/L: Initial dose: 5 mg once a day MF: Platelets less than 50 x 10(9)/L: Avoid use MF: ESRD (CrCl less than 15 mL/min) not on dialysis: Avoid use MF: ESRD on dialysis: See DialysisModerate or Severe Renal Impairment (CrCl 15 to less than 60 mL/min):PV: Initial dose: 5 mg twice a day PV: ESRD (CrCl less than 15 mL/min) not on dialysis: Avoid use PV: ESRD on dialysis: See DialysisModerate or Severe Renal Impairment (CrCl 15 to less than 60 mL/min):Acute GVHD: Initial dose: 5 mg once a day Chronic GVHD: Initial dose: 5 mg twice a day GVHD (acute or chronic) (CrCl less than 15 mL/min) not on dialysis: Avoid the use GVHD (acute or chronic): ESRD on dialysis: See DialysisLiver Dose Adjustments Mild, Moderate, or Severe Hepatic Impairment (Child-Pugh Class A, B, C):MF: Platelet Count greater than 150 x 10(9)/L: No adjustment recommended MF: Platelet Count: 100 to 150 x 10(9)/L: Initial dose: 10 mg twice a day MF: Platelet Count: 50 to less than 100 x 10(9)/L: Initial dose: 5 mg once a day MF: Platelets less than 50 x 10(9)/L: Avoid useMild, Moderate, or Severe Hepatic Impairment (Child-Pugh Class A, B, C):PV: Initial dose: 5 mg twice a dayAcute GVHD:Mild, Moderate, or Severe Hepatic Impairment (based on NCI criteria without liver GVHD): No adjustment is recommended Stage 1, 2, or 3 Liver Acute GVHD: No adjustment recommended Stage 4 Liver Acute GVHD: Initial dose: 5 mg once a dayChronic GVHD:Mild, Moderate or Severe Hepatic Impairment (based on NCI criteria without liver GVHD): No adjustment is recommended Score 1 or 2 Liver Chronic GVHD: No adjustment recommended Score 3 Liver Chronic GVHD: Monitor blood counts more frequently for toxicity and modify dosage for adverse reactions if they occurDose Adjustments DRUG INTERACTIONS:Avoid concomitant use of Ruxolitinib with Fluconazole at doses greater than 200 mg/day Modify the dose of Ruxolitinib when used with Strong CYP450 3A4 Inhibitors or Fluconazole less than 200 mg/day MF: Initial dose with platelets 100 x 10(9)/L or greater: 10 mg twice a day MF: Initial dose with platelets 50 to less than 100 x 10(9)/L: 5 mg once a day PV: Initial dose: 5 mg twice a dayMF OR PV ON STABLE RUXOLITINIB (adding strong CYP450 3A4 inhibitor or fluconazole dose less than 200 mg/day):A dose greater than or equal to 10 mg twice a day: Decrease dose by 50% (rounded to closest tablet strength) Stable on 5 mg twice a day: Reduce to 5 mg once a day Stable on 5 mg once a day: Avoid the use of strong CYP450 3A4 inhibitor or fluconazole or interrupt ruxolitinib for the duration of strong CYP450 3A4 inhibitor or fluconazole useACUTE GVHD: With fluconazole 200 mg/day or less: Initial dose: 5 mg once a day CHRONIC GVHD: With fluconazole 200 mg/day or less: Initial dose: 5 mg twice a day ACUTE OR CHRONIC GVHD: With CYP450 3A4 Inhibitors: Monitor blood counts more frequently for toxicity and modify the ruxolitinib dosage for adverse reactions if they occur GVHD: DOSE MODIFICATIONS for ADVERSE REACTIONS Dose Level Reductions for Patients with GVHD:A dose of 10 mg twice a day should be reduced to 5 mg twice a day A dose of 5 mg twice a day should be reduced to 5 mg once a day Patients unable to tolerate 5 mg once a day should have treatment interrupted until their clinical and/or laboratory parameters recoverDOSE MODIFICATION for Patients with ACUTE GVHD:Clinically significant thrombocytopenia after supportive measures: Reduce dose by 1 level; when platelets recover to previous values, dosing may return to prior dose level ANC less than 1 × 10(9) considered related to therapy: Hold for up to 14 days; resume at 1 dose level lower upon recovery Total Bilirubin Elevation, no liver GVHD: Total bilirubin elevated 3 to 5 × ULN (times upper limit of normal), continue at 1 dose level lower until recovery Total bilirubin elevated greater than 5 to less than 10 × ULN, hold for up to 14 days until bilirubin is 1.5 or less than ULN, resume at current dose upon recovery Total bilirubin greater than 10 × ULN, hold for up to 14 days until bilirubin is 1.5 or less than ULN, resume at 1 dose level lower upon recovery Total Bilirubin Elevation, liver GVHD: Total bilirubin greater than 3 × ULN, continue at 1 dose level lower until recoveryDOSE MODIFICATION for Patients with CHRONIC GVHD:Platelet count less than 20 × 10(9)/L: Reduce by 1 dose level; if resolved within 7 days, may return to initial dose level, if not resolved within 7 days, maintain at 1 dose level lower ANC less than 0.75 × 10(9)/L (considered related to therapy): Reduce by 1 dose level, resume at initial dose level upon recovery ANC less than 0.5 × 10(9)/L (considered related to therapy): Hold for up to 14 days, resume at 1 dose level lower upon recovery; may resume initial dose level when ANC greater than 1 × 10(9)/L Total bilirubin elevated 3 to 5 × ULN: Continue at 1 dose level lower until recovery; if resolved within 14 days, then increase by 1 dose level, if not resolved within 14 days, then maintain the decreased dose level Total bilirubin elevated greater than 5 to less than 10 × ULN: Hold for up to 14 days until resolved; resume at current dose upon recovery, if not resolved within 14 days, resume at 1 dose level lower upon recovery Total bilirubin greater than 10 × ULN: Hold for up to 14 days until resolved, resume at 1 dose level lower upon recovery, if not resolved within 14 days, discontinue Other Adverse Reactions: Grade 3: Continue at 1 dose level lower until recovery Other Adverse Reactions: Grade 4: DiscontinueTherapy Discontinuation:MF or PV: When discontinuing therapy for reasons other than thrombocytopenia, a gradual tapering should be considered, for example by 5 mg twice daily each week. Acute or Chronic GVHD: Consider tapering therapy after 6 months in patients with response who have discontinued therapeutic doses of corticosteroids; taper by 1 dose level approximately every 8 weeks (10 mg twice daily to 5 mg once daily). If GVHD signs or symptoms recur during or after the taper, consider retreatmentAdministration advice:Take orally without regard to meals For a missed dose, the patient should not take an additional dose but should take the next usual scheduled dose Suspend 1 table in approximately 40 mL of water; stir for approximately 10 minutes Administer suspension using an appropriate syringe within 6 hours of the tablet being dispersed; rinse with 75 mL of water after administration The effect of tube-feeding preparations on drug exposure has not been evaluated Perform pretreatment complete blood count (CBC) and monitor CBCs every 2 to 4 weeks until doses are stabilized, and then as clinically indicated Perform periodic skin examinations Assess lipid parameters approximately 8¬ to 12 weeks following initiation of therapy; monitor accordingly Patients should be advised to read the FDA-approved patient labeling (Patient Information). Patients should be aware of potential adverse events including thrombocytopenia, anemia, neutropenia, infections, and increased cholesterol. Patients should be advised to continue therapy as prescribed and talk with their healthcare provider prior to discontinuation. Patients should be aware that drug interactions may require dose modifications and they should discuss all medication use with their healthcare provider.Side Effects The Most Commondizziness headache tiredness shortness of breath weight gain gas diarrhea constipation nausea rash muscle or joint pain swelling of the arms, legs or other parts of the body unusual or heavy bleeding or bruising fever, sore throat, chills, cough, chest pain, night sweats, frequent, painful, urgent urination, and other signs of infection burning, tingling, itching, or skin sensitivity on one side of the body or face with painful rash or blisters appearing several days later. new sores, bumps, or discoloration or other changes to the skin pale skin, tiredness, or shortness of breath (especially while exercising) difficulty moving or keeping your balance, weakness of the legs or arms that keeps getting worse, difficulty understanding or speaking, loss of memory, vision problems, or changes in personality swelling, pain, tenderness, warmth or redness in one or both legs shortness of breath difficulty breathing pain in the chest, arms, back, neck, jaw, or stomach breaking out in cold sweat nausea or vomiting lightheadedness slow or difficult speech numbness or weakness of the face, arm, or leg on one side of your bodyMore commonBlack, tarry stools bladder pain bleeding gums blood in the urine or stools blurred vision bruising chest tightness chills cloudy urine collection of blood under the skin cough coughing up blood deep, dark purple bruise difficult, burning, or painful urination difficulty in breathing or swallowing dizziness fever frequent urge to urinate headache hoarseness increased menstrual flow or vaginal bleeding itching, pain, redness, or swelling large, flat, blue or purplish patches in the skin lower back or side pain nervousness nosebleeds painful or difficult urination pale skin paralysis pinpoint red spots on the skin pounding in the ears prolonged bleeding from cuts pus in the urine red or dark brown urine small, red or purple spots on the skin slow or fast heartbeat sore throat swelling tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over the affected area trouble breathing ulcers, sores, or white spots in the mouth unusual bleeding or bruising unusual tiredness or weaknessRarePainful blisters on the trunk of the body Anxiety chest pain fainting pain, redness, or swelling in the arm or leg pains in the chest, groin, or legs, especially calves of the legs persistent non-healing sore pink growth reddish patch or irritated area severe headaches of sudden onset sudden loss of coordination sudden onset of slurred speech sudden vision changes shiny bump a white, yellow, or waxy scar-like areaDrug InteractionDRUG INTERACTIONAbacavir Abacavir may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Abaloparatide The therapeutic efficacy of Abaloparatide can be decreased when used in combination with Ruxolitinib.Abametapir The serum concentration of Ruxolitinib can be increased when it is combined with Abametapir.Abatacept The metabolism of Ruxolitinib can be increased when combined with Abatacept.Abciximab The risk or severity of bleeding can be increased when Abciximab is combined with Ruxolitinib.Abrocitinib The metabolism of Abrocitinib can be decreased when combined with Ruxolitinib.Acalabrutinib The metabolism of Ruxolitinib can be decreased when combined with Acalabrutinib.Acebutolol Ruxolitinib may increase the bradycardic activities of Acebutolol.Aceclofenac Aceclofenac may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Acemetacin Acemetacin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Acenocoumarol The risk or severity of bleeding can be increased when Acenocoumarol is combined with Ruxolitinib.Acetaminophen The metabolism of Ruxolitinib can be increased when combined with Acetaminophen.Acetazolamide The metabolism of Ruxolitinib can be decreased when combined with Acetazolamide.Acetohexamide The metabolism of Ruxolitinib can be decreased when combined with Acetohexamide.Acetyl sulfisoxazole The metabolism of Ruxolitinib can be decreased when combined with Acetyl sulfisoxazole.Acetylsalicylic acid The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Ruxolitinib.Aclidinium Ruxolitinib may decrease the excretion rate of Aclidinium which could result in a higher serum level.Acrivastine Ruxolitinib may decrease the excretion rate of Acrivastine which could result in a higher serum level.Acyclovir Acyclovir may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Adalimumab The metabolism of Ruxolitinib can be increased when combined with Adalimumab.Adefovir dipivoxil Adefovir dipivoxil may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Adenovirus type The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Ruxolitinib.Agomelatine The metabolism of Ruxolitinib can be decreased when combined with Agomelatine.Albendazole The metabolism of Ruxolitinib can be decreased when combined with Albendazole.Albutrepenonacog Ruxolitinib may decrease the excretion rate of Albutrepenonacog alfa which could result in a higher serum level.Alclofenac Alclofenac may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Aldesleukin The metabolism of Ruxolitinib can be decreased when combined with Aldesleukin.Alefacept The risk or severity of adverse effects can be increased when Alefacept is combined with Ruxolitinib.Alemtuzumab The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Ruxolitinib.Alfentanil Ruxolitinib may increase the bradycardic activities of Alfentanil.Allogeneic The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Ruxolitinib.Allopurinol The risk or severity of adverse effects can be increased when Allopurinol is combined with Ruxolitinib.Almasilate Ruxolitinib may decrease the excretion rate of Almasilate which could result in a higher serum level.Almotriptan Almotriptan may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Alogliptin Alogliptin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Alosetron The metabolism of Ruxolitinib can be decreased when combined with Alosetron.Alpelisib The serum concentration of Ruxolitinib can be decreased when it is combined with Alpelisib.Alprazolam Alprazolam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Alteplase The risk or severity of bleeding can be increased when Alteplase is combined with Ruxolitinib.Altretamine The risk or severity of adverse effects can be increased when Altretamine is combined with Ruxolitinib.Amantadine Amantadine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Amikacin Ruxolitinib may decrease the excretion rate of Amikacin which could result in a higher serum level.Amiloride Amiloride may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Aminoglutethimide The metabolism of Ruxolitinib can be increased when combined with Aminoglutethimide.Aminophenazone Aminophenazone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Amiodarone The metabolism of Ruxolitinib can be decreased when combined with Amiodarone.Amitriptyline Amitriptyline may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Amlodipine Ruxolitinib may increase the bradycardic activities of Amlodipine.Ammonium chloride Ammonium chloride may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Amobarbital The metabolism of Ruxolitinib can be increased when combined with Amobarbital.Amodiaquine The metabolism of Ruxolitinib can be decreased when combined with Amodiaquine.Amoxicillin Amoxicillin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Amphetamine Amphetamine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Amphotericin B Amphotericin B may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ampicillin Ampicillin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Amprenavir The metabolism of Ruxolitinib can be decreased when combined with Amprenavir.Amrinone Amrinone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Amsacrine The risk or severity of adverse effects can be increased when Amsacrine is combined with Ruxolitinib.Anagrelide The risk or severity of bleeding can be increased when Anagrelide is combined with Ruxolitinib.Anakinra The metabolism of Ruxolitinib can be increased when combined with Anakinra.Ancestim Ruxolitinib may decrease the excretion rate of Ancestim which could result in a higher serum level.Ancrod The risk or severity of bleeding can be increased when Ancrod is combined with Ruxolitinib.Anifrolumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Anifrolumab.Anistreplase The risk or severity of bleeding can be increased when Anistreplase is combined with Ruxolitinib.Anthrax immune The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Ruxolitinib.Anthrax vaccine The risk or severity of infection can be increased when Anthrax vaccine is combined with Ruxolitinib.Antihemophilic Ruxolitinib may decrease the excretion rate of Antihemophilic factor (recombinant), PEGylated which could result in a higher serum level.antilymphocyte The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Antilymphocyte immunoglobulin (horse).Antipyrine Antipyrine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Antithrombin Alfa The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Ruxolitinib.Antithrombin Ruxolitinib may decrease the excretion rate of Antithrombin III human which could result in a higher serum level.Antithymocyte The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Ruxolitinib.Antrafenine