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Xeljanz (tofacitinib) Disease Interactions

There are 11 disease interactions with Xeljanz (tofacitinib):

Major

Tofacitinib (Includes Xeljanz) ↔ Gi Perforation

Severe Potential Hazard, Moderate plausibility

Applies to: Gastrointestinal Perforation

Therapy with tofacitinib should be administered with caution in patients who may be at increased risk for gastrointestinal perforation, such as those with a history of diverticulitis. Patients presenting with new onset of abdominal symptoms should be evaluated promptly for early identification of gastrointestinal perforation.

Major

Tofacitinib (Includes Xeljanz) ↔ Tuberculosis

Severe Potential Hazard, Moderate plausibility

Applies to: Tuberculosis -- Active, Tuberculosis -- Latent

Before initiating tofacitinib, patients should be screened for latent or active tuberculosis infection. Anti-tuberculosis therapy should also be considered before initiation of tofacitinib in patients with a history of latent or active tuberculosis in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent tuberculosis but having risk factors for tuberculosis infection. Patients should be closely monitored for any signs and symptoms of tuberculosis, including those patients who tested negative for latent tuberculosis infection before initiating therapy. Patients with latent tuberculosis should be treated with standard therapy before initiation of treatment and should be closely screen for whether initiating anti-tuberculosis therapy is appropriate.

Major

Tofacitinib (Includes Xeljanz) ↔ Viral Reactivation

Severe Potential Hazard, Moderate plausibility

Applies to: Infectious Hepatitis

Tofacitinib has been associated with viral reactivation, including cases of herpes virus reactivation. It is recommended to screen for the occurrence of viral hepatitis before starting therapy. Close monitoring is recommended, and appropriate supportive treatment should be initiated if appropriate.

Major

Tofacitinib (Includes Xeljanz) ↔ Hepatic Disorder

Severe Potential Hazard, Moderate plausibility

Applies to: Liver Disease, Infectious Hepatitis

The use of tofacitinib has been associated with an increased incidence of liver enzyme elevation. No dose adjustment of tofacitinib is necessary in patients with mild hepatic impairment. Patients with moderate hepatic impairment have higher levels of the drug; therefore, the recommended dose of tofacitinib is 5 mg once daily for these patients. Tofacitinib has not been studied in patients with severe hepatic impairment, and its use is not recommended in these patients. The safety and efficacy of tofacitinib has not been studied in patients with positive hepatitis B virus or hepatitis C virus serology. Routine monitoring of liver test is recommended, and if drug-induced liver injury is suspected, therapy should be interrupted until this diagnosis has been excluded. Close monitoring is recommended..

Major

Tofacitinib (Includes Xeljanz) ↔ Infections

Severe Potential Hazard, Moderate plausibility

Applies to: Infection - Bacterial/Fungal/Protozoal/Viral

Serious and sometimes fatal infections due to bacterial, mycobacterial, invasive fungal, viral, or other opportunistic pathogens have been reported in patients receiving tofacitinib. It is recommended to avoid the use of tofacitinib in patients with an active, serious infection, including localized infections and to consider the risks and benefits of treatment before starting treatment. Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment. Treatment should be interrupted if a patient develops a serious infection, an opportunistic infection, or sepsis and appropriate therapy should be instituted according to clinical guidelines. Close monitoring is recommended.

Major

Tofacitinib (Includes Xeljanz) ↔ Renal Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

No dose adjustment of tofacitinib is necessary in patients with mild renal impairment. Patients with moderate and severe renal impairment had greater tofacitinib blood levels; therefore, the recommended dose of tofacitinib is 5 mg once daily for these patients. Close monitoring and caution should be exercised when using tofacitinib in these patients.

Moderate

Tofacitinib (Includes Xeljanz) ↔ Cytopenias

Moderate Potential Hazard, Moderate plausibility

Applies to: Lymphocytopenia, Neutropenia, Hemoglobinopathy

Adverse hematologic effects including neutropenia, lymphocytosis, and anemia have been associated with the use of tofacitinib. It is recommended to avoid starting therapy in patients with an absolute lymphocyte count less than 500 cells/mm3, an absolute neutrophil count (ANC) less than 1000 cells/mm3, or who have hemoglobin levels less than 9 g/dL. Interrupt treatment if recommended levels drop and monitor levels at baseline and periodically based on clinical guidelines.

Moderate

Tofacitinib (Includes Xeljanz) ↔ Gi Obstruction

Moderate Potential Hazard, Moderate plausibility

Applies to: Gastrointestinal Obstruction

Patients with gastrointestinal obstruction, particularly those with preexisting severe gastrointestinal narrowing (pathologic or iatrogenic), should not be given drugs utilizing a non-deformable extended release formulation. In such patients, the ingested drug may remain in the stomach for an extended period, then released suddenly as a bolus when normal gut motility is restored, thereby increasing the risk for adverse effects and/or an overdose.

Moderate

Tofacitinib (Includes Xeljanz) ↔ Hyperlipidemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease, Hyperlipidemia

Hyperlipidemia has been observed in patients receiving tofacitinib. Patients with preexisting hyperlipidemia may require close monitoring during therapy, and adjustments made accordingly in their lipid-lowering regimen. Tofacitinib therapy should be administered with caution in these patients.

Moderate

Tofacitinib (Includes Xeljanz) ↔ Malignancies

Moderate Potential Hazard, Moderate plausibility

Applies to: Skin Cancer, Lymphoma

Malignancies, including lymphomas, have been reported with the use of tofacitinib. Before starting therapy with this agent, the prescriber should balance the benefits against the risks of therapy in patients with a known malignancy other than a successfully treated non-melanoma skin cancer, or when considering continuing therapy in patients who develop a malignancy. Periodic examination is recommended for patients who are at increased risk for cancer.

Moderate

Tofacitinib (Includes Xeljanz) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

The use of tofacitinib increases the risk of infections in diabetic patients. Close monitoring and caution should be exercised when treating patients with diabetes.

Xeljanz (tofacitinib) drug Interactions

There are 386 drug interactions with Xeljanz (tofacitinib)

Xeljanz (tofacitinib) alcohol/food Interactions

There is 1 alcohol/food interaction with Xeljanz (tofacitinib)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2017 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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