How it is administered

Fedratinib is taken by mouth as a capsule. The recommended dose is 400 mg once daily, with or without food. For patients who have difficulty swallowing capsules or require a nasogastric tube, the contents of the capsule can be mixed with approximately 180 mL of a liquid nutritional supplement (like Ensure® Plus) and taken orally or via nasogastric tube within 2 hours of preparation. If a dose is missed, skip it and take the next dose at the usual time the following day. Do not take two doses at once.

How it works

Fedratinib is a type of medication called a kinase inhibitor. It works by blocking the activity of certain enzymes in the body, specifically Janus Associated Kinase 2 (JAK2) and FMS-like tyrosine kinase 3 (FLT3). These enzymes are involved in the signaling pathways that control the growth and survival of blood cells.

In some blood cancers, such as myelofibrosis, JAK2 is abnormally active, leading to the uncontrolled growth of abnormal blood cells and scarring in the bone marrow. By inhibiting JAK2, fedratinib helps reduce the abnormal signaling, slows down the production of abnormal cells, and can help decrease symptoms like enlarged spleen and other related problems. This can improve quality of life and help manage the disease, although it may not cure it.

Who Should take it

Fedratinib is indicated for adults with intermediate-2 or high-risk primary or secondary myelofibrosis, including those who developed myelofibrosis after polycythemia vera or essential thrombocythemia. Myelofibrosis is a rare type of blood cancer that affects the bone marrow and disrupts normal blood cell production.

Patients who have symptoms such as an enlarged spleen, anemia, or other complications from myelofibrosis may benefit from fedratinib. It is especially considered for those who need to control symptoms and improve their blood counts or quality of life. Your healthcare provider will determine if this medication is appropriate based on your specific condition and risk factors.

Who should not take it

Fedratinib should not be started in patients with thiamine (Vitamin B1) deficiency. Thiamine levels should be checked before starting treatment, and any deficiency should be corrected first. If you have a history of serious allergic reactions to fedratinib or any of its ingredients, you should not take this medication.

Caution is also needed in patients with severe liver or kidney problems, and those who are pregnant or breastfeeding, as the safety is not well established in these groups. Always inform your healthcare provider of your full medical history before starting fedratinib.

Commonly used with

Fedratinib is often used alone for the treatment of myelofibrosis. However, patients may also receive supportive treatments such as blood transfusions for anemia, medications to manage side effects (like anti-nausea or anti-diarrheal drugs), and vitamin B1 (thiamine) supplementation to prevent deficiency.

It is important to inform your doctor about all other medications you are taking, as fedratinib can interact with other drugs, especially those that affect the liver enzymes (CYP3A4, CYP2C19, CYP2D6).

Commonly tested with

Fedratinib has been tested in clinical trials both as a single agent and in comparison with placebo or best available therapy for myelofibrosis. It has also been studied in patients who have previously been treated with other JAK inhibitors, such as ruxolitinib.

During treatment, your healthcare team will regularly monitor your blood counts, liver and kidney function, and thiamine levels to ensure safety and effectiveness. Additional medications, such as antiemetics or antidiarrheals, may be tested alongside fedratinib to manage side effects.