Antrafenine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Apalutamide The metabolism of Ruxolitinib can be increased when combined with Apalutamide.Apixaban The risk or severity of bleeding can be increased when Apixaban is combined with Ruxolitinib.Apremilast The metabolism of Ruxolitinib can be increased when combined with Apremilast.Aprepitant The metabolism of Ruxolitinib can be decreased when combined with Aprepitant.Ardeparin The risk or severity of bleeding can be increased when Ardeparin is combined with Ruxolitinib.Arformoterol Arformoterol may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Argatroban The risk or severity of bleeding can be increased when Argatroban is combined with Ruxolitinib.Armodafinil The metabolism of Ruxolitinib can be increased when combined with Armodafinil.Arsenic trioxide The risk or severity of adverse effects can be increased when Arsenic trioxide is combined with Ruxolitinib.Artemether The metabolism of Ruxolitinib can be decreased when combined with Artemether.Articaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Articaine.Asciminib The serum concentration of Ruxolitinib can be increased when it is combined with Asciminib.Astemizole The metabolism of Ruxolitinib can be decreased when combined with Astemizole.A COVID-19 Vaccine The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Ruxolitinib.Asunaprevir The metabolism of Ruxolitinib can be increased when combined with Asunaprevir.Atazanavir The metabolism of Ruxolitinib can be decreased when combined with Atazanavir.Atenolol Ruxolitinib may increase the bradycardic activities of Atenolol.Atomoxetine Atomoxetine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Atovaquone The metabolism of Ruxolitinib can be decreased when combined with Atovaquone.Auranofin Auranofin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Aurothioglucose Ruxolitinib may decrease the excretion rate of Aurothioglucose which could result in a higher serum level.Avacopan The metabolism of Ruxolitinib can be decreased when combined with Avacopan.Avanafil The serum concentration of Avanafil can be increased when it is combined with Ruxolitinib.Avapritinib The metabolism of Ruxolitinib can be decreased when combined with Avapritinib.Avatrombopag The metabolism of Ruxolitinib can be increased when combined with Avatrombopag.Azacitidine The risk or severity of adverse effects can be increased when Azacitidine is combined with Ruxolitinib.Azathioprine The risk or severity of adverse effects can be increased when Azathioprine is combined with Ruxolitinib.Azelaic acid Azelaic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Azelastine The metabolism of Ruxolitinib can be decreased when combined with Azelastine.Azithromycin The metabolism of Ruxolitinib can be decreased when combined with Azithromycin.Aztreonam Aztreonam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Bacillus The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Ruxolitinib.Bacillus calmette The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Ruxolitinib.Bacillus calm The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Ruxolitinib.Bacitracin Bacitracin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Baclofen Baclofen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Balsalazide Balsalazide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Baricitinib The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Baricitinib.Basiliximab The risk or severity of adverse effects can be increased when Basiliximab is combined with Ruxolitinib.BCG vaccine The risk or severity of infection can be increased when BCG vaccine is combined with Ruxolitinib.Beclomethasone The metabolism of Ruxolitinib can be increased when combined with Beclomethasone dipropionate.Belatacept The risk or severity of adverse effects can be increased when Belatacept is combined with Ruxolitinib.Belimumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Belimumab.Belinostat The risk or severity of adverse effects can be increased when Belinostat is combined with Ruxolitinib.Belumosudil The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Belumosudil.Belzutifan The serum concentration of Ruxolitinib can be decreased when it is combined with Belzutifan.Bemiparin The risk or severity of bleeding can be increased when Bemiparin is combined with Ruxolitinib.Bendamustine The risk or severity of adverse effects can be increased when Bendamustine is combined with Ruxolitinib.Bendroflumethiazide Ruxolitinib may increase the bradycardic activities of Bendroflumethiazide.Benorilate Benorilate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Benoxaprofen Benoxaprofen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Benserazide Ruxolitinib may decrease the excretion rate of Benserazide which could result in a higher serum level.Benzatropine Benzatropine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Benznidazole Ruxolitinib may decrease the excretion rate of Benznidazole which could result in a higher serum level.Benzocaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Benzocaine.Benzthiazide Benzthiazide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Benzydamine Benzydamine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Benzyl alcohol The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Benzyl alcohol.Bepotastine Bepotastine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Bepridil Ruxolitinib may increase the bradycardic activities of Bepridil.Beractant Ruxolitinib may increase the bradycardic activities of Beractant.Berotralstat The serum concentration of Ruxolitinib can be increased when it is combined with Berotralstat.Betamethasone The metabolism of Ruxolitinib can be increased when combined with Betamethasone.Betamethasone The metabolism of Ruxolitinib can be increased when combined with Betamethasone phosphate.Betaxolol Ruxolitinib may increase the bradycardic activities of Betaxolol.Betrixaban The risk or severity of bleeding can be increased when Betrixaban is combined with Ruxolitinib.Bexarotene The metabolism of Ruxolitinib can be increased when combined with Bexarotene.Bicalutamide The metabolism of Ruxolitinib can be decreased when combined with Bicalutamide.Bicisate Ruxolitinib may decrease the excretion rate of Bicisate which could result in a higher serum level.Bifonazole The metabolism of Ruxolitinib can be decreased when combined with Bifonazole.Bimekizumab The metabolism of Ruxolitinib can be increased when combined with Bimekizumab.Bismuth subgallate Ruxolitinib may decrease the excretion rate of Bismuth subgallate which could result in a higher serum level.Bisoprolol Ruxolitinib may increase the bradycardic activities of Bisoprolol.Bisoxatin Ruxolitinib may decrease the excretion rate of Bisoxatin which could result in a higher serum level.Bivalirudin The risk or severity of bleeding can be increased when Bivalirudin is combined with Ruxolitinib.Bleomycin The risk or severity of adverse effects can be increased when Bleomycin is combined with Ruxolitinib.Blinatumomab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Blinatumomab.Boceprevir The metabolism of Ruxolitinib can be decreased when combined with Boceprevir.Bordetella pertussis The therapeutic efficacy of Bordetella pertussis toxoid antigen (formaldehyde, glutaraldehyde inactivated) can be decreased when used in combination with Ruxolitinib.Bortezomib The risk or severity of adverse effects can be increased when Bortezomib is combined with Ruxolitinib.Bosentan The metabolism of Ruxolitinib can be increased when combined with Bosentan.Bosutinib The metabolism of Ruxolitinib can be decreased when combined with Bosutinib.Brentuximab vedotin The metabolism of Ruxolitinib can be decreased when combined with Brentuximab vedotin.Bretylium Ruxolitinib may increase the bradycardic activities of Bretylium.Brivaracetam Brivaracetam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Brodalumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Brodalumab.Bromazepam Bromazepam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Bromotheophylline Bromotheophylline may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Budesonide The metabolism of Ruxolitinib can be increased when combined with Budesonide.Bumadizone Bumadizone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Bumetanide Bumetanide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Bupivacaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Bupivacaine.Buprenorphine The metabolism of Ruxolitinib can be decreased when combined with Buprenorphine.Bupropion Bupropion may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Buspirone Buspirone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Busulfan The risk or severity of adverse effects can be increased when Busulfan is combined with Ruxolitinib.Butabarbital Butabarbital may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Butacaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Butacaine.Butalbital The metabolism of Ruxolitinib can be increased when combined with Butalbital.Butamben The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Butamben.Cabazitaxel The risk or severity of adverse effects can be increased when Cabazitaxel is combined with Ruxolitinib.Cabozantinib The metabolism of Ruxolitinib can be decreased when combined with Cabozantinib.Calcitriol The metabolism of Ruxolitinib can be increased when combined with Calcitriol.Calfactant Ruxolitinib may increase the bradycardic activities of Calfactant.Canagliflozin Canagliflozin may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Canakinumab The metabolism of Ruxolitinib can be increased when combined with Canakinumab.Candesartan cilex The metabolism of Ruxolitinib can be decreased when combined with Candesartan cilexetil.Candicidin The metabolism of Ruxolitinib can be decreased when combined with Candicidin.Cangrelor The risk or severity of bleeding can be increased when Cangrelor is combined with Ruxolitinib.Cannabidiol The metabolism of Ruxolitinib can be decreased when combined with Cannabidiol.Carnosic acid Carnosic acid may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Capecitabine The serum concentration of Ruxolitinib can be increased when it is combined with Capecitabine.Caplacizumab The risk or severity of bleeding can be increased when Caplacizumab is combined with Ruxolitinib.Capreomycin Ruxolitinib may decrease the excretion rate of Capreomycin which could result in a higher serum level.Capsaicin The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Capsaicin.Carbamazepine The metabolism of Ruxolitinib can be increased when combined with Carbamazepine.Carbidopa Carbidopa may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Carbimazole The therapeutic efficacy of Carbimazole can be decreased when used in combination with Ruxolitinib.Carboplatin The risk or severity of adverse effects can be increased when Carboplatin is combined with Ruxolitinib.Carfilzomib The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Carfilzomib.Carmustine The risk or severity of adverse effects can be increased when Carmustine is combined with Ruxolitinib.Carprofen Carprofen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Carvedilol Ruxolitinib may increase the bradycardic activities of Carvedilol.Cefaclor Cefaclor may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefadroxil Cefadroxil may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefalotin Cefalotin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefamandole Cefamandole may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefapirin Cefapirin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefazolin Cefazolin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefdinir Cefdinir may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefditoren Cefditoren may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefepime Cefepime may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefmenoxime Cefmenoxime may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefmetazole Cefmetazole may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefonicid Cefonicid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefoperazone Cefoperazone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ceforanide Ceforanide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefotaxime Cefotaxime may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefotetan Cefotetan may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefotiam Cefotiam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefoxitin Cefoxitin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefpiramide Cefpiramide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefpirome Cefpirome may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefpodoxime Cefpodoxime may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefprozil Cefprozil may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefradine The metabolism of Ruxolitinib can be increased when combined with Cefradine.Ceftaroline fosamil Ceftaroline fosamil may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ceftazidime Ceftazidime may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ceftibuten Ceftibuten may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ceftizoxime Ceftizoxime may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ceftobiprole Ceftobiprole may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ceftolozane Ruxolitinib may decrease the excretion rate of Ceftolozane which could result in a higher serum level.Ceftriaxone Ceftriaxone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cefuroxime Cefuroxime may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Celecoxib Celecoxib may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Celiprolol Ruxolitinib may increase the bradycardic activities of Celiprolol.Cenobamate The serum concentration of Ruxolitinib can be decreased when it is combined with Cenobamate.Cephalexin The metabolism of Ruxolitinib can be decreased when combined with Cephalexin.Cephaloglycin Cephaloglycin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ceritinib Ruxolitinib may increase the bradycardic activities of Ceritinib.Cerivastatin The metabolism of Ruxolitinib can be increased when combined with Cerivastatin.Certolizumab The metabolism of Ruxolitinib can be increased when combined with Certolizumab pegol.Cetirizine Cetirizine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cevimeline Cevimeline may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Chloral hydrate Chloral hydrate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Chlorambucil The risk or severity of adverse effects can be increased when Chlorambucil is combined with Ruxolitinib.Chloramphenicol The metabolism of Ruxolitinib can be decreased when combined with Chloramphenicol.Chloroprocaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Chloroprocaine.Chloroquine Chloroquine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Chlorothiazide Chlorothiazide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Chloroxylenol Ruxolitinib may decrease the excretion rate of Chloroxylenol which could result in a higher serum level.Chlorpromazine The metabolism of Ruxolitinib can be increased when combined with Chlorpromazine.Chlorpropamide Chlorpropamide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Chlorthalidone Chlorthalidone may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Chlorzoxazone Chlorzoxazone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Choline C 11 Ruxolitinib may decrease the excretion rate of Choline C 11 which could result in a higher serum level.Choline magnesium Choline magnesium trisalicylate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Choline salicylate Ruxolitinib may decrease the excretion rate of Choline salicylate which could result in a higher serum level.Chondroitin sulfate Ruxolitinib may decrease the excretion rate of Chondroitin sulfate which could result in a higher serum level.Chromic chloride Ruxolitinib may decrease the excretion rate of Chromic chloride which could result in a higher serum level.Chromic nitrate Ruxolitinib may decrease the excretion rate of Chromic nitrate which could result in a higher serum level.Chromium Ruxolitinib may decrease the excretion rate of Chromium which could result in a higher serum level.Chromium gluconate Ruxolitinib may decrease the excretion rate of Chromium gluconate which could result