Home Drug Guide Baricitinib

Drug Guide

Generic Name

Baricitinib

Brand Names Olumiant

Classification

Therapeutic: Immunosuppressant, Rheumatologic agent

Pharmacological: Janus kinase (JAK) inhibitor

FDA Approved Indications

  • Rheumatoid arthritis in adults who have not responded well to other treatments
  • COVID-19 (emergency use authorization for certain hospitalized patients, as of 2021)

Mechanism of Action

Baricitinib inhibits Janus kinase (JAK) 1 and 2 enzymes, disrupting the JAK-STAT signaling pathway, which is involved in the inflammatory process and immune response, thereby reducing inflammation.

Dosage and Administration

Adult: Typically, 2 mg or 4 mg once daily, with adjustments based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; assess renal function regularly.

Renal Impairment: Dose adjustment may be necessary in patients with renal impairment.

Hepatic Impairment: No specific adjustment required for mild to moderate hepatic impairment; caution in severe hepatic impairment.

Pharmacokinetics

Absorption: Well absorbed orally, peak plasma levels in approximately 1 hour.

Distribution: Wide distribution with a volume of distribution approximately 76 L.

Metabolism: Primarily metabolized via CYP3A4 and other pathways; minimal formation of active metabolites.

Excretion: Excreted mainly via urine (about 75%), with some in feces.

Half Life: Approximately 12 hours.

Contraindications

  • Hypersensitivity to baricitinib or any component of the formulation.
  • Active infections, including tuberculosis.

Precautions

  • Risk of serious infections, including opportunistic infections; screen for infections before initiating treatment.
  • Monitor patients for signs of infection.
  • Use caution in patients with a history of cardiac or pulmonary conditions, or liver disease.
  • Assess risk of thrombosis; caution in patients with a history of thromboembolic events.

Adverse Reactions - Common

  • Infections (upper respiratory, urinary tract infections) (Common)
  • Elevated liver enzymes (Common)
  • Increased blood lipids (LDL, HDL) (Common)
  • Nausea, headache (Common)

Adverse Reactions - Serious

  • Serious infections (pneumonia, cellulitis, herpes zoster) (Uncommon)
  • Thromboembolic events (deep vein thrombosis, pulmonary embolism) (Uncommon)
  • Blood disorders (neutropenia, anemia) (Uncommon)
  • Liver damage (Uncommon)

Drug-Drug Interactions

  • Other immunosuppressants or biologic agents
  • CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) which may increase baricitinib levels
  • CYP3A4 inducers (e.g., rifampin) which may decrease effectiveness

Drug-Food Interactions

  • No significant interactions reported

Drug-Herb Interactions

  • Limited data, caution advised

Nursing Implications

Assessment: Monitor for signs of infection, thrombosis, liver function, and blood counts.

Diagnoses:

  • Risk for infection
  • Risk for bleeding or clotting
  • Impaired skin integrity

Implementation: Administer once daily, monitor laboratory parameters regularly, educate patient on infection signs.

Evaluation: Assess effectiveness in controlling symptoms, track lab parameters, monitor for adverse effects.

Patient/Family Teaching

  • Report signs of infection, unusual bleeding, or blood clots immediately.
  • Take the medication exactly as prescribed.
  • Maintain regular follow-up appointments and lab assessments.
  • Avoid live vaccines during treatment.

Special Considerations

Black Box Warnings:

  • Serious infections, including tuberculosis and opportunistic infections.
  • Malignancies, including lymphomas and other cancers.
  • Thromboembolism, including deep vein thrombosis and pulmonary embolism.

Genetic Factors: Pharmacogenetic testing not routinely required.

Lab Test Interference: May elevate liver enzymes and lipid levels; monitor accordingly.

Overdose Management

Signs/Symptoms: Potential increased risk of infections, liver enzyme elevations, and blood count abnormalities.

Treatment: Supportive care; no specific antidote. Discontinue drug and provide symptomatic treatment as needed.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable for the duration of the shelf-life when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.