Tofacitinib Tablets 5mg

Q1: What is Tofajak (Tofacitinib 5mg) used for?

Tofajak is an oral JAK inhibitor used for rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, and ankylosing spondylitis. In HIV patients, it may be prescribed for co-existing inflammatory conditions requiring JAK pathway inhibition.

Q2: How does Tofacitinib reduce inflammation in HIV patients?

Tofacitinib inhibits JAK1 and JAK3 signaling, reducing IL-6, IL-2, IFN-γ, and other pro-inflammatory cytokines. This modulates T-cell and B-cell activity, reducing joint and bowel inflammation in autoimmune conditions.

Q3: What is the standard dose of Tofajak 5mg?

For rheumatoid arthritis: 5mg twice daily. For ulcerative colitis (induction): 10mg twice daily for 8 weeks, then 5mg twice daily maintenance. The 5mg dose is the maintenance standard for most indications.

Q4: What additional infection risks does Tofacitinib add in HIV patients?

JAK inhibitors increase the risk of serious opportunistic infections, TB reactivation, fungal infections, and viral reactivations. In HIV patients, this risk is compounded. Adequate CD4 count (generally >200), suppressed viral load, and TB screening are required before starting.

Q5: What thromboembolism risk is associated with Tofacitinib?

Tofacitinib 10mg twice daily is associated with increased DVT and pulmonary embolism risk. The 5mg dose carries lower but real risk. Use with caution in patients with cardiovascular risk factors — a concern particularly relevant in HIV patients with chronic inflammation.

Q6: How does Tofacitinib interact with HIV antiretrovirals?

CYP3A4 inhibitors in HIV regimens (ritonavir, cobicistat-boosted PIs) increase Tofacitinib levels — dose reduction to 5mg once daily may be required. CYP3A4/CYP2C19 inducers reduce levels. Full pharmacist review of drug interactions is essential.

Q7: What TB screening is mandatory before Tofacitinib?

Latent TB testing (IGRA or Mantoux) is required before starting. HIV patients are at higher baseline TB risk. Positive tests require preventive TB therapy before Tofacitinib initiation. Annual TB screening is recommended during therapy.

Q8: What are the most common side effects?

Upper respiratory infections, nasopharyngitis, diarrhea, headache, and elevated liver enzymes are most common. Neutropenia and anemia can occur, requiring regular CBC monitoring.

Q9: What monitoring is required during Tofacitinib therapy in HIV patients?

CBC (including lymphocytes) at baseline and monthly for the first 3 months, then every 3 months. LFTs at baseline and periodically. CD4 count and viral load monitoring continues alongside regular HIV management.

Q10: Can Tofacitinib be taken during pregnancy?

Tofacitinib is contraindicated during pregnancy. Animal studies show teratogenicity. Effective contraception is required during treatment and for at least 4 weeks after stopping.

Q11: How should Tofajak 5mg be stored?

Store at room temperature below 30°C away from moisture. Keep in original packaging out of reach of children.

Q12: Do I need a prescription for Tofajak?

Yes. Tofacitinib requires specialist prescribing, mandatory TB screening, and in HIV patients, coordinated management between rheumatology/gastroenterology and HIV specialists.