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As is the case with any medication, Xeljanz (tofacitinib) interactions can occur. During these circumstances, the dosage of Xeljanz may be adjusted or the drug may not be recommended. These safety measures will ensure that negative interactions can be reduced, controlled, or prevented entirely.

Drug Interactions

The FDA states that the following drugs may have interactions when taken with Xeljanz:

  • Strong inhibitors of CP3A4 [e.g., ketoconazole (Xolegel, Nizoral A-D, Nizoral, Extina)]
  • Moderate inhibitors of CYP3A4 that are co-administered with strong inhibitors of CYP2C19 [e.g., fluconazole (Diflucan)]
  • Strong CYP3A4 inducers [e.g., rifampin (Rifadin)]
  • Immunosuppressive drugs [e.g., azathioprine (Azasan), tacrolimus (Envarsus XR, Protopic, Astagraf XL, Prograf), cyclosporine (Sandimmune, Neoral, Gengraf, Restasis MultiDose, Restasis)]

This drug interaction list may not be complete; other interactions may occur that are not listed here.

Xeljanz and Antibiotics

Antibiotics, as well as antifungals, can treat certain infections. If you are taking Xeljanz along with an antibiotic, the antibiotic drug may prevent the body from properly metabolizing tofacitinib. This issue leads to the drug levels changing in the system.

Types of antibiotics that increase the side effects of tofacitinib include clarithromycin (Biaxin XL) and erythromycin (Eryped, Ery-Tab). Erythromycin and Clarithromycin can treat various bacterial infections.

Types of antifungals that increase the side effects of Xeljanz include ketoconazole (Nizoral, Extina, Xolegel), itraconazole (Sporanox, Omnel, Tolsura), fluconazole (Diflucan), and voriconazole (Vfend, Vfend IV). These drugs can treat fungal infections in various areas of the body.

Xeljanz and Methotrexate

Patients may take Xeljanz along with methotrexate [Otrexup (PF), Xatmep, Trexall] when treating rheumatoid arthritis and psoriatic arthritis. When taking this combination, a possible complication is perforation of the intestines or stomach (tears). If you have experienced or are presently experiencing ulcers in the stomach or inflammation in sections of the large intestine (diverticulitis), inform your healthcare provider.

In some cases, taking methotrexate and tofacitinib together could lead to increased risk of developing potentially fatal infections. Reported infections may include:

  • Invasive fungal infections, such as pneumocystis pneumonia (PCP) and cryptococcosis
  • Active tuberculosis
  • Bacterial infections
  • Viral infections like herpes zoster (shingles)
  • Other infections caused by opportunistic pathogens

Patients should seek medical attention until the serious infection is brought under control.

Xeljanz and Prednisone

Patients can use tofacitinib with prednisone (Rayos, Prednisone Intensol, Deltasone). Prednisone is a corticosteroid that can treat a variety of different medical conditions, including asthma, arthritis, blood disorders, cancer, and immune system disorders.

When taking Xeljanz and a corticosteroid together, the risk of developing a serious infection may increase. These infections may lead to hospitalization or even death. Serious infections that may develop include:

  • Active tuberculosis
  • Invasive fungal infections
  • Bacterial infections
  • Viral infections
  • Infections from opportunistic pathogens

Tofacitinib and Ruxolitinib

Patients may also take tofacitinib with ruxolitinib (Jakafi), which is another JAK inhibitor. Ruxolitinib can help treat myelofibrosis (a type of bone marrow cancer). When taking a combination of these two drugs, the potential of developing serious and fatal infections increase. There may also be an increased risk of some cancers, such as lymphoma and skin cancers.

Food Interactions

There will be times when the food and beverages may have a certain interaction with medications. In the case of Xeljanz, patients may take the drug with or without food. However, food and drink to avoid while taking this medication include:

  • Grapefruit and grapefruit juice

Please take note that the list of foods and drinks may not be complete. As experts conduct more studies, there may be other foods and beverages experts find will cause certain interactions with this drug.

Grapefruit Interactions

Patients should avoid drinking grapefruit juice when taking Xeljanz. Studies show that grapefruit juice can increase the levels of tofacitinib in the body. At these increased levels, there is the potential chance of having increased side effects.

Xeljanz and Alcohol

For more information, please visit our page on Xeljanz and alcohol interactions.

Disease & Conditions Interactions

When taking certain medications, the drug may increase the risk of negative side effects for patients who have certain medical conditions or diseases. One of the most common side effects is the increased chance of developing a serious or life-threatening infection or the worsening of an existing infection.

According to the FDA, diseases and medical conditions that may negatively interact with Xeljanz includes:

  • Diabetes
  • Chronic lung disease
  • Weak immune systems
  • Human immunodeficiency virus (HIV)
  • Tuberculosis (TB)
  • Hepatitis B
  • Hepatitis C
  • Fungal infections of histoplasmosis, coccidioidomycosis, or blastomycosis contracted by people who lived, have lived, or have traveled through certain parts of the country, such as Ohio, the Southwest, or the Mississippi River valley

This list may not complete. There may be other diseases and medical conditions that may have a negative interaction with this drug.

Xeljanz and Pregnancy

For more information, please visit our page on Xeljanz and pregnancy risks.

Xeljanz and Weight Gain

Studies have not shown whether Xeljanz will cause weight gain in patients. Experts do know, though, that people who have weight gain issues may be more at risk of developing rheumatoid arthritis.

Some people may experience weight loss from taking certain medications, such as Xeljanz. Some side effects of tofacitinib are stomach pain, little or no appetite, diarrhea and vomiting. These side effects may inadvertently lead to weight loss.

Xeljanz and Alopecia

Clinical trials are underway at the time of writing to determine if Xeljanz is an acceptable treatment for extensive alopecia areata. There is currently no FDA approval for using tofacitinib for this medical condition, though.

Tofacitinib and Crohn’s Disease

Clinical trials for using tofacitinib for the treatment of Crohn’s disease were conducted, according to Oxford Academic. However, due to conflicting results during phase II induction and maintenance testing in patients, the clinical development of this drug to treat the disease was discontinued.

Tofacitinib and Herpes Zoster

Patients who have ulcerative colitis may be at a higher risk of experiencing herpes zoster (shingles) when taking tofacitinib at 5mg and 10 mg doses twice a day. There may also be an increased chance of experiencing the serious infection multidermatomal herpes zoster. Other serious infections of opportunistic herpes zoster–such as ophthalmologic, meningoencephalitis, and disseminated cutaneous–may occur when taking tofacitinib twice a day at 10mg.

Tofacitinib and Surgery

Since tofacitinib is designed to block the body’s immune system from creating enzymes that fight infections, it could potentially slow down the healing process for patients who are undergoing surgery, according to the John Hopkins Arthritis Center.

Tofacitinib and DVT (Deep Vein Thrombosis)

Patients with rheumatoid arthritis who are 50 years of age or older and have at least one risk factor of heart disease have experienced blood clots in the veins of their legs (deep vein thrombosis) when taking a higher dosage of this drug than what is recommended. The recommended dosage is 5mg for Xeljanz twice a day and 11mg for Xeljanz XR once a day.

Disclaimer: this article does not constitute or replace medical advice. If you have an emergency or a serious medical question, please contact a medical professional or call 911 immediately. To see our full medical disclaimer, visit our Terms of Use page.


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