Upadacitinib Dosage
Medically reviewed by Drugs.com. Last updated on Sep 15, 2023.
Applies to the following strengths: 45 mg; 15 mg; 30 mg; 1 mg/mL
Usual Adult Dose for:
- Rheumatoid Arthritis
- Psoriatic Arthritis
- Atopic Dermatitis
- Ulcerative Colitis - Active
- Ulcerative Colitis - Maintenance
- Crohn's Disease - Acute
- Crohn's Disease - Maintenance
- Ankylosing Spondylitis
- Axial Spondyloarthritis
Usual Geriatric Dose for:
Usual Pediatric Dose for:
Additional dosage information:
Usual Adult Dose for Rheumatoid Arthritis
15 mg orally once a day
Comments:
- This drug may be used as monotherapy or in combination with methotrexate or other nonbiologic disease modifying antirheumatic drugs (DMARDs).
- This drug is not recommended in patients with an absolute lymphocyte count (ALC) less than 500 cells/mm3, absolute neutrophil count (ANC) less than 1000 cells/mm3, or hemoglobin level less than 8 g/dL.
- Limitations of use: This drug is not recommended in combination with other Janus kinase (JAK) inhibitors, biologic DMARDs, or with potent immunosuppressants such as azathioprine and cyclosporine.
Use: Treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response or intolerance to one or more tumor necrosis factor (TNF) blockers.
Usual Adult Dose for Psoriatic Arthritis
15 mg orally once daily
Comments:
- Limitations of use: Not recommended to use in combination with other JAK inhibitors, biologic DMARDs, or with potent immunosuppressants such as azathioprine and cyclosporine.
Use: Adults with active psoriatic arthritis with inadequate response or intolerance to TNF blockers
Usual Adult Dose for Atopic Dermatitis
Initiation dose: 15 mg orally once daily
Maximum dose: 30 mg orally once daily (if no response with initial dose)
Duration of therapy: Discontinue if no response is achieved with 30 mg/day dose
Comments:
- Use the lowest dose to maintain response
- Limitations of use: Not recommended to use in combination with other JAK inhibitors, biologic immunomodulators, or with other immunosuppressants
Use: Adults with refractory, moderate to severe atopic dermatitis that has not been adequately controlled with other systemic drug products, including biologics, or when other therapies are inadvisable
Usual Adult Dose for Ulcerative Colitis - Active
Induction dosage: 45 mg orally once a day for 8 weeks. This dosage can be continued for 8 additional weeks in patients with no adequate response.
Maintenance dosage: 15 or 30 mg once a day
Maximum dosage: 30 mg once a day can be considered for patients with refractory, severe, or extensive disease.
Comments:
- Discontinue treatment if an adequate therapeutic response is not achieved with 30 mg dosage.
- Use the lowest effective dosage needed to maintain response.
- Limitations of use:
- Not recommended for use with other Janus kinase (JAK) inhibitors, biological therapies for ulcerative colitis, or with potent immunosuppressants such as azathioprine and cyclosporine.
Use: Treatment of adult patients with moderately to severely active ulcerative colitis who have had an inadequate response or intolerance to one or more tumor necrosis factor (TNF) blockers.
Usual Adult Dose for Ulcerative Colitis - Maintenance
Induction dosage: 45 mg orally once a day for 8 weeks. This dosage can be continued for 8 additional weeks in patients with no adequate response.
Maintenance dosage: 15 or 30 mg once a day
Maximum dosage: 30 mg once a day can be considered for patients with refractory, severe, or extensive disease.
Comments:
- Discontinue treatment if an adequate therapeutic response is not achieved with 30 mg dosage.
- Use the lowest effective dosage needed to maintain response.
- Limitations of use:
- Not recommended for use with other Janus kinase (JAK) inhibitors, biological therapies for ulcerative colitis, or with potent immunosuppressants such as azathioprine and cyclosporine.
Use: Treatment of adult patients with moderately to severely active ulcerative colitis who have had an inadequate response or intolerance to one or more tumor necrosis factor (TNF) blockers.
Usual Adult Dose for Crohn's Disease - Acute
Induction dosage: 45 mg orally once a day for 12 weeks
Recommended maintenance dosage: 15 mg once a day
Maximum dosage: 30 mg once a day can be considered for patients with refractory, severe, or extensive disease.
