Joenja (leniolisib) is a kinase inhibitor used to treat activated phosphoinositide 3-kinase delta (PI3K-delta) syndrome (APDS), which is a rare, inherited condition that affects your immune system. Like all medicines, Joenja can cause side effects and may interact with other medicines.
Keep reading to learn about the possible side effects of Joenja, how to manage them, and which medicines may interact with Joenja.
This article doesn't include every possible side effect or interaction. Tell your health care provider about any symptoms that concern you or don't improve.
Joenja Side Effects
Common side effects
In adults and children 12 years and older, the most common side effects include:
- Headache
- Sinusitis (sinus inflammation)
- Atopic dermatitis (a type of eczema)
In children aged 4 years to less than 12 years, additional common side effects include:
- Abdominal pain
- Cough
- Respiratory tract infection
Serious side effects
Serious allergic reactions, including anaphylaxis, have been reported in people taking Joenja. If you have symptoms that feel serious or life-threatening, seek medical care right away.
How to Manage Joenja Side Effects
While not a complete guide, the following tips can help you prevent or manage the common side effects of Joenja.
1. Headache
Headache is a commonly reported side effect of Joenja. Symptoms may include mild-to-moderate head pain or pressure.
To help manage headaches:
- Rest in a quiet, dark room if needed.
- Drink enough fluids throughout the day.
- Try relaxation techniques, such as deep breathing.
- Maintain a regular sleep schedule.
- Eat regular meals or snacks.
An over-the-counter (OTC) pain reliever may help ease your headache, but check with your health care provider or pharmacist first to make sure it's safe for you.
2. Sinusitis
Sinusitis happens when the tissue lining your sinuses becomes inflamed, often because of an infection. Symptoms may include facial pain or pressure, a stuffy or runny nose, thick nasal discharge, and headache.
To help manage sinusitis:
- Use a saline nasal spray or rinse to help clear congestion.
- Use a humidifier to keep the air moist.
- Stay well hydrated.
- Apply a warm compress to your face to ease pressure or pain.
Contact your health care provider if the symptoms last more than 10 days, keep coming back, or come with a fever. You may need antibiotics or other treatment.
3. Atopic dermatitis (eczema)
Atopic dermatitis, a type of eczema, can happen while taking Joenja. Symptoms may include dry, itchy, red, or inflamed patches of skin.
To help manage skin symptoms:
- Moisturize regularly, especially after bathing, using a fragrance-free moisturizer.
- Take short, lukewarm showers or baths instead of hot ones.
- Choose fragrance-free soaps, detergents, and skin products.
- Avoid scratching, as scratching can make the symptoms worse or lead to skin infections.
If your skin symptoms are severe, spread quickly, or don't improve, your health care provider may prescribe a topical medicine.
4. Weight gain
Though not a common side effect, Joenja may cause weight gain. Some people have become overweight while taking it. Healthy lifestyle habits may help lower this risk. Try to:
- Follow a nutritious diet that includes fruits, vegetables, whole grains, and healthy fats.
- Limit foods high in saturated fat or added sugars.
- Stay physically active with regular movement, such as walking, based on your health care provider's advice.
Your health care provider can help you track your weight over time and talk with you about ways to manage any changes.
5. Low white blood cell counts (neutropenia)
Joenja can lower the number of neutrophils, a type of white blood cell that helps fight infection. This is measured with a blood test. In studies, mild-to-moderate drops in neutrophils were common, though no one had a severe drop in neutrophils or an infection related to it.
Your health care provider will likely check your blood counts periodically while you're taking Joenja. Contact them if you develop signs of infection, such as:
- Fever or chills
- Sore throat
- New cough or shortness of breath
If your neutrophil count drops too low, your health care provider may want to monitor you more closely.
6. Serious allergic reactions
Serious allergic reactions, including anaphylaxis (a sudden, severe, whole-body allergic reaction), have been reported in people taking Joenja, though this wasn't seen in the original clinical trial.
Symptoms of a serious allergic reaction include:
- Hives, itching, or skin redness
- Swelling of the face, lips, tongue, or throat
- Trouble breathing or swallowing
- A fast heartbeat, dizziness, or fainting
If you notice any of these symptoms, stop taking Joenja and seek emergency medical care right away. Don't restart Joenja without talking to your health care provider first.
7. Side effects more common in children
Children aged 4 years to less than 12 years taking Joenja have reported abdominal pain, cough, and respiratory tract infections more often than older patients have.
For abdominal pain:
- Offer smaller, more frequent meals instead of large ones.
- Avoid greasy or spicy foods that may worsen stomach discomfort.
- Contact your child's health care provider if pain is severe, doesn't improve, or comes with vomiting or fever.