in a higher serum level.Chromium nicotinate Ruxolitinib may decrease the excretion rate of Chromium nicotinate which could result in a higher serum level.Chromous sulfate Ruxolitinib may decrease the excretion rate of Chromous sulfate which could result in a higher serum level.Ciclesonide The risk or severity of adverse effects can be increased when Ciclesonide is combined with Ruxolitinib.Cidofovir Cidofovir may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Cilostazol The risk or severity of bleeding can be increased when Cilostazol is combined with Ruxolitinib.Cimetidine The metabolism of Ruxolitinib can be decreased when combined with Cimetidine.Cinchocaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Cinchocaine.Cinnarizine Ruxolitinib may increase the bradycardic activities of Cinnarizine.Ciprofloxacin The metabolism of Ruxolitinib can be decreased when combined with Ciprofloxacin.Cisapride The metabolism of Ruxolitinib can be decreased when combined with Cisapride.Cisplatin The risk or severity of adverse effects can be increased when Cisplatin is combined with Ruxolitinib.Citalopram The metabolism of Ruxolitinib can be decreased when combined with Citalopram.Cladribine The risk or severity of adverse effects can be increased when Cladribine is combined with Ruxolitinib.Clarithromycin The metabolism of Ruxolitinib can be decreased when combined with Clarithromycin.Clevidipine Ruxolitinib may increase the bradycardic activities of Clevidipine.Clobazam The metabolism of Ruxolitinib can be increased when combined with Clobazam.Clobetasol prop The metabolism of Ruxolitinib can be increased when combined with Clobetasol propionate.Clofarabine The risk or severity of adverse effects can be increased when Clofarabine is combined with Ruxolitinib.Clofazimine The metabolism of Ruxolitinib can be decreased when combined with Clofazimine.Clofibrate The metabolism of Ruxolitinib can be increased when combined with Clofibrate.Clomipramine Clomipramine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Clonazepam Clonazepam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Clonidine Ruxolitinib may increase the bradycardic activities of Clonidine.Clopidogrel The metabolism of Ruxolitinib can be decreased when combined with Clopidogrel.Clorazepic acid Clorazepic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Clostridium The therapeutic efficacy of Clostridium tetani toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Ruxolitinib.Clove oil Ruxolitinib may decrease the excretion rate of Clove oil which could result in a higher serum level.Clozapine The risk or severity of neutropenia can be increased when Ruxolitinib is combined with Clozapine.Cobicistat The metabolism of Ruxolitinib can be decreased when combined with Cobicistat.Cobimetinib The metabolism of Ruxolitinib can be decreased when combined with Cobimetinib.Cocaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Cocaine.Colchicine Colchicine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Colistimethate Colistimethate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Colistin Ruxolitinib may decrease the excretion rate of Colistin which could result in a higher serum level.Conivaptan The metabolism of Ruxolitinib can be decreased when combined with Conivaptan.Conjugated estrogens Conjugated estrogens may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Corifollitropin alfa Ruxolitinib may decrease the excretion rate of Corifollitropin alfa which could result in a higher serum level.Corticotropin The metabolism of Ruxolitinib can be increased when combined with Corticotropin.Cortisone acetate The metabolism of Ruxolitinib can be increased when combined with Cortisone acetate.Corynebacterium The therapeutic efficacy of Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Ruxolitinib.Crizotinib The metabolism of Ruxolitinib can be decreased when combined with Crizotinib.Curcumin The metabolism of Ruxolitinib can be decreased when combined with Curcumin.Cyanocobalamin The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Ruxolitinib.Cyclandelate Ruxolitinib may increase the bradycardic activities of Cyclandelate.Cyclizine The metabolism of Ruxolitinib can be decreased when combined with Cyclizine.Cyclopenthiazide Cyclopenthiazide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Cyclophosphamide The metabolism of Ruxolitinib can be increased when combined with Cyclophosphamide.Cyclosporine Ruxolitinib may increase the immunosuppressive activities of Cyclosporine.Cyclothiazide Cyclothiazide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Cyproterone ace The metabolism of Ruxolitinib can be decreased when combined with Cyproterone acetate.Cytarabine The risk or severity of adverse effects can be increased when Cytarabine is combined with Ruxolitinib.Dabigatran The risk or severity of bleeding can be increased when Dabigatran is combined with Ruxolitinib.Dabigatran et Dabigatran etexilate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Dabrafenib The serum concentration of Ruxolitinib can be decreased when it is combined with Dabrafenib.Dacarbazine The risk or severity of adverse effects can be increased when Dacarbazine is combined with Ruxolitinib.Dacomitinib The metabolism of Ruxolitinib can be decreased when combined with Dacomitinib.Dactinomycin The risk or severity of adverse effects can be increased when Dactinomycin is combined with Ruxolitinib.Dalfampridine Dalfampridine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Dalfopristin The metabolism of Ruxolitinib can be decreased when combined with Dalfopristin.Dalteparin The risk or severity of bleeding can be increased when Dalteparin is combined with Ruxolitinib.Danaparoid The risk or severity of bleeding can be increased when Danaparoid is combined with Ruxolitinib.Danazol The metabolism of Ruxolitinib can be decreased when combined with Danazol.Dapagliflozin Dapagliflozin may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Dapsone The metabolism of Ruxolitinib can be increased when combined with Dapsone.Daptomycin Daptomycin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Darbepoetin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ruxolitinib.Darunavir The serum concentration of Ruxolitinib can be increased when it is combined with Darunavir.Dasatinib The metabolism of Ruxolitinib can be decreased when combined with Dasatinib.Daunorubicin The metabolism of Ruxolitinib can be decreased when combined with Daunorubicin.Decitabine The risk or severity of adverse effects can be increased when Decitabine is combined with Ruxolitinib.Deferasirox The metabolism of Ruxolitinib can be increased when combined with Deferasirox.Deferiprone Deferiprone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Defibrotide The risk or severity of bleeding can be increased when Defibrotide is combined with Ruxolitinib.Deflazacort The metabolism of Ruxolitinib can be increased when combined with Deflazacort.Delafloxacin The metabolism of Ruxolitinib can be increased when combined with Delafloxacin.Delavirdine The metabolism of Ruxolitinib can be decreased when combined with Delavirdine.Denosumab The risk or severity of adverse effects can be increased when Denosumab is combined with Ruxolitinib.Desipramine The metabolism of Ruxolitinib can be decreased when combined with Desipramine.Desirudin The risk or severity of bleeding can be increased when Desirudin is combined with Ruxolitinib.Desmopressin Desmopressin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Desogestrel The metabolism of Ruxolitinib can be decreased when combined with Desogestrel.Desoximetasone The risk or severity of adverse effects can be increased when Desoximetasone is combined with Ruxolitinib.Desvenlafaxine The metabolism of Ruxolitinib can be decreased when combined with Desvenlafaxine.Deucravacitinib The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Deucravacitinib.Deutetrabenazine Ruxolitinib may decrease the excretion rate of Deutetrabenazine which could result in a higher serum level.Dexamethasone The metabolism of Ruxolitinib can be increased when combined with Dexamethasone.Dexamethasone acetate The metabolism of Ruxolitinib can be increased when combined with Dexamethasone acetate.Dexibuprofen Dexibuprofen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Dexketoprofen Dexketoprofen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Dexmedetomidine Ruxolitinib may increase the bradycardic activities of Dexmedetomidine.Dexpanthenol Ruxolitinib may decrease the excretion rate of Dexpanthenol which could result in a higher serum level.Dexrazoxane The risk or severity of adverse effects can be increased when Dexrazoxane is combined with Ruxolitinib.Dextran Ruxolitinib may decrease the excretion rate of Dextran which could result in a higher serum level.Dextromethorphan The metabolism of Ruxolitinib can be decreased when combined with Dextromethorphan.Dextropropoxyph The metabolism of Ruxolitinib can be decreased when combined with Dextropropoxyphene.Diacerein The metabolism of Ruxolitinib can be decreased when combined with Diacerein.Diatrizoate Diatrizoate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Diazepam Diazepam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Dichlorobenzyl Ruxolitinib may decrease the excretion rate of Dichlorobenzyl alcohol which could result in a higher serum level.Diclofenac Diclofenac may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Diclofenamide Diclofenamide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Dicloxacillin The metabolism of Ruxolitinib can be increased when combined with Dicloxacillin.Dicoumarol The risk or severity of bleeding can be increased when Dicoumarol is combined with Ruxolitinib.Dicyclomine Dicyclomine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Didanosine Didanosine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Dienogest Ruxolitinib may decrease the excretion rate of Dienogest which could result in a higher serum level.Diethylstilbestrol The metabolism of Ruxolitinib can be decreased when combined with Diethylstilbestrol.Diflunisal Diflunisal may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Difluocortolone The metabolism of Ruxolitinib can be increased when combined with Difluocortolone.Digoxin Ruxolitinib may increase the bradycardic activities of Digoxin.Dihydroergocornine The metabolism of Ruxolitinib can be decreased when combined with Dihydroergocornine.Dihydroergocristine The metabolism of Ruxolitinib can be decreased when combined with Dihydroergocristine.Dihydroergotamine The metabolism of Ruxolitinib can be decreased when combined with Dihydroergotamine.Dihydrostreptomycin Dihydrostreptomycin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Diltiazem Ruxolitinib may increase the bradycardic activities of Diltiazem.Dimercaprol Dimercaprol may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Dimethyl fumarate The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Dimethyl fumarate.Dimethyl sulfoxide The metabolism of Ruxolitinib can be decreased when combined with Dimethyl sulfoxide.Dinutuximab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Dinutuximab.Diosmin The metabolism of Ruxolitinib can be decreased when combined with Diosmin.Diphenhydramine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Diphenhydramine.Dipyridamole The risk or severity of bleeding can be increased when Dipyridamole is combined with Ruxolitinib.Diroximel fumarate The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Diroximel fumarate.Disopyramide Disopyramide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.DL-Methylephedrine Ruxolitinib may decrease the excretion rate of DL-Methylephedrine which could result in a higher serum level.Dobutamine Dobutamine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Docetaxel The metabolism of Ruxolitinib can be decreased when combined with Docetaxel.Doconexent The metabolism of Ruxolitinib can be decreased when combined with Doconexent.Donepezil Ruxolitinib may increase the bradycardic activities of Donepezil.Dopamine Dopamine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Doripenem Doripenem may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Doxacurium Doxacurium may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Doxazosin The metabolism of Ruxolitinib can be decreased when combined with Doxazosin.Doxepin Doxepin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Doxorubicin The metabolism of Ruxolitinib can be decreased when combined with Doxorubicin.Doxycycline Doxycycline may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Dronabinol The metabolism of Ruxolitinib can be decreased when combined with Dronabinol.Dronedarone The serum concentration of Ruxolitinib can be increased when it is combined with Dronedarone.Drospirenone The metabolism of Ruxolitinib can be decreased when combined with Drospirenone.Drotrecogin alfa The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Ruxolitinib.Droxidopa Droxidopa may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Duloxetine Duloxetine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Duvelisib The metabolism of Ruxolitinib can be decreased when combined with Duvelisib.Dyclonine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Dyclonine.Dyphylline Dyphylline may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ebastine The metabolism of Ruxolitinib can be decreased when combined with Ebastine.Ebola Zaire The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Ruxolitinib.Echinacea The metabolism of Ruxolitinib can be increased when combined with Echinacea.Eculizumab The risk or severity of adverse effects can be increased when Eculizumab is combined with Ruxolitinib.Edetic acid The risk or severity of bleeding can be increased when Edetic acid is combined with Ruxolitinib.Edoxaban Ruxolitinib may decrease the excretion rate of Edoxaban which could result in a higher serum level.Edrophonium Edrophonium may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Efalizumab The risk or severity of adverse effects can be increased when Efalizumab is combined with Ruxolitinib.Efavirenz The metabolism of Ruxolitinib can be decreased when combined with Efavirenz.Eletriptan The metabolism of Ruxolitinib can be decreased when combined with Eletriptan.Elexacaftor The metabolism of Ruxolitinib can be decreased when combined with Elexacaftor.Elvitegravir The metabolism of Ruxolitinib can be decreased when combined with Elvitegravir.Emapalumab The metabolism of Ruxolitinib can be increased when combined with Emapalumab.Enalaprilat Ruxolitinib may decrease the excretion rate of Enalaprilat which could result in a higher serum level.Enasidenib The metabolism of Ruxolitinib can be increased when combined with Enasidenib.Enoxaparin The risk or severity of bleeding can be increased when Enoxaparin is combined with Ruxolitinib.Enzalutamide The serum concentration of Ruxolitinib can be decreased when it is combined with Enzalutamide.Epinephrine The metabolism of Ruxolitinib can be decreased when combined with Epinephrine.Epirubicin The risk or severity of adverse effects can be increased when Epirubicin is combined with Ruxolitinib.Eplerenone Eplerenone may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Epoprostenol The risk or severity of bleeding can be increased when Epoprostenol is combined with Ruxolitinib.Eptifibatide The risk or severity of bleeding can be increased when Eptifibatide is combined with Ruxolitinib.Erdafitinib The metabolism of Erdafitinib can be decreased when combined with Ruxolitinib.Ergotamine The metabolism of Ruxolitinib can be decreased when combined with Ergotamine.Eribulin The risk or severity of adverse effects can be increased when Eribulin is combined with Ruxolitinib.Erlotinib The metabolism of Ruxolitinib can be decreased when combined with Erlotinib.Ertapenem Ertapenem may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ertugliflozin Ertugliflozin may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Erythromycin The metabolism of Ruxolitinib can be decreased when combined with Erythromycin.Erythropoietin The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Ruxolitinib.Esketamine The metabolism of Ruxolitinib can be increased when combined with Esketamine.Eslicarbazepine The metabolism of Ruxolitinib can be increased when combined with Eslicarbazepine.Eslicarbazepine acetate The metabolism of Ruxolitinib can be increased when combined with Eslicarbazepine