Medical Information

Tofacitinib, as a JAK inhibitor, requires special attention to the risk of infection, cardiovascular events, and serious adverse reactions such as thrombosis. Individualized medication plans are needed for special populations. The following system explains its precautions and key points for medication for special populations, covering risk monitoring, dose adjustment, and contraindication management.

1. Core precautions

(1) Serious infection: Increased risk of bacterial/viral/fungal infections, prohibited during active infections. Screening for tuberculosis before treatment and monitoring for signs of infection during treatment.

(2) Cardiovascular risk: For individuals over 50 years old with cardiovascular risk factors, the benefit risk ratio needs to be evaluated. Stop taking medication immediately if chest tightness or palpitations occur.

(3) Thrombosis: The incidence of deep vein thrombosis increases, and postoperative patients delay medication until the wound heals. Close monitoring is required when combining estrogen drugs.

2. Laboratory monitoring requirements

(1) Blood routine: Neutrophils (<1 × 10 ⁹/L paused) and lymphocytes (<0.5 × 10 ⁹/L discontinued) are tested before treatment and monthly.

(2) Liver function: ALT/AST should be reduced when the upper limit is greater than 3 times, and permanently discontinued when the upper limit is greater than 5 times. Patients with alcoholic liver disease are prohibited from using it.

(3) Blood lipid profile: LDL levels were measured at baseline and week 12, and statin treatment was initiated if the elevation exceeded 190mg/dL.

3. Medication for special populations

(1) Pregnancy: Animals show embryotoxicity, human data is limited. After confirming the pregnancy status, weigh the pros and cons and strictly use contraception.

(2) Breastfeeding period: Medication may be secreted into breast milk. Breastfeeding is prohibited during treatment and 18 hours after discontinuation of medication.

(3) Elderly patients: The risk of infection increases by 2 times for those over 65 years old. It is recommended to start with a low dose (5mgbid).

4. Drug interactions

(1) Strong CYP3A4 inhibitors (such as ketoconazole): dose halved. Avoid using it in combination with fluconazole.

(2) Immunosuppressants: Do not use in combination with biologics to increase the risk of PML. When used in conjunction with MTX, a 30% reduction is required.

(3) Live vaccine: Vaccination is prohibited during treatment and within 3 months after discontinuation. The response to inactivated vaccines may be weakened.