Can Jakafi (ruxolitinib) cause diarrhea?

Jakafi (Ruxolitinib) and Diarrhea: Clinical Implications

Yes, Jakafi (ruxolitinib) can cause diarrhea as a recognized side effect, with gastrointestinal symptoms including diarrhea reported in clinical studies and guidelines. 1

Gastrointestinal Side Effects of Jakafi

Jakafi, a JAK1/2 inhibitor, is associated with several gastrointestinal adverse events:

• Diarrhea is specifically mentioned in clinical guidelines as one of the gastrointestinal side effects of oral JAK inhibitors 1
• Other gastrointestinal symptoms that may occur with Jakafi include:
  • Abdominal pain
  • Nausea
  • Vomiting

Incidence and Severity

The British Journal of Dermatology guidelines report that JAK inhibitors can cause gastrointestinal symptoms with the following characteristics:

• Diarrhea has been reported with oral JAK inhibitor use 1
• Nausea occurs in approximately 3-7% of patients in rheumatoid arthritis studies 1
• In atopic dermatitis studies, nausea frequency was higher at 7-20% 1

While the exact incidence of diarrhea specifically with Jakafi is not precisely quantified in the available evidence, it is recognized as a potential adverse effect of JAK inhibitor therapy.

Management of JAK Inhibitor-Associated Diarrhea

For patients experiencing diarrhea while on Jakafi:

1. Assess severity and duration

   • Mild to moderate diarrhea may be managed symptomatically
   • Severe or persistent diarrhea requires medical evaluation

2. Consider dosage modification

   • Temporary dose reduction may be necessary in cases of moderate to severe diarrhea
   • In severe cases, temporary discontinuation might be required

3. Supportive care

   • Maintain hydration
   • Anti-diarrheal medications as appropriate
   • Monitor for electrolyte imbalances

Other Important Safety Considerations with Jakafi

While managing diarrhea, be aware of other potential adverse effects:

• Infections: Jakafi can increase risk of infections, particularly herpes zoster 1
• Hematologic effects: Monitor for anemia, thrombocytopenia, and neutropenia 2
• Thromboembolism: Increased risk of venous thromboembolism has been reported with JAK inhibitors 3

Clinical Monitoring Recommendations

For patients on Jakafi who develop diarrhea:

• Rule out infectious causes, particularly in immunocompromised patients
• Monitor for signs of dehydration or electrolyte disturbances
• Evaluate for other potential causes of diarrhea
• Consider dose adjustment if diarrhea is persistent or severe

Conclusion

Diarrhea is a recognized side effect of Jakafi (ruxolitinib) therapy. While it may not be the most common adverse effect, clinicians should be aware of this potential complication and manage it appropriately to maintain patient quality of life and treatment adherence.