acetate.Esmolol Ruxolitinib may increase the bradycardic activities of Esmolol.Estazolam Estazolam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Estetrol The metabolism of Ruxolitinib can be decreased when combined with Estetrol.Estradiol Estradiol may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Estradiol acetate The metabolism of Ruxolitinib can be increased when combined with Estradiol acetate.Estradiol benzoate The metabolism of Ruxolitinib can be increased when combined with Estradiol benzoate.Estradiol cypionate The metabolism of Ruxolitinib can be increased when combined with Estradiol cypionate.Estradiol dienanthate The metabolism of Ruxolitinib can be increased when combined with Estradiol dienanthate.Estradiol valerate The metabolism of Ruxolitinib can be increased when combined with Estradiol valerate.Estramustine The risk or severity of adverse effects can be increased when Estramustine is combined with Ruxolitinib.Estrone sulfate The metabolism of Ruxolitinib can be decreased when combined with Estrone sulfate.Eszopiclone Eszopiclone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Etacrynic acid Etacrynic acid may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Etafedrine Ruxolitinib may decrease the excretion rate of Etafedrine which could result in a higher serum level.Etanercept The metabolism of Ruxolitinib can be increased when combined with Etanercept.Ethambutol The metabolism of Ruxolitinib can be decreased when combined with Ethambutol.Ethanol The metabolism of Ruxolitinib can be increased when combined with Ethanol.Ethinylestradiol The metabolism of Ruxolitinib can be decreased when combined with Ethinylestradiol.Ethosuximide Ruxolitinib may increase the bradycardic activities of Ethosuximide.Ethyl chloride The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Ethyl chloride.Etidocaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Etidocaine.Etodolac Etodolac may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Etomidate Etomidate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Etonogestrel Etonogestrel may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Etoposide The risk or severity of adverse effects can be increased when Etoposide is combined with Ruxolitinib.Etoricoxib The metabolism of Ruxolitinib can be decreased when combined with Etoricoxib.Etravirine The metabolism of Ruxolitinib can be increased when combined with Etravirine.Eucalyptus oil Ruxolitinib may decrease the excretion rate of Eucalyptus oil which could result in a higher serum level.Everolimus The risk or severity of adverse effects can be increased when Everolimus is combined with Ruxolitinib.Ezogabine Ezogabine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Famtozinameran The therapeutic efficacy of Famtozinameran can be decreased when used in combination with Ruxolitinib.Felbamate The metabolism of Ruxolitinib can be increased when combined with Felbamate.Felodipine Ruxolitinib may increase the bradycardic activities of Felodipine.Fenbufen Fenbufen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Fenofibrate The metabolism of Ruxolitinib can be decreased when combined with Fenofibrate.Fenofibric acid Ruxolitinib may decrease the excretion rate of Fenofibric acid which could result in a higher serum level.Fenoldopam Fenoldopam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Fenoprofen Fenoprofen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Fentanyl Ruxolitinib may increase the bradycardic activities of Fentanyl.Fesoterodine Fesoterodine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Fexinidazole The metabolism of Ruxolitinib can be decreased when combined with Fexinidazole.Filgotinib The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Filgotinib.Finerenone Finerenone may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Fingolimod Ruxolitinib may increase the immunosuppressive activities of Fingolimod.Flavoxate Flavoxate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Flecainide The metabolism of Ruxolitinib can be decreased when combined with Flecainide.Floctafenine Floctafenine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Florbetaben (18F) Ruxolitinib may decrease the excretion rate of Florbetaben (18F) which could result in a higher serum level.Florbetapir (18F) Ruxolitinib may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level.Floxuridine The metabolism of Ruxolitinib can be decreased when combined with Floxuridine.Flucloxacillin The metabolism of Ruxolitinib can be increased when combined with Flucloxacillin.Fluconazole The serum concentration of Ruxolitinib can be increased when it is combined with Fluconazole.Flucytosine The risk or severity of adverse effects can be increased when Flucytosine is combined with Ruxolitinib.Fludarabine The risk or severity of adverse effects can be increased when Fludarabine is combined with Ruxolitinib.Fludeoxyglucose (18F) Ruxolitinib may decrease the excretion rate of Fludeoxyglucose (18F) which could result in a higher serum level.Fludrocortisone The risk or severity of adverse effects can be increased when Fludrocortisone is combined with Ruxolitinib.Fluindione The risk or severity of bleeding can be increased when Fluindione is combined with Ruxolitinib.Flumazenil Flumazenil may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Flunarizine Ruxolitinib may increase the bradycardic activities of Flunarizine.Flunisolide The metabolism of Ruxolitinib can be increased when combined with Flunisolide.Flunitrazepam The metabolism of Ruxolitinib can be decreased when combined with Flunitrazepam.Fluocinolone acetonide The metabolism of Ruxolitinib can be increased when combined with Fluocinolone acetonide.Fluocinonide The metabolism of Ruxolitinib can be increased when combined with Fluocinonide.Fluocortolone The metabolism of Ruxolitinib can be increased when combined with Fluocortolone.Fluorometholone The risk or severity of adverse effects can be increased when Fluorometholone is combined with Ruxolitinib.Fluorouracil The metabolism of Ruxolitinib can be decreased when combined with Fluorouracil.Fluoxetine The metabolism of Ruxolitinib can be decreased when combined with Fluoxetine.Flupentixol The risk or severity of myelosuppression can be increased when Flupentixol is combined with Ruxolitinib.Fluprednisolone The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Fluprednisolone.Flurazepam Flurazepam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Flurbiprofen Flurbiprofen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Fluspirilene Ruxolitinib may increase the bradycardic activities of Fluspirilene.Flutamide Flutamide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Fluticasone The metabolism of Ruxolitinib can be increased when combined with Fluticasone.Fluticasone fur The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Fluticasone furoate.Fluticasone prop The metabolism of Ruxolitinib can be decreased when combined with Fluticasone propionate.Fluvastatin The metabolism of Ruxolitinib can be decreased when combined with Fluvastatin.Fluvoxamine The metabolism of Ruxolitinib can be decreased when combined with Fluvoxamine.Folic acid Folic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Follitropin The therapeutic efficacy of Follitropin can be decreased when used in combination with Ruxolitinib.Fomepizole Fomepizole may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Fondaparinux Fondaparinux may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Formestane The metabolism of Ruxolitinib can be increased when combined with Formestane.Formoterol The metabolism of Ruxolitinib can be decreased when combined with Formoterol.Fosamprenavir The metabolism of Ruxolitinib can be decreased when combined with Fosamprenavir.Fosaprepitant The metabolism of Ruxolitinib can be increased when combined with Fosaprepitant.Foscarnet Foscarnet may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Fosfomycin Fosfomycin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Fosinopril Fosinopril may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Fosnetupitant The metabolism of Ruxolitinib can be decreased when combined with Fosnetupitant.Fosphenytoin The metabolism of Ruxolitinib can be increased when combined with Fosphenytoin.Fostamatinib The metabolism of Ruxolitinib can be decreased when combined with Fostamatinib.Framycetin Framycetin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Furosemide Furosemide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Fusidic acid The metabolism of Ruxolitinib can be decreased when combined with Fusidic acid.Gabapentin enacarbil Gabapentin enacarbil may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Gadobenic acid Gadobenic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Gadodiamide Gadodiamide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Gadofosveset trisodium Gadofosveset trisodium may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Gadopentetic acid Gadopentetic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Gadoteric acid Ruxolitinib may decrease the excretion rate of Gadoteric acid which could result in a higher serum level.Gadoteridol Gadoteridol may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Galantamine Ruxolitinib may increase the bradycardic activities of Galantamine.Gallium nitrate The risk or severity of adverse effects can be increased when Gallium nitrate is combined with Ruxolitinib.Ganciclovir Ganciclovir may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Gemcitabine The risk or severity of adverse effects can be increased when Gemcitabine is combined with Ruxolitinib.Gemfibrozil The metabolism of Ruxolitinib can be decreased when combined with Gemfibrozil.Gemtuzumab The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Ruxolitinib.Gentamicin Ruxolitinib may decrease the excretion rate of Gentamicin which could result in a higher serum level.Gilteritinib The metabolism of Ruxolitinib can be decreased when combined with Gilteritinib.Gimeracil Ruxolitinib may decrease the excretion rate of Gimeracil which could result in a higher serum level.Ginkgo biloba The metabolism of Ruxolitinib can be decreased when combined with Ginkgo biloba.Givosiran Givosiran may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Glatiramer The risk or severity of adverse effects can be increased when Glatiramer is combined with Ruxolitinib.Glecaprevir The metabolism of Ruxolitinib can be decreased when combined with Glecaprevir.Gliclazide The metabolism of Ruxolitinib can be decreased when combined with Gliclazide.Glimepiride The metabolism of Ruxolitinib can be decreased when combined with Glimepiride.Glipizide Glipizide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Gliquidone The metabolism of Ruxolitinib can be decreased when combined with Gliquidone.Glyburide The metabolism of Ruxolitinib can be decreased when combined with Glyburide.Glycerol phenyl The metabolism of Ruxolitinib can be increased when combined with Glycerol phenylbutyrate.Golimumab The metabolism of Ruxolitinib can be increased when combined with Golimumab.Golodirsen Ruxolitinib may decrease the excretion rate of Golodirsen which could result in a higher serum level.Goserelin Goserelin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Griseofulvin The metabolism of Ruxolitinib can be increased when combined with Griseofulvin.Guanethidine Guanethidine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Guanfacine Ruxolitinib may increase the bradycardic activities of Guanfacine.Guselkumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Guselkumab.Haemophilus The therapeutic efficacy of Haemophilus influenzae type B strain 20752 capsular polysaccharide tetanus toxoid conjugate antigen can be decreased when used in combination with Ruxolitinib.Haloperidol The serum concentration of Haloperidol can be increased when it is combined with Ruxolitinib.Halothane The metabolism of Ruxolitinib can be decreased when combined with Halothane.Heparin The risk or severity of bleeding can be increased when Heparin is combined with Ruxolitinib.Hepatitis A Vaccine The therapeutic efficacy of Hepatitis A Vaccine can be decreased when used in combination with Ruxolitinib.Hepatitis B Vacc The therapeutic efficacy of Hepatitis B Vaccine (Recombinant) can be decreased when used in combination with Ruxolitinib.Human adenovirus The risk or severity of infection can be increased when Human adenovirus e serotype 4 strain cl-68578 antigen is combined with Ruxolitinib.Hydralazine The metabolism of Ruxolitinib can be decreased when combined with Hydralazine.Hydrochlorothiazide Hydrochlorothiazide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Hydrocortamate The metabolism of Ruxolitinib can be increased when combined with Hydrocortamate.Hydrocortisone The metabolism of Ruxolitinib can be increased when combined with Hydrocortisone.Hydrocortisone ace The metabolism of Ruxolitinib can be increased when combined with Hydrocortisone acetate.Hydrocortisone bu The metabolism of Ruxolitinib can be increased when combined with Hydrocortisone butyrate.Hydrocortisone suc The metabolism of Ruxolitinib can be increased when combined with Hydrocortisone succinate.Hydroflumethiazide Hydroflumethiazide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Hydromorphone Hydromorphone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Hydroxocobalamin Hydroxocobalamin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Hydroxychloroquine The risk or severity of adverse effects can be increased when Hydroxychloroquine is combined with Ruxolitinib.Hydroxyethyl Starch Ruxolitinib may decrease the excretion rate of Hydroxyethyl Starch which could result in a higher serum level.Hydroxyurea The risk or severity of adverse effects can be increased when Hydroxyurea is combined with Ruxolitinib.Ibritumomab tiu The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Ruxolitinib.Ibrutinib The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Ibrutinib.Ibuprofen Ibuprofen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ibutilide Ibutilide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Icatibant Icatibant may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Icosapent Icosapent may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Icosapent ethyl The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Ruxolitinib.Idarubicin The risk or severity of adverse effects can be increased when Idarubicin is combined with Ruxolitinib.Idarucizumab Ruxolitinib may decrease the excretion rate of Idarucizumab which could result in a higher serum level.Idebenone Ruxolitinib may decrease the excretion rate of Idebenone which could result in a higher serum level.Idelalisib The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Idelalisib.Ifosfamide The metabolism of Ruxolitinib can be increased when combined with Ifosfamide.Iloprost The risk or severity of bleeding can be increased when Iloprost is combined with Ruxolitinib.Imatinib The serum concentration of Ruxolitinib can be increased when it is combined with Imatinib.Imipramine Imipramine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Indapamide Indapamide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Indigotindisulfonic acid Ruxolitinib may decrease the excretion rate of Indigotindisulfonic acid which could result in a higher serum level.Indinavir The metabolism of Ruxolitinib can be decreased when combined with Indinavir.Inositol Ruxolitinib may decrease the excretion rate of Inositol which could result in a higher serum level.Inotersen Inotersen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Interferon alfa-2a The risk or severity of adverse effects can be increased when Interferon alfa-2a is combined with Ruxolitinib.Interferon alfa-2b The risk or severity of adverse effects can be increased when Interferon alfa-2b is combined with Ruxolitinib.Interferon alfa-n1 The risk or severity of adverse effects can be increased when Interferon alfa-n1 is combined with Ruxolitinib.Interferon alfa-n3 The risk or severity of adverse effects can be increased when Interferon alfa-n3 is combined with Ruxolitinib.Interferon alfacon-1 The risk or severity of adverse effects can be increased when Interferon alfacon-1 is combined with Ruxolitinib.Interferon beta-1b The risk or severity of adverse effects can be increased when Interferon beta-1b is combined with Ruxolitinib.Interferon gamm The risk or severity of adverse effects can be increased when