Comments:
- Discontinue treatment if an adequate therapeutic response is not achieved with 30 mg dosage.
- Use the lowest effective dosage needed to maintain response.
- Limitations of use:
- Not recommended for use with other JAK inhibitors, biological therapies for Crohn's disease, or with potent immunosuppressants such as azathioprine and cyclosporine.
Use: Treatment of adult patients with moderately to severely active Crohn's disease who have had an inadequate response or intolerance to one or more TNF blockers.
Usual Adult Dose for Crohn's Disease - Maintenance
Induction dosage: 45 mg orally once a day for 12 weeks
Recommended maintenance dosage: 15 mg once a day
Maximum dosage: 30 mg once a day can be considered for patients with refractory, severe, or extensive disease.
Comments:
- Discontinue treatment if an adequate therapeutic response is not achieved with 30 mg dosage.
- Use the lowest effective dosage needed to maintain response.
- Limitations of use:
- Not recommended for use with other JAK inhibitors, biological therapies for Crohn's disease, or with potent immunosuppressants such as azathioprine and cyclosporine.
Use: Treatment of adult patients with moderately to severely active Crohn's disease who have had an inadequate response or intolerance to one or more TNF blockers.
Usual Adult Dose for Ankylosing Spondylitis
Recommended dosage: 15 mg orally once daily
Comments:
- Limitations of use:
- Not recommended to use in combination with other JAK inhibitors, biologic disease-modifying antirheumatic drugs (DMARDs), or with potent immunosuppressants such as azathioprine and cyclosporine.
Use: Adults with active ankylosing spondylitis who have had an inadequate response or intolerance to one or more TNF blockers. with inadequate response or intolerance to TNF blockers
Usual Adult Dose for Axial Spondyloarthritis
Recommended dosage: 15 mg orally once daily
Comments:
- Limitations of use:
- Not recommended to use in combination with other JAK inhibitors, biologic DMARDs, or with potent immunosuppressants such as azathioprine and cyclosporine.
Use: Adults with active non-radiographic axial spondyloarthritis with objective signs of inflammation who have had an inadequate response or intolerance to TNF blocker therapy.
Usual Geriatric Dose for Atopic Dermatitis
Adults 65 years of age and older: 15 mg orally once daily
Comments:
- Use the lowest dose to maintain response
- Limitations of use: Not recommended to use in combination with other JAK inhibitors, biologic immunomodulators, or with other immunosuppressants
Use: Adults 65 years and older with refractory, moderate to severe atopic dermatitis that has not been adequately controlled with other systemic drug products, including biologics, or when other therapies are inadvisable
Usual Pediatric Dose for Atopic Dermatitis
Patients 12 years of age and older weighing at least 40 kg:
Initiation dose: 15 mg orally once daily
Maintenance dose: 30 mg orally once daily (if no response with initial dose)
Maximum dose: 30 mg orally once daily
Duration of therapy: Discontinue if no response is achieved with 30 mg dose
Comments:
- Use the lowest dose to maintain response
- Limitations of use: Not recommended to use in combination with other JAK inhibitors, biologic immunomodulators, or with other immunosuppressants
Use: Pediatric patients older than 12 years old and weighing at least 40 kg with refractory, moderate to severe atopic dermatitis that has not been adequately controlled with other systemic drug products, including biologics, or when other therapies are inadvisable
Renal Dose Adjustments
Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, and Non-radiographic Axial Spondyloarthritis:
No adjustment recommended.
Atopic Dermatitis:
- Mild and Moderate Renal Dysfunction: No adjustment recommended
- Severe Renal Dysfunction (CrCl 15 to less than 30 mL/min): 15 mg once a day
- End-stage renal disease (CrCl less than 15 mL/min): Not recommended
Ulcerative Colitis:
- Mild and Moderate Renal Dysfunction: No adjustment recommended
- Severe Renal Dysfunction (CrCl 15 to less than 30 mL/min):
- Induction: 30 mg once a day for 8 weeks
- Maintenance: 15 mg once a day
- End-stage renal disease (CrCl less than 15 mL/min): Not recommended
Crohn's Disease:