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  4. Assess for the risk of developing serious bacterial, mycobacterial, fungal, and viral infections Active serious infections should have resolved before starting therapy Tuberculosis TB infection has been reported; before initiating, evaluate patients for TB risk factors, and those at higher risk should be tested for latent infection; risk factors include, but are not limited to, prior residence in or travel to countries with a high prevalence of tuberculosis, close contact with a person with active tuberculosis, and a history of active or latent tuberculosis where an adequate course of treatment cannot be confirmed; the decision to continue therapy during treatment of active tuberculosis should be based on overall risk- benefit determination Carefully observe patients for signs and symptoms of infection and initiate appropriate treatment promptly Herpes zoster Inform patients about early signs and symptoms of herpes zoster and advise to seek treatment as early as possible Progressive multifocal leukoencephalopathy PML Reported with ruxolitinib treatment for myelofibrosis; if suspected, discontinue drug and evaluate Hepatitis B viral load HBV- DNA titer increases, with or without associated elevations in alanine aminotransferase and aspartate aminotransferase, reported in patients with chronic HBV infection; effect of ruxolitinib on viral replication unknown; treat and monitor patients with chronic HBV infection according to clinical guidelines. taking doxycycline These commonly include tingling in the hands feet and a metallic taste.

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