Interferon gamma-1b is combined with Ruxolitinib.Iobenguane sulfate I Ruxolitinib may decrease the excretion rate of Iobenguane sulfate I-123 which could result in a higher serum level.Iodixanol Iodixanol may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ioflupane I-123 Ioflupane I-123 may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Iopromide Ruxolitinib may decrease the excretion rate of Iopromide which could result in a higher serum level.Iothalamic acid Ruxolitinib may decrease the excretion rate of Iothalamic acid which could result in a higher serum level.Ioversol Ruxolitinib may decrease the excretion rate of Ioversol which could result in a higher serum level.Ioxilan Ruxolitinib may decrease the excretion rate of Ioxilan which could result in a higher serum level.Ipecac Ruxolitinib may decrease the excretion rate of Ipecac which could result in a higher serum level.Ipilimumab Ipilimumab may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Irbesartan The metabolism of Ruxolitinib can be decreased when combined with Irbesartan.Irinotecan The risk or severity of adverse effects can be increased when Irinotecan is combined with Ruxolitinib.Isavuconazole The metabolism of Ruxolitinib can be increased when combined with Isavuconazole.Isavuconazonium The metabolism of Ruxolitinib can be increased when combined with Isavuconazonium.Isoniazid The metabolism of Ruxolitinib can be decreased when combined with Isoniazid.Isosorbide Isosorbide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Isosorbide monon Isosorbide mononitrate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Isosulfan blue Ruxolitinib may decrease the excretion rate of Isosulfan blue which could result in a higher serum level.Isotretinoin Isotretinoin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Isoxicam Isoxicam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Isradipine Ruxolitinib may increase the bradycardic activities of Isradipine.Istradefylline The metabolism of Istradefylline can be decreased when combined with Ruxolitinib.Itraconazole The metabolism of Ruxolitinib can be decreased when combined with Itraconazole.Ivabradine Ruxolitinib may increase the bradycardic activities of Ivabradine.Ivacaftor The metabolism of Ruxolitinib can be decreased when combined with Ivacaftor.Ivosidenib The metabolism of Ruxolitinib can be increased when combined with Ivosidenib.Ixabepilone The risk or severity of adverse effects can be increased when Ixabepilone is combined with Ruxolitinib.Ixazomib Ruxolitinib may decrease the excretion rate of Ixazomib which could result in a higher serum level.Ixekizumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Ixekizumab.Janssen COVID-19 The therapeutic efficacy of Janssen COVID-19 Vaccine can be decreased when used in combination with Ruxolitinib.Japencephalitis virus The therapeutic efficacy of Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated) can be decreased when used in combination with Ruxolitinib.Kanamycin Ruxolitinib may decrease the excretion rate of Kanamycin which could result in a higher serum level.Ketamine Ketamine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ketazolam The metabolism of Ruxolitinib can be decreased when combined with Ketazolam.Ketoconazole The metabolism of Ruxolitinib can be decreased when combined with Ketoconazole.Ketoprofen Ketoprofen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ketorolac Ketorolac may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Labetalol Ruxolitinib may increase the bradycardic activities of Labetalol.Lacidipine Ruxolitinib may increase the bradycardic activities of Lacidipine.Lacosamide Ruxolitinib may increase the bradycardic activities of Lacosamide.Lamivudine Lamivudine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lamotrigine Ruxolitinib may increase the bradycardic activities of Lamotrigine.Lanreotide Ruxolitinib may increase the bradycardic activities of Lanreotide.Lansoprazole The metabolism of Ruxolitinib can be decreased when combined with Lansoprazole.Lapatinib The metabolism of Ruxolitinib can be decreased when combined with Lapatinib.Latamoxef Latamoxef may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ledipasvir Ruxolitinib may decrease the excretion rate of Ledipasvir which could result in a higher serum level.Lefamulin The serum concentration of Ruxolitinib can be increased when it is combined with Lefamulin.Leflunomide The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Leflunomide.Lenalidomide The risk or severity of adverse effects can be increased when Lenalidomide is combined with Ruxolitinib.Lepirudin The risk or severity of bleeding can be increased when Lepirudin is combined with Ruxolitinib.Lercanidipine Ruxolitinib may increase the bradycardic activities of Lercanidipine.Lesinurad The metabolism of Ruxolitinib can be increased when combined with Lesinurad.Letermovir The metabolism of Ruxolitinib can be decreased when combined with Letermovir.Leuprolide Leuprolide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Levobetaxolol Ruxolitinib may increase the bradycardic activities of Levobetaxolol.Levobupivacaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Levobupivacaine.Levocarnitine Levocarnitine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Levocetirizine Levocetirizine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Levofloxacin Levofloxacin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Levoketoconazole The metabolism of Ruxolitinib can be decreased when combined with Levoketoconazole.Levomenthol Ruxolitinib may increase the bradycardic activities of Levomenthol.Levomilnacipran Ruxolitinib may decrease the excretion rate of Levomilnacipran which could result in a higher serum level.Levosalbutamol Ruxolitinib may decrease the excretion rate of Levosalbutamol which could result in a higher serum level.Levothyroxine The therapeutic efficacy of Levothyroxine can be decreased when used in combination with Ruxolitinib.Lidocaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Lidocaine.Lidoflazine Ruxolitinib may increase the bradycardic activities of Lidoflazine.Linagliptin The metabolism of Ruxolitinib can be decreased when combined with Linagliptin.Linezolid The risk or severity of adverse effects can be increased when Linezolid is combined with Ruxolitinib.Liothyronine The therapeutic efficacy of Liothyronine can be decreased when used in combination with Ruxolitinib.Liotrix The therapeutic efficacy of Liotrix can be decreased when used in combination with Ruxolitinib.Lipegfilgrastim Ruxolitinib may increase the myelosuppressive activities of Lipegfilgrastim.Lisinopril Lisinopril may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lithium carbonate Ruxolitinib may decrease the excretion rate of Lithium carbonate which could result in a higher serum level.Lithium citrate Lithium citrate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lixisenatide Ruxolitinib may decrease the excretion rate of Lixisenatide which could result in a higher serum level.Lofexidine Lofexidine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lomitapide The metabolism of Ruxolitinib can be decreased when combined with Lomitapide.Lomustine The risk or severity of adverse effects can be increased when Lomustine is combined with Ruxolitinib.Lonafarnib The metabolism of Ruxolitinib can be decreased when combined with Lonafarnib.Loperamide Ruxolitinib may increase the bradycardic activities of Loperamide.Lopinavir The metabolism of Ruxolitinib can be decreased when combined with Lopinavir.Loracarbef Loracarbef may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lorazepam Lorazepam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lorcaserin Lorcaserin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lorlatinib The metabolism of Ruxolitinib can be increased when combined with Lorlatinib.Lornoxicam Lornoxicam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lorpiprazole Ruxolitinib may decrease the excretion rate of Lorpiprazole which could result in a higher serum level.Losartan The metabolism of Ruxolitinib can be decreased when combined with Losartan.Lovastatin The metabolism of Ruxolitinib can be decreased when combined with Lovastatin.Loxoprofen Loxoprofen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lubiprostone Lubiprostone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lucinactant Ruxolitinib may increase the bradycardic activities of Lucinactant.Lumacaftor The metabolism of Ruxolitinib can be increased when combined with Lumacaftor.Lumiracoxib Lumiracoxib may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Lynestrenol The metabolism of Lynestrenol can be decreased when combined with Ruxolitinib.Macitentan Ruxolitinib may decrease the excretion rate of Macitentan which could result in a higher serum level.Magnesium The serum concentration of Magnesium can be decreased when it is combined with Ruxolitinib.Magnesium carb Ruxolitinib may decrease the excretion rate of Magnesium carbonate which could result in a higher serum level.Magnesium chlo Ruxolitinib may decrease the excretion rate of Magnesium chloride which could result in a higher serum level.Magnesium hyd Ruxolitinib may decrease the excretion rate of Magnesium hydroxide which could result in a higher serum level.Magnesium sulfate Ruxolitinib may increase the bradycardic activities of Magnesium sulfate.Magnesium tris Ruxolitinib may decrease the excretion rate of Magnesium trisilicate which could result in a higher serum level.Mangafodipir Mangafodipir may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Manidipine Ruxolitinib may increase the bradycardic activities of Manidipine.Mannitol Mannitol may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Maprotiline Maprotiline may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Mavacamten The serum concentration of Ruxolitinib can be decreased when it is combined with Mavacamten.Measles virus vaccine The therapeutic efficacy of Measles virus vaccine live attenuated can be decreased when used in combination with Ruxolitinib.Mecamylamine Mecamylamine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Mechlorethamine The risk or severity of adverse effects can be increased when Mechlorethamine is combined with Ruxolitinib.Meclofenamic acid Meclofenamic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Medroxyprogester The metabolism of Ruxolitinib can be increased when combined with Medroxyprogesterone acetate.Mefenamic acid Mefenamic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Megestrol acetate Megestrol acetate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Meloxicam The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Meloxicam.Melphalan The risk or severity of adverse effects can be increased when Melphalan is combined with Ruxolitinib.Memantine Memantine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Meningococcal The therapeutic efficacy of Meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine can be decreased when used in combination with Ruxolitinib.Meperidine The metabolism of Ruxolitinib can be decreased when combined with Meperidine.Mephenytoin The metabolism of Ruxolitinib can be decreased when combined with Mephenytoin.Mepivacaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Mepivacaine.Mepolizumab The risk or severity of adverse effects can be increased when Mepolizumab is combined with Ruxolitinib.Meprednisone The metabolism of Ruxolitinib can be increased when combined with Meprednisone.Mercaptopurine The risk or severity of adverse effects can be increased when Mercaptopurine is combined with Ruxolitinib.Meropenem Meropenem may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Mesalazine Mesalazine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Mestranol The metabolism of Ruxolitinib can be decreased when combined with Mestranol.Metamfetamine Metamfetamine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Metamizole The risk or severity of myelosuppression can be increased when Metamizole is combined with Ruxolitinib.Metaxalone Metaxalone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Metformin Metformin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Methadone The metabolism of Ruxolitinib can be decreased when combined with Methadone.Methazolamide Methazolamide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Methimazole The metabolism of Ruxolitinib can be decreased when combined with Methimazole.Methotrexate The risk or severity of adverse effects can be increased when Methotrexate is combined with Ruxolitinib.Methoxsalen Methoxsalen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Methoxy pol The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Ruxolitinib.Methoxyflurane The metabolism of Ruxolitinib can be decreased when combined with Methoxyflurane.Methsuximide Ruxolitinib may increase the bradycardic activities of Methsuximide.Methyldopa Ruxolitinib may increase the bradycardic activities of Methyldopa.Methylene blue The metabolism of Ruxolitinib can be decreased when combined with Methylene blue.Methylergometrine The metabolism of Ruxolitinib can be decreased when combined with Methylergometrine.Methylnaltrexone Methylnaltrexone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Methylphenobarbital The metabolism of Ruxolitinib can be increased when combined with Methylphenobarbital.Methylprednisolone The metabolism of Ruxolitinib can be increased when combined with Methylprednisolone.Methylprednisone The metabolism of Ruxolitinib can be decreased when combined with Methylprednisone.Methyltestosterone Methyltestosterone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Methysergide The metabolism of Ruxolitinib can be decreased when combined with Methysergide.Meticrane Meticrane may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Metoclopramide Metoclopramide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Metolazone Metolazone may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Metoprolol Ruxolitinib may increase the bradycardic activities of Metoprolol.Metreleptin The metabolism of Ruxolitinib can be increased when combined with Metreleptin.Metronidazole The metabolism of Ruxolitinib can be decreased when combined with Metronidazole.Metyrapone The metabolism of Ruxolitinib can be increased when combined with Metyrapone.Miconazole The metabolism of Ruxolitinib can be decreased when combined with Miconazole.Midazolam The metabolism of Ruxolitinib can be decreased when combined with Midazolam.Midodrine Ruxolitinib may increase the bradycardic activities of Midodrine.Midostaurin The metabolism of Ruxolitinib can be decreased when combined with Midostaurin.Mifepristone The metabolism of Ruxolitinib can be increased when combined with Mifepristone.Migalastat Migalastat may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Milnacipran The metabolism of Ruxolitinib can be decreased when combined with Milnacipran.Milrinone Milrinone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Miocamycin The metabolism of Ruxolitinib can be decreased when combined with Miocamycin.Mirabegron Ruxolitinib may decrease the excretion rate of Mirabegron which could result in a higher serum level.Mirtazapine The metabolism of Ruxolitinib can be decreased when combined with Mirtazapine.Mitapivat The metabolism of Ruxolitinib can be increased when combined with Mitapivat.Mitomycin The risk or severity of adverse effects can be increased when Mitomycin is combined with Ruxolitinib.Mitotane The metabolism of Ruxolitinib can be increased when combined with Mitotane.Mitoxantrone The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ruxolitinib.Mobocertinib The serum concentration of Ruxolitinib can be decreased when it is combined with Mobocertinib.Modafinil The metabolism of Ruxolitinib can be increased when combined with Modafinil.Mo COVID-19 The therapeutic efficacy of Moderna COVID-19 Vaccine can be decreased when used in combination with Ruxolitinib.Modified vaccinia ankara The therapeutic efficacy of Modified vaccinia ankara can be decreased when used in combination with Ruxolitinib.Mometasone furoate The metabolism of Ruxolitinib can be increased when combined with Mometasone furoate.Monomethyl fum The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Monomethyl fumarate.Montelukast The metabolism of Ruxolitinib can be decreased when combined with Montelukast.Mosunetuzumab The metabolism of Ruxolitinib can be decreased when combined with