Drug Interaction Report

GENERALLY AVOID: Coadministration of deuruxolitinib with other Janus Kinase (JAK) inhibitors, biologic immunomodulators, or other potent immunosuppressants (e.g., cyclosporine) may potentiate the risk of infections, major adverse cardiovascular events (MACE), and other malignancies, including lymphomas. Serious and sometimes fatal infections including bacterial, mycobacterial (e.g., tuberculosis), fungal, viral including viral reactivation, and other opportunistic infections have been reported in patients who have received deuruxolitinib. Opportunistic infections include tuberculosis, multidermatomal herpes zoster, oral/esophageal candidiasis, and cryptococcosis. Lymphoma and other malignancies, including non-melanoma skin cancers, have also been observed with the use of deuruxolitinib and other Janus kinase (JAK) inhibitors.

MANAGEMENT: Concomitant use of deuruxolitinib with other Janus kinase (JAK) inhibitors, biologic disease-modifying antirheumatic drugs (DMARDs), or potent immunosuppressants (e.g., azathioprine, cyclosporine) is not recommended. Patients receiving deuruxolitinib should be closely monitored for the development of signs and symptoms of infection during and after treatment, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy. If a patient develops a serious infection, deuruxolitinib therapy should be interrupted until the infection is controlled.

ADJUST DOSING INTERVAL: Consumption of food has led to a 27% decrease in the bioavailability of orally administered tacrolimus.

MANAGEMENT: Tacrolimus should be administered at least one hour before or two hours after meals.

GENERALLY AVOID: Grapefruit juice has been reported to increase tacrolimus trough concentrations. Data are limited, but inhibition of the CYP450 enzyme system appears to be involved.

MANAGEMENT: The clinician may want to recommend that the patient avoid ingesting large amounts of grapefruit juice while taking tacrolimus.

MONITOR: Smoking during treatment with deuruxolitinib may increase the risk of major adverse cardiovascular events (MACE) and the risk of developing malignancies. In clinical studies of deuruxolitinib, individuals who were current or former smokers had an additional increased risk of overall malignancies. Also, deuruxolitinib may increase patients' risk of MACE, including myocardial infarction, stroke, and cardiovascular death.

MANAGEMENT: Caution is advised if deuruxolitinib is prescribed to current or past smokers. Patients should be informed about the symptoms of serious cardiovascular events and the steps to take if they occur. The manufacturer recommends discontinuing deuruxolitinib in patients that have experienced a myocardial infarction or stroke. Deuruxolitinib may be taken with or without food.