FormWeb • tofacitinib

Huntsville Hospital

Approved Hospital Formulary

Suggestions or Corrections? Above and Beyond Nominations Formulary Request

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Medications not yet evaluated by P&T are considered NON-FORMULARY . . . . . Always check 2 unique patient identifiers - NAME and DATE OF BIRTH - at every step! . . . . . Please be sure to document all clinical activities daily.

Huntsville Hospital

Approved Hospital Formulary

Suggestions or Corrections? Above and Beyond Nominations Formulary Request

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tofacitinib

tofacitinib

Restricted In Setting of COVID-19
Non-formulary Miscellaneous Programs

Drug Name	Form	Strength	Formulary Unrestricted	Formulary Restricted	Non-Formulary	Interchange
Xeljanz XR	TABLET, EXTENDED RELEASE, ORAL	11 mg
Xeljanz	TABLET, ORAL	5 mg

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Comments:

Xeljanz medication guide

When utilized for COVID19, tofacitinib (Xeljanz) is restricted to use during a baricitinib shortage. Patients must meet Huntsville Hospital approved criteria for use and any FDA EUA guidance.

Tofacitinib (Xeljanz) use for other indications remains unrestricted.

Reviewed: January 22, 2013 (Xeljanz) and 26 July 2016 (Xeljanz XR)

Updated: October 2021 (Xeljanz - COVID19)

Last updated: Jun. 28, 2022

Black Box Warning: Patients treated with tofacitinib citrate are at increased risk for developing serious infections that may lead to hospitalization or death
HAZ-MED: Group 2

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