Mosunetuzumab.Moxisylyte Ruxolitinib may decrease the excretion rate of Moxisylyte which could result in a higher serum level.Mumps virus The therapeutic efficacy of Mumps virus strain B level jeryl lynn live antigen can be decreased when used in combination with Ruxolitinib.Muromonab The risk or severity of adverse effects can be increased when Muromonab is combined with Ruxolitinib.Muzolimine Muzolimine may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Mycophenolate l The risk or severity of adverse effects can be increased when Mycophenolate mofetil is combined with Ruxolitinib.Mycophenolic acid The risk or severity of adverse effects can be increased when Mycophenolic acid is combined with Ruxolitinib.N-acetyltyrosine Ruxolitinib may decrease the excretion rate of N-acetyltyrosine which could result in a higher serum level.Nabilone The metabolism of Ruxolitinib can be decreased when combined with Nabilone.Nabumetone Nabumetone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Nadolol Ruxolitinib may increase the bradycardic activities of Nadolol.Nadroparin The risk or severity of bleeding can be increased when Nadroparin is combined with Ruxolitinib.Nafcillin The metabolism of Ruxolitinib can be increased when combined with Nafcillin.Naldemedine Ruxolitinib may decrease the excretion rate of Naldemedine which could result in a higher serum level.Nalmefene Nalmefene may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Naloxone Naloxone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Naproxen Naproxen may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Natalizumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Natalizumab.Nateglinide Nateglinide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Nebivolol Ruxolitinib may increase the bradycardic activities of Nebivolol.Nedaplatin Ruxolitinib may decrease the excretion rate of Nedaplatin which could result in a higher serum level.Nedocromil Nedocromil may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Nefazodone The metabolism of Ruxolitinib can be decreased when combined with Nefazodone.Nelarabine The risk or severity of adverse effects can be increased when Nelarabine is combined with Ruxolitinib.Nelfinavir The metabolism of Ruxolitinib can be decreased when combined with Nelfinavir.Neomycin Ruxolitinib may decrease the excretion rate of Neomycin which could result in a higher serum level.Netilmicin Ruxolitinib may decrease the excretion rate of Netilmicin which could result in a higher serum level.Netupitant The metabolism of Ruxolitinib can be decreased when combined with Netupitant.Nevirapine The metabolism of Ruxolitinib can be decreased when combined with Nevirapine.Niacin The metabolism of Ruxolitinib can be decreased when combined with Niacin.Nicardipine Ruxolitinib may increase the bradycardic activities of Nicardipine.Niclosamide The metabolism of Ruxolitinib can be decreased when combined with Niclosamide.Nicorandil Ruxolitinib may decrease the excretion rate of Nicorandil which could result in a higher serum level.Nifedipine Ruxolitinib may increase the bradycardic activities of Nifedipine.Nilotinib The metabolism of Ruxolitinib can be decreased when combined with Nilotinib.Nilutamide The metabolism of Ruxolitinib can be decreased when combined with Nilutamide.Nilvadipine Ruxolitinib may increase the bradycardic activities of Nilvadipine.Nimesulide Ruxolitinib may increase the bradycardic activities of Nimesulide.Nimodipine Ruxolitinib may increase the bradycardic activities of Nimodipine.Nintedanib The metabolism of Ruxolitinib can be decreased when combined with Nintedanib.Nisoldipine Ruxolitinib may increase the bradycardic activities of Nisoldipine.Nitrendipine Ruxolitinib may increase the bradycardic activities of Nitrendipine.Nitric Oxide Nitric Oxide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Nitrofurantoin Nitrofurantoin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Nitroprusside Nitroprusside may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Norethisterone The metabolism of Ruxolitinib can be decreased when combined with Norethisterone.Norgestimate The metabolism of Ruxolitinib can be increased when combined with Norgestimate.Noscapine The metabolism of Ruxolitinib can be decreased when combined with Noscapine.Nuvaxovid The therapeutic efficacy of Nuvaxovid can be decreased when used in combination with Ruxolitinib.Nylidrin Ruxolitinib may increase the bradycardic activities of Nylidrin.Obinutuzumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Obinutuzumab.Ocrelizumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Ocrelizumab.Octinoxate Ruxolitinib may decrease the excretion rate of Octinoxate which could result in a higher serum level.Octreotide The serum concentration of Ruxolitinib can be increased when it is combined with Octreotide.Ofatumumab The risk or severity of adverse effects can be increased when Ofatumumab is combined with Ruxolitinib.Olanzapine The metabolism of Ruxolitinib can be decreased when combined with Olanzapine.Olaparib The metabolism of Ruxolitinib can be decreased when combined with Olaparib.Olodaterol The metabolism of Olodaterol can be decreased when combined with Ruxolitinib.Olsalazine Olsalazine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Omeprazole The metabolism of Ruxolitinib can be decreased when combined with Omeprazole.Ondansetron The metabolism of Ruxolitinib can be decreased when combined with Ondansetron.Opium Ruxolitinib may decrease the excretion rate of Opium which could result in a higher serum level.Oritavancin The metabolism of Ruxolitinib can be increased when combined with Oritavancin.Orphenadrine The metabolism of Ruxolitinib can be decreased when combined with Orphenadrine.Oseltamivir Oseltamivir may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Osilodrostat The metabolism of Ruxolitinib can be decreased when combined with Osilodrostat.Osimertinib The metabolism of Ruxolitinib can be decreased when combined with Osimertinib.Ospemifene The metabolism of Ruxolitinib can be decreased when combined with Ospemifene.Oxacillin Oxacillin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Oxaliplatin The risk or severity of adverse effects can be increased when Oxaliplatin is combined with Ruxolitinib.Oxandrolone The metabolism of Ruxolitinib can be decreased when combined with Oxandrolone.Oxaprozin Oxaprozin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Oxazepam Oxazepam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Oxcarbazepine The metabolism of Ruxolitinib can be increased when combined with Oxcarbazepine.Oxetacaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Oxetacaine.Oxprenolol Ruxolitinib may increase the bradycardic activities of Oxprenolol.Oxybenzone Oxybenzone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Oxybuprocaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Oxybuprocaine.Oxybutynin The metabolism of Ruxolitinib can be decreased when combined with Oxybutynin.Oxyphenbutazone Oxyphenbutazone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Oxyquinoline Ruxolitinib may decrease the excretion rate of Oxyquinoline which could result in a higher serum level.Ozanimod The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Ozanimod.Paclitaxel The metabolism of Ruxolitinib can be increased when combined with Paclitaxel.Pacritinib The serum concentration of Ruxolitinib can be increased when it is combined with Pacritinib.Palbociclib The metabolism of Ruxolitinib can be decreased when combined with Palbociclib.Palifermin The therapeutic efficacy of Palifermin can be decreased when used in combination with Ruxolitinib.Paliperidone Paliperidone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Palonosetron Palonosetron may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pamidronic acid Pamidronic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Panobinostat The risk or severity of adverse effects can be increased when Panobinostat is combined with Ruxolitinib.Pantoprazole Pantoprazole may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Paramethadione The metabolism of Ruxolitinib can be decreased when combined with Paramethadione.Parathyroid hormone The therapeutic efficacy of Parathyroid hormone can be decreased when used in combination with Ruxolitinib.Parecoxib Parecoxib may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Parnaparin The risk or severity of bleeding can be increased when Parnaparin is combined with Ruxolitinib.Paromomycin Paromomycin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Paroxetine The metabolism of Ruxolitinib can be decreased when combined with Paroxetine.Pasireotide Ruxolitinib may increase the bradycardic activities of Pasireotide.Patent Blue Ruxolitinib may decrease the excretion rate of Patent Blue which could result in a higher serum level.Pazopanib The metabolism of Ruxolitinib can be decreased when combined with Pazopanib.Pegaptanib Pegaptanib may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pegaspargase The risk or severity of adverse effects can be increased when Pegaspargase is combined with Ruxolitinib.Pegcetacoplan The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Pegcetacoplan.Peginesatide The risk or severity of Thrombosis can be increased when Peginesatide is combined with Ruxolitinib.Peginterferon alfa-2a The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Ruxolitinib.Peginterferon alfa-2b The metabolism of Ruxolitinib can be increased when combined with Peginterferon alfa-2b.Peginterferon beta-1a The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Peginterferon beta-1a.Pemetrexed The risk or severity of adverse effects can be increased when Pemetrexed is combined with Ruxolitinib.Penbutolol Ruxolitinib may increase the bradycardic activities of Penbutolol.Penicillamine The risk or severity of adverse effects can be increased when Penicillamine is combined with Ruxolitinib.Pentaerythritol tetranitrate Pentaerythritol tetranitrate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pentamidine Pentamidine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pentastarch Ruxolitinib may decrease the excretion rate of Pentastarch which could result in a higher serum level.Pentetic acid Ruxolitinib may decrease the excretion rate of Pentetic acid which could result in a higher serum level.Pentobarbital The metabolism of Ruxolitinib can be increased when combined with Pentobarbital.Pentosan polysulfate The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Ruxolitinib.Pentostatin The risk or severity of adverse effects can be increased when Pentostatin is combined with Ruxolitinib.Pentoxifylline The risk or severity of bleeding can be increased when Pentoxifylline is combined with Ruxolitinib.Perampanel The metabolism of Ruxolitinib can be increased when combined with Perampanel.Perhexiline Ruxolitinib may increase the bradycardic activities of Perhexiline.Perindopril Perindopril may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Permethrin Permethrin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pertussis vaccine The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Ruxolitinib.Phenazopyridine Phenazopyridine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Phenelzine Phenelzine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Phenindione The risk or severity of bleeding can be increased when Phenindione is combined with Ruxolitinib.Phenobarbital The metabolism of Ruxolitinib can be increased when combined with Phenobarbital.Phenol The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Phenol.Phenprocoumon The risk or severity of bleeding can be increased when Phenprocoumon is combined with Ruxolitinib.Phentolamine Phentolamine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Phenylalanine The risk or severity of adverse effects can be increased when Phenylalanine is combined with Ruxolitinib.Phenylbutazone The metabolism of Ruxolitinib can be increased when combined with Phenylbutazone.Phenytoin The metabolism of Ruxolitinib can be increased when combined with Phenytoin.Pholcodine Ruxolitinib may decrease the excretion rate of Pholcodine which could result in a higher serum level.Phosphoric acid Ruxolitinib may decrease the excretion rate of Phosphoric acid which could result in a higher serum level.Phylloquinone Phylloquinone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Picosulfuric acid Ruxolitinib may decrease the excretion rate of Picosulfuric acid which could result in a higher serum level.Pimavanserin The metabolism of Ruxolitinib can be decreased when combined with Pimavanserin.Pimecrolimus The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Ruxolitinib.Pimozide The metabolism of Ruxolitinib can be decreased when combined with Pimozide.Pinaverium Ruxolitinib may increase the bradycardic activities of Pinaverium.Pindolol Ruxolitinib may increase the bradycardic activities of Pindolol.Piperacillin Piperacillin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Piperaquine The metabolism of Ruxolitinib can be decreased when combined with Piperaquine.Piracetam Ruxolitinib may decrease the excretion rate of Piracetam which could result in a higher serum level.Piretanide Piretanide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Pirfenidone The risk or severity of adverse effects can be increased when Pirfenidone is combined with Ruxolitinib.Piroxicam Piroxicam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pitavastatin The metabolism of Ruxolitinib can be decreased when combined with Pitavastatin.Pitolisant The serum concentration of Ruxolitinib can be decreased when it is combined with Pitolisant.Plazomicin Ruxolitinib may decrease the excretion rate of Plazomicin which could result in a higher serum level.Plerixafor Plerixafor may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Polythiazide Polythiazide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Pomalidomide The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Pomalidomide.Ponatinib The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Ponatinib.Ponesimod The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Ponesimod.Poractant alfa Ruxolitinib may increase the bradycardic activities of Poractant alfa.Posaconazole The metabolism of Ruxolitinib can be decreased when combined with Posaconazole.Potassium Potassium may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Potassium acetate Ruxolitinib may decrease the excretion rate of Potassium acetate which could result in a higher serum level.Potassium bicarb Ruxolitinib may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level.Potassium cation Potassium cation may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Potassium chloride Potassium chloride may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Potassium citrate Potassium citrate may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Potassium Iodide The therapeutic efficacy of Potassium Iodide can be decreased when used in combination with Ruxolitinib.Potassium nitrate Ruxolitinib may decrease the excretion rate of Potassium nitrate which could result in a higher serum level.Potassium perc The therapeutic efficacy of Potassium perchlorate can be decreased when used in combination with Ruxolitinib.Potassium sulfate Ruxolitinib may decrease the excretion rate of Potassium sulfate which could result in a higher serum level.Practolol Ruxolitinib may increase the bradycardic activities of Practolol.Pralatrexate The risk or severity of adverse effects can be increased when Pralatrexate is combined with Ruxolitinib.Pralidoxime Pralidoxime may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pralsetinib The metabolism of Ruxolitinib can be increased when combined with Pralsetinib.Pramipexole Pramipexole may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pramocaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Pramocaine.Prasugrel The risk or severity of bleeding can be increased when Prasugrel is combined with Ruxolitinib.Prednisolone The metabolism of Ruxolitinib can be increased when combined with Prednisolone.Prednisolone ace The metabolism of Ruxolitinib can be increased when combined with Prednisolone acetate.Prednisolone phosphate The metabolism of Ruxolitinib can be increased when combined with Prednisolone phosphate.Prednisone The risk or severity of adverse effects can be increased when Prednisone is combined with Ruxolitinib.Prednisone acetate The metabolism of Ruxolitinib can be increased