For cough and respiratory infections:
- Make sure your child drinks enough fluids.
- Use a humidifier to keep the air moist.
- Use saline sprays for a stuffy nose and warm salt water gargles for a sore throat if your child is old enough.
- Because APDS already affects the immune system, contact your child's health care provider if the symptoms don't improve or they get worse or come with a fever.
If your child develops any side effect that concerns you, even if it isn't listed here, contact their health care provider.
Joenja Interactions
Joenja can interact with other medicines. An interaction happens when a substance changes how a medicine works or affects the body. Some interactions can make Joenja less effective, while others can raise the levels of Joenja or another medicine in your body and increase the risk of side effects.
Many of Joenja's interactions happen because it's broken down in the body by a liver enzyme called CYP3A4. Joenja also affects certain transport proteins in the body, including breast cancer resistance protein (BCRP) and organic anion transporting polypeptides 1B1 and 1B3 (OATP1B1 and OATP1B3), that help move some other medicines through the body.
This isn't a full list of interactions, but the following are important to know about while taking Joenja.
Medicines that can raise Joenja levels in your body
Some medicines slow down how your body breaks down Joenja. This can raise Joenja levels in your body and the risk of side effects.
One example is itraconazole, an antifungal medicine. Taking Joenja with itraconazole roughly doubled Joenja levels in the body in a study.
Joenja shouldn't be taken with itraconazole or other similarly strong CYP3A4 inhibitors, such as clarithromycin (an antibiotic) or ketoconazole (another antifungal medicine).
Certain other medicines, called moderate CYP3A4 inhibitors, such as erythromycin (an antibiotic), may also raise Joenja levels, though usually by a smaller amount. If you need to take one of these medicines, your health care provider may want to watch you more closely for side effects.
Before starting Joenja, tell your health care provider about all the medicines you take so they can check for this kind of interaction.
Medicines that can make Joenja less effective
Some medicines speed up how your body breaks down Joenja. This can lower Joenja levels in your body and keep it from working as well as it should.
Examples include:
- Efavirenz, a medicine used for HIV
- Rifampin, an antibiotic used for tuberculosis
Joenja shouldn't be taken with these medicines. If you need one of them for another condition, your health care provider can help you weigh your options and decide on the best approach.
Medicines whose levels Joenja can raise
Joenja can raise the levels of certain other medicines in your body by affecting transport proteins (BCRP, OATP1B1, and OATP1B3) that normally help move these medicines through the body.
One example is rosuvastatin, a cholesterol-lowering medicine (statin). In a study, taking Joenja along with rosuvastatin roughly doubled rosuvastatin levels in the body, which could raise the risk of side effects from rosuvastatin.
Joenja shouldn't be taken with rosuvastatin or other medicines affected by these same transport proteins. Tell your health care provider about all the medicines you take, including cholesterol medicines, so they can check whether this applies to you.
FAQs: Joenja Interactions
Does Joenja interact with alcohol?
The prescribing information for Joenja doesn't specifically address alcohol use. Ask your health care provider whether it's safe for you to drink alcohol while taking Joenja, especially because APDS itself can affect how well your immune system fights off infections.
Does Joenja affect birth control pills?
Joenja was studied together with a combined birth control pill containing ethinylestradiol and levonorgestrel. Joenja raised ethinylestradiol levels somewhat (by about 25%-30%) but didn't change levonorgestrel levels. Based on this, Joenja isn't expected to make this type of birth control pill less effective. Still, tell your health care provider about any hormonal birth control you use.
Joenja may cause harm to a developing fetus. Effective contraception is recommended during treatment and for one week after your last dose.
Does Joenja interact with antacids or heartburn medicines?
Joenja can be harder for your body to absorb when your stomach is less acidic than usual. Even so, studies in people with APDS didn't show that acid-reducing medicines, such as proton pump inhibitors (such as omeprazole) or H2 blockers (such as famotidine), had a meaningful effect on how well Joenja worked. Still, let your health care provider know if you regularly take these medicines.
Reducing Your Risk of Side Effects and Interactions
You can help reduce your risk of side effects and interactions by taking Joenja exactly as prescribed and following your health care provider's instructions.
Helpful tips include:
- Tell your pharmacist and other health care providers about everything you take, including prescription medicines, OTC medicines, and vitamins, herbs, or other supplements.
- Ask before starting or stopping anything, including other medicines or supplements.
- Keep all recommended lab test appointments so your health care provider can monitor your blood counts and other measures.
- Report any new or worsening symptoms to your health care provider.
Your health care provider can adjust your treatment plan as needed. Don't change the dose or stop taking Joenja on your own.