when combined with Prednisone acetate.Pregabalin Ruxolitinib may increase the bradycardic activities of Pregabalin.Prenylamine Ruxolitinib may increase the bradycardic activities of Prenylamine.Pretomanid The metabolism of Ruxolitinib can be decreased when combined with Pretomanid.Prilocaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Prilocaine.Primaquine The metabolism of Ruxolitinib can be decreased when combined with Primaquine.Primidone The metabolism of Ruxolitinib can be increased when combined with Primidone.Probenecid The metabolism of Ruxolitinib can be increased when combined with Probenecid.Procainamide Ruxolitinib may decrease the excretion rate of Procainamide which could result in a higher serum level.Procaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Procaine.Procaine benzylpenicillin Ruxolitinib may decrease the excretion rate of Procaine benzylpenicillin which could result in a higher serum level.Procarbazine The risk or severity of adverse effects can be increased when Procarbazine is combined with Ruxolitinib.Progesterone The metabolism of Ruxolitinib can be decreased when combined with Progesterone.Proguanil The metabolism of Ruxolitinib can be decreased when combined with Proguanil.Promazine The metabolism of Ruxolitinib can be decreased when combined with Promazine.Promethazine The metabolism of Ruxolitinib can be decreased when combined with Promethazine.Propafenone Ruxolitinib may increase the bradycardic activities of Propafenone.Propantheline Propantheline may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Proparacaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Proparacaine.Propiverine Ruxolitinib may decrease the excretion rate of Propiverine which could result in a higher serum level.Propofol The metabolism of Ruxolitinib can be decreased when combined with Propofol.Propoxycaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Propoxycaine.Propranolol Ruxolitinib may increase the bradycardic activities of Propranolol.Propylthiouracil The therapeutic efficacy of Propylthiouracil can be decreased when used in combination with Ruxolitinib.Protein C The risk or severity of bleeding can be increased when Protein C is combined with Ruxolitinib.Protein S human The risk or severity of bleeding can be increased when Protein S human is combined with Ruxolitinib.Protirelin The therapeutic efficacy of Protirelin can be decreased when used in combination with Ruxolitinib.Prucalopride Prucalopride may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pyrantel Ruxolitinib may decrease the excretion rate of Pyrantel which could result in a higher serum level.Pyrazinamide Pyrazinamide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pyridoxine Pyridoxine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Pyrithione Pyrithione may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Quazepam The metabolism of Ruxolitinib can be decreased when combined with Quazepam.Quetiapine Quetiapine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Quinethazone Quinethazone may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Quinidine The metabolism of Ruxolitinib can be decreased when combined with Quinidine.Quinine The metabolism of Ruxolitinib can be increased when combined with Quinine.Quinupristin The metabolism of Ruxolitinib can be decreased when combined with Quinupristin.Rabeprazole Rabeprazole may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Rimmune globul The therapeutic efficacy of Rabies immune globulin, human can be decreased when used in combination with Ruxolitinib.Rabie antigen, A The therapeutic efficacy of Rabies virus inactivated antigen, A can be decreased when used in combination with Ruxolitinib.Rabie antigen, B The therapeutic efficacy of Rabies virus inactivated antigen, B can be decreased when used in combination with Ruxolitinib.Raloxifene The metabolism of Ruxolitinib can be decreased when combined with Raloxifene.Raltitrexed The risk or severity of adverse effects can be increased when Raltitrexed is combined with Ruxolitinib.Ramelteon Ramelteon may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ranitidine Ranitidine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ranolazine The metabolism of Ruxolitinib can be decreased when combined with Ranolazine.Rasagiline Rasagiline may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ravulizumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Ravulizumab.Regorafenib Ruxolitinib may increase the bradycardic activities of Regorafenib.Remdesivir The metabolism of Ruxolitinib can be decreased when combined with Remdesivir.Remifentanil Ruxolitinib may increase the bradycardic activities of Remifentanil.Reserpine Reserpine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Resorcinol Ruxolitinib may decrease the excretion rate of Resorcinol which could result in a higher serum level.Reteplase The risk or severity of bleeding can be increased when Reteplase is combined with Ruxolitinib.Reviparin The risk or severity of bleeding can be increased when Reviparin is combined with Ruxolitinib.Ribavirin Ribavirin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ribociclib The metabolism of Ruxolitinib can be decreased when combined with Ribociclib.Ribostamycin Ruxolitinib may decrease the excretion rate of Ribostamycin which could result in a higher serum level.Rifabutin The metabolism of Ruxolitinib can be increased when combined with Rifabutin.Rifampicin The metabolism of Ruxolitinib can be increased when combined with Rifampicin.Rifamycin The metabolism of Ruxolitinib can be increased when combined with Rifamycin.Rifapentine The metabolism of Ruxolitinib can be increased when combined with Rifapentine.Rilonacept The metabolism of Ruxolitinib can be increased when combined with Rilonacept.Rilpivirine The metabolism of Ruxolitinib can be decreased when combined with Rilpivirine.Rimexolone The metabolism of Ruxolitinib can be increased when combined with Rimexolone.Risankizumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Risankizumab.Ritonavir The metabolism of Ruxolitinib can be decreased when combined with Ritonavir.Rituximab The risk or severity of adverse effects can be increased when Rituximab is combined with Ruxolitinib.Rivaroxaban Rivaroxaban may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Rivastigmine Ruxolitinib may increase the bradycardic activities of Rivastigmine.Rizatriptan Rizatriptan may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Rofecoxib The metabolism of Ruxolitinib can be increased when combined with Rofecoxib.Roflumilast Roflumilast may increase the immunosuppressive activities of Ruxolitinib.Ropeginterferon The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Ropeginterferon alfa-2b.Ropivacaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Ropivacaine.Rosiglitazone Rosiglitazone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Rosuvastatin The metabolism of Ruxolitinib can be decreased when combined with Rosuvastatin.Rotavirus vaccine The therapeutic efficacy of Rotavirus vaccine can be decreased when used in combination with Ruxolitinib.Roxithromycin The metabolism of Ruxolitinib can be decreased when combined with Roxithromycin.Rubella virus va The risk or severity of infection can be increased when Rubella virus vaccine is combined with Ruxolitinib.Rucaparib The metabolism of Ruxolitinib can be decreased when combined with Rucaparib.Rufinamide The metabolism of Ruxolitinib can be increased when combined with Rufinamide.Rupatadine The metabolism of Rupatadine can be decreased when combined with Ruxolitinib.Sacubitril Ruxolitinib may decrease the excretion rate of Sacubitril which could result in a higher serum level.Salbutamol Salbutamol may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Salicylamide Salicylamide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Salicylic acid Salicylic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Salmon calcitonin The therapeutic efficacy of Salmon calcitonin can be decreased when used in combination with Ruxolitinib.Salsalate Salsalate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Saquinavir The metabolism of Ruxolitinib can be decreased when combined with Saquinavir.Sarilumab The metabolism of Ruxolitinib can be increased when combined with Sarilumab.Satralizumab The serum concentration of Ruxolitinib can be decreased when it is combined with Satralizumab.Saxagliptin Saxagliptin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Secobarbital The metabolism of Ruxolitinib can be increased when combined with Secobarbital.Secukinumab The metabolism of Ruxolitinib can be increased when combined with Secukinumab.Selegiline The metabolism of Ruxolitinib can be decreased when combined with Selegiline.Selenious acid Ruxolitinib may decrease the excretion rate of Selenious acid which could result in a higher serum level.Selenium Ruxolitinib may decrease the excretion rate of Selenium which could result in a higher serum level.Selumetinib The metabolism of Selumetinib can be decreased when combined with Ruxolitinib.Sertraline The metabolism of Ruxolitinib can be decreased when combined with Sertraline.Sibutramine Sibutramine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Sildenafil The metabolism of Ruxolitinib can be decreased when combined with Sildenafil.Siltuximab The metabolism of Ruxolitinib can be increased when combined with Siltuximab.Simeprevir The metabolism of Ruxolitinib can be decreased when combined with Simeprevir.Simvastatin The metabolism of Ruxolitinib can be decreased when combined with Simvastatin.Siponimod The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Siponimod.Sipuleucel-T The therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Ruxolitinib.Sirolimus The risk or severity of adverse effects can be increased when Sirolimus is combined with Ruxolitinib.Sitagliptin Sitagliptin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Sitaxentan The metabolism of Ruxolitinib can be decreased when combined with Sitaxentan.Smallpox (Vaccinia) The therapeutic efficacy of Smallpox (Vaccinia) Vaccine, Live can be decreased when used in combination with Ruxolitinib.Sodium acetate Ruxolitinib may decrease the excretion rate of Sodium acetate which could result in a higher serum level.Sodium aurothiomalate Ruxolitinib may decrease the excretion rate of Sodium aurothiomalate which could result in a higher serum level.Sodium citrate The risk or severity of bleeding can be increased when Sodium citrate is combined with Ruxolitinib.Sodium fluoride Ruxolitinib may decrease the excretion rate of Sodium fluoride which could result in a higher serum level.Sodium sulfate Ruxolitinib may decrease the excretion rate of Sodium sulfate which could result in a higher serum level.Sofosbuvir Ruxolitinib may decrease the excretion rate of Sofosbuvir which could result in a higher serum level.Solriamfetol Ruxolitinib may decrease the excretion rate of Solriamfetol which could result in a higher serum level.Somatostatin The metabolism of Ruxolitinib can be decreased when combined with Somatostatin.Somatrogon The metabolism of Ruxolitinib can be increased when combined with Somatrogon.Sorafenib The risk or severity of adverse effects can be increased when Sorafenib is combined with Ruxolitinib.Sorbitol Sorbitol may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Sotalol Ruxolitinib may increase the bradycardic activities of Sotalol.Sotorasib The serum concentration of Ruxolitinib can be decreased when it is combined with Sotorasib.Spesolimab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Spesolimab.Spironolactone Spironolactone may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.St. John's Wort The metabolism of Ruxolitinib can be increased when combined with St. John's Wort.Stiripentol The metabolism of Ruxolitinib can be decreased when combined with Stiripentol.Streptokinase The risk or severity of bleeding can be increased when Streptokinase is combined with Ruxolitinib.Streptomycin Ruxolitinib may decrease the excretion rate of Streptomycin which could result in a higher serum level.Streptozocin The risk or severity of adverse effects can be increased when Streptozocin is combined with Ruxolitinib.Strontium chloride Ruxolitinib may decrease the excretion rate of Strontium chloride which could result in a higher serum level.Sucralfate Sucralfate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Sufentanil Ruxolitinib may increase the bradycardic activities of Sufentanil.Sulbactam Ruxolitinib may decrease the excretion rate of Sulbactam which could result in a higher serum level.Sulfadiazine The metabolism of Ruxolitinib can be decreased when combined with Sulfadiazine.Sulfamethizole The metabolism of Ruxolitinib can be decreased when combined with Sulfamethizole.Sulfamethoxazole The risk or severity of myelosuppression can be increased when Sulfamethoxazole is combined with Ruxolitinib.Sulfaphenazole The metabolism of Ruxolitinib can be decreased when combined with Sulfaphenazole.Sulfapyridine The metabolism of Ruxolitinib can be decreased when combined with Sulfapyridine.Sulfasalazine The risk or severity of adverse effects can be increased when Sulfasalazine is combined with Ruxolitinib.Sulfinpyrazone The metabolism of Ruxolitinib can be increased when combined with Sulfinpyrazone.Sulfisoxazole The metabolism of Ruxolitinib can be decreased when combined with Sulfisoxazole.Sulindac Sulindac may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Sulodexide The risk or severity of bleeding can be increased when Sulodexide is combined with Ruxolitinib.Sumatriptan Sumatriptan may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Sunitinib The risk or severity of adverse effects can be increased when Sunitinib is combined with Ruxolitinib.Suvorexant The metabolism of Ruxolitinib can be decreased when combined with Suvorexant.Syn Estrogens, A Ruxolitinib may decrease the excretion rate of Synthetic Conjugated Estrogens, A which could result in a higher serum level.Syn  Estrogens, B Ruxolitinib may decrease the excretion rate of Synthetic Conjugated Estrogens, B which could result in a higher serum level.Tacrolimus Tacrolimus may increase the immunosuppressive activities of Ruxolitinib.Tadalafil Tadalafil may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tamoxifen The metabolism of Ruxolitinib can be increased when combined with Tamoxifen.Tamsulosin Tamsulosin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tasimelteon The metabolism of Ruxolitinib can be decreased when combined with Tasimelteon.Tazemetostat The metabolism of Ruxolitinib can be decreased when combined with Tazemetostat.Technetium T Ruxolitinib may decrease the excretion rate of Technetium Tc-99m exametazime which could result in a higher serum level.Technetium Ruxolitinib may decrease the excretion rate of Technetium Tc-99m mebrofenin which could result in a higher serum level.Technetium Tc-99 Ruxolitinib may decrease the excretion rate of Technetium Tc-99m oxidronate which could result in a higher serum level.Technetium Tc-99m p Ruxolitinib may decrease the excretion rate of Technetium Tc-99m pyrophosphate which could result in a higher serum level.Tecovirimat The metabolism of Ruxolitinib can be increased when combined with Tecovirimat.Tedizolid phosphate The risk or severity of myelosuppression can be increased when Ruxolitinib is combined with Tedizolid phosphate.Teduglutide Ruxolitinib may decrease the excretion rate of Teduglutide which could result in a higher serum level.Tegafur Ruxolitinib may decrease the excretion rate of Tegafur which could result in a higher serum level.Telaprevir The metabolism of Ruxolitinib can be decreased when combined with Telaprevir.Telavancin Telavancin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Telithromycin The metabolism of Ruxolitinib can be decreased when combined with Telithromycin.Telotristat ethyl The serum concentration of Ruxolitinib can be decreased when it is combined with Telotristat ethyl.Temazepam Temazepam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Temozolomide The risk or severity of adverse effects can be increased when Temozolomide is combined with Ruxolitinib.Temsirolimus The risk or severity of adverse effects can be increased when Temsirolimus is combined with Ruxolitinib.Tenecteplase The risk or severity of bleeding can be increased when Tenecteplase is combined with Ruxolitinib.Teniposide The metabolism of Ruxolitinib can be decreased when combined with Teniposide.Tenofovir alafenamide The serum concentration of Tenofovir alafenamide can be increased when it is combined with Ruxolitinib.Tenofovir disoproxil Tenofovir disoproxil may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tenoxicam Tenoxicam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tepotinib The metabolism of Ruxolitinib can be decreased when combined with Tepotinib.Teprotumumab The risk or severity of adverse effects can be increased when Teprotumumab is combined with Ruxolitinib.Terbinafine The metabolism of Ruxolitinib can be increased when combined with Terbinafine.Terbutaline Terbutaline may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Terfenadine The metabolism of Ruxolitinib can be decreased when combined with Terfenadine.Teriflunomide The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Teriflunomide.Teriparatide The therapeutic efficacy of Teriparatide can be decreased when used in combination with Ruxolitinib.Testolactone Testolactone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Testosterone The metabolism of Ruxolitinib can be increased when combined with Testosterone.Testosterone cypionate Ruxolitinib may decrease the excretion rate of Testosterone cypionate which could result in a higher serum level.Testosterone ena Ruxolitinib may decrease the excretion rate of Testosterone enanthate which could result in a higher serum level.Testosterone propi Testosterone propionate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Testosterone undeca Ruxolitinib may decrease the excretion rate of Testosterone undecanoate which could result in a higher serum level.Tetracaine The risk or severity of methemoglobinemia can be increased when Ruxolitinib is combined with Tetracaine.Tetracycline The metabolism of Ruxolitinib can be decreased when combined with Tetracycline.Tetradecyl hydrogen Ruxolitinib may decrease the excretion rate of Tetradecyl hydrogen sulfate (ester) which could result in a higher serum level.Thalidomide The risk or severity of adverse effects can be increased when Thalidomide is combined with Ruxolitinib.Thiabendazole Thiabendazole may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Thiamylal The metabolism of Ruxolitinib can be increased when combined with Thiamylal.Thiethylperazine Thiethylperazine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Thiotepa The risk or severity of adverse effects can be increased when Thiotepa is combined with Ruxolitinib.Thyroid, porcine The therapeutic efficacy of Thyroid, porcine can be decreased when used in combination with Ruxolitinib.Thyrotropin alfa The therapeutic efficacy of Thyrotropin alfa can be decreased when used in combination with Ruxolitinib.Tiaprofenic acid Tiaprofenic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Ticagrelor The metabolism of Ruxolitinib can be decreased when combined with Ticagrelor.Tick-borne ence The therapeutic efficacy of Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Ruxolitinib.Ticlopidine The metabolism of Ruxolitinib can be decreased when combined with Ticlopidine.Tiludronic acid Tiludronic acid may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Timolol Ruxolitinib may increase the bradycardic activities of Timolol.Tinidazole Tinidazole may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tinzaparin The risk or severity of bleeding can be increased when Tinzaparin is combined with Ruxolitinib.Tioguanine The risk or severity of adverse effects can be increased when Tioguanine is combined with Ruxolitinib.Tiopronin Tiopronin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tiotropium Tiotropium may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tipranavir The metabolism of Ruxolitinib can be decreased when combined with Tipranavir.Tirofiban The risk or severity of bleeding can be increased when Tirofiban is combined with Ruxolitinib.Tixocortol The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Tixocortol.Tizanidine Ruxolitinib may increase the bradycardic activities of Tizanidine.Tobramycin Ruxolitinib may decrease the excretion rate of Tobramycin which could result in a higher serum level.Tocilizumab The metabolism of Ruxolitinib can be increased when combined with Tocilizumab.Tocopherol Ruxolitinib may decrease the excretion rate of Tocopherol which could result in a higher serum level.Tofacitinib Ruxolitinib may increase the immunosuppressive activities of Tofacitinib.Tolazamide Tolazamide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tolbutamide Tolbutamide may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tolcapone Tolcapone may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tolfenamic acid Ruxolitinib may increase the bradycardic activities of Tolfenamic acid.Tolmetin Tolmetin may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tolterodine Tolterodine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Tolvaptan Tolvaptan may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Topiramate The metabolism of Ruxolitinib can be increased when combined with Topiramate.Topotecan The risk or severity of adverse effects can be increased when Topotecan is combined with Ruxolitinib.Torasemide The metabolism of Ruxolitinib can be decreased when combined with Torasemide.Tositumomab The risk or severity of adverse effects can be increased when Tositumomab is combined with Ruxolitinib.Trabectedin The risk or severity of adverse effects can be increased when Trabectedin is combined with Ruxolitinib.Tramadol Tramadol may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Trametinib Ruxolitinib may decrease the excretion rate of Trametinib which could result in a higher serum level.Tranylcypromine The metabolism of Ruxolitinib can be decreased when combined with Tranylcypromine.Trastuzumab Trastuzumab may increase the neutropenic activities of Ruxolitinib.Trastuzumab The risk or severity of adverse effects can be increased when Trastuzumab emtansine is combined with Ruxolitinib.Treprostinil The metabolism of Ruxolitinib can be decreased when combined with Treprostinil.Tretinoin The risk or severity of adverse effects can be increased when Tretinoin is combined with Ruxolitinib.Triamcinolone The metabolism of Ruxolitinib can be increased when combined with Triamcinolone.Triamterene Triamterene may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Triazolam Triazolam may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Trichlormethiazide Trichlormethiazide may increase the excretion rate of Ruxolitinib which could result in a lower serum level and potentially a reduction in efficacy.Triclabendazole The metabolism of Ruxolitinib can be decreased when combined with Triclabendazole.Triethylenetetramine Triethylenetetramine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Trifluridine The risk or severity of adverse effects can be increased when Trifluridine is combined with Ruxolitinib.Triflusal The risk or severity of bleeding can be increased when Triflusal is combined with Ruxolitinib.Trilostane The risk or severity of adverse effects can be increased when Trilostane is combined with Ruxolitinib.Trimebutine Ruxolitinib may increase the bradycardic activities of Trimebutine.Trimethadione Ruxolitinib may increase the bradycardic activities of Trimethadione.Trimethoprim Trimethoprim may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Trimetrexate Trimetrexate may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Trimipramine The metabolism of Ruxolitinib can be decreased when combined with Trimipramine.Troglitazone The metabolism of Ruxolitinib can be increased when combined with Troglitazone.Troleandomycin The metabolism of Ruxolitinib can be decreased when combined with Troleandomycin.Tropisetron Ruxolitinib may decrease the excretion rate of Tropisetron which could result in a higher serum level.Tucatinib The metabolism of Tucatinib can be decreased when combined with Ruxolitinib.Typhoid vaccine The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Ruxolitinib.Typhoid Vaccine Live The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Ruxolitinib.Typhoid Vi polys The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Ruxolitinib.Ublituximab The risk or severity of infection can be increased when Ublituximab is combined with Ruxolitinib.Upadacitinib The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Upadacitinib.Urokinase The risk or severity of bleeding can be increased when Urokinase is combined with Ruxolitinib.Vaborbactam Ruxolitinib may decrease the excretion rate of Vaborbactam which could result in a higher serum level.Valaciclovir Valaciclovir may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Valbenazine Ruxolitinib may decrease the excretion rate of Valbenazine which could result in a higher serum level.Valdecoxib The metabolism of Ruxolitinib can be decreased when combined with Valdecoxib.Valganciclovir Valganciclovir may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Valproic acid The metabolism of Ruxolitinib can be decreased when combined with Valproic acid.Valsartan The metabolism of Ruxolitinib can be decreased when combined with Valsartan.Vancomycin Ruxolitinib may decrease the excretion rate of Vancomycin which could result in a higher serum level.Varenicline Varenicline may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Varicella zoster va The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Ruxolitinib.Varicella zoster The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Ruxolitinib.Vedolizumab The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Vedolizumab.Vemurafenib The metabolism of Ruxolitinib can be increased when combined with Vemurafenib.Venetoclax The metabolism of Ruxolitinib can be decreased when combined with Venetoclax.Venlafaxine Venlafaxine may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Verapamil Ruxolitinib may increase the bradycardic activities of Verapamil.Vibrio cholerae The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Ruxolitinib.Vilanterol The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Vilanterol.Viloxazine The metabolism of Ruxolitinib can be decreased when combined with Viloxazine.Vinblastine The metabolism of Ruxolitinib can be increased when combined with Vinblastine.Vincristine The risk or severity of adverse effects can be increased when Vincristine is combined with Ruxolitinib.Vindesine The risk or severity of adverse effects can be increased when Vindesine is combined with Ruxolitinib.Vinorelbine The risk or severity of adverse effects can be increased when Vinorelbine is combined with Ruxolitinib.Vismodegib The metabolism of Ruxolitinib can be decreased when combined with Vismodegib.Vitamin E The metabolism of Ruxolitinib can be increased when combined with Vitamin E.Voclosporin The risk or severity of adverse effects can be increased when Ruxolitinib is combined with Voclosporin.Vorapaxar The metabolism of Ruxolitinib can be decreased when combined with Vorapaxar.Voriconazole The metabolism of Ruxolitinib can be decreased when combined with Voriconazole.Vorinostat The risk or severity of adverse effects can be increased when Vorinostat is combined with Ruxolitinib.Vortioxetine Ruxolitinib may decrease the excretion rate of Vortioxetine which could result in a higher serum level.Voxelotor The serum concentration of Ruxolitinib can be increased when it is combined with Voxelotor.Warfarin The metabolism of Ruxolitinib can be increased when combined with Warfarin.Ximelagatran The risk or severity of bleeding can be increased when Ximelagatran is combined with Ruxolitinib.Yellow fever vaccine The risk or severity of infection can be increased when Yellow fever vaccine is combined with Ruxolitinib.Zafirlukast The metabolism of Ruxolitinib can be decreased when combined with Zafirlukast.Zaleplon Zaleplon may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Zanamivir Zanamivir may decrease the excretion rate of Ruxolitinib which could result in a higher serum level.Zidovudine The risk or severity of adverse effects can be increased when Zidovudine is combined with Ruxolitinib.Zileuton The metabolism of Ruxolitinib can be decreased when combined with Zileuton.Zimelidine The metabolism of Ruxolitinib can be decreased when combined with Zimelidine.Ziprasidone The metabolism of Ruxolitinib can be decreased when combined with Ziprasidone.Zolpidem The metabolism of Ruxolitinib can be decreased when combined with Zolpidem.Zonisamide Ruxolitinib may increase the bradycardic activities of Zonisamide.Zopiclone The metabolism of Ruxolitinib can be decreased when combined with Zopiclone.Zuclopenthixol The metabolism of Ruxolitinib can be decreased when combined with Zuclopenthixol.Pregnancy and Lactation AU TGA pregnancy category: C US FDA pregnancy category: N Pregnancy When pregnant rats and rabbits were administered ruxolitinib during the period of organogenesis adverse developmental outcomes occurred at doses associated with maternal toxicity (see Data). There are no studies on the use of Jakafi in pregnant women to inform drug-associated risks. The background risk of major birth defects and miscarriage for the indicated populations is unknown. Adverse outcomes in pregnancy occur regardless of the health of the mother or the use of medications. The background risk in the U.S. general population of major birth defects is 2% to 4% and miscarriage is 15% to 20% of clinically recognized pregnancies. Lactation No information is available on the clinical use of ruxolitinib during breastfeeding. Because ruxolitinib is 97% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during ruxolitinib therapy and for 2 weeks after the last dose.Why is this medication prescribed?

Ruxolitinib is used to treat myelofibrosis (a cancer of the bone marrow in which the bone marrow is replaced by scar tissue and causes decreased blood cell production). It is also used to treat polycythemia vera (PV; a slow growing cancer of the blood in which the bone marrow makes too many red blood cells) in people who were not able to be treated successfully with hydroxyurea. Ruxolitinib is also used to treat acute graft versus host disease (aGVHD; a…

How should this medicine be used?

Ruxolitinib comes as a tablet to take by mouth. It is usually taken with or without food two times a day. Take ruxolitinib at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ruxolitinib exactly as directed. Do not take more or less of it, or take it more often than prescribed by your doctor. If you are being treated…

References

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Written by Dr. Harun Ar Rashid, MD - Arthritis, Bones, Joints Pain, Trauma, and Internal Medicine Specialist

Dr. Md. Harun Ar Rashid, MPH, MD, PhD, is a highly respected medical specialist celebrated for his exceptional clinical expertise and unwavering commitment to patient care. With advanced qualifications including MPH, MD, and PhD, he integrates cutting-edge research with a compassionate approach to medicine, ensuring that every patient receives personalized and effective treatment. His extensive training and hands-on experience enable him to diagnose complex conditions accurately and develop innovative treatment strategies tailored to individual needs. In addition to his clinical practice, Dr. Harun Ar Rashid is dedicated to medical education and research, writing and inventory creative thinking, innovative idea, critical care managementing make in his community to outreach, often participating in initiatives that promote health awareness and advance medical knowledge. His career is a testament to the high standards represented by his credentials, and he continues to contribute significantly to his field, driving improvements in both patient outcomes and healthcare practices. Born and educated in Bangladesh, Dr. Rashid earned his BPT from the University of Dhaka before pursuing postgraduate training internationally. He completed his MD in Internal Medicine at King’s College London, where he developed a special interest in inflammatory arthritis and metabolic bone disease. He then undertook a PhD in Orthopedic Science at the University of Oxford, conducting pioneering research on cytokine signaling pathways in rheumatoid arthritis. Following his doctoral studies, Dr. Rashid returned to clinical work with a fellowship in interventional pain management at the Rx University School of Medicine, refining his skills in image-guided joint injections and minimally invasive pain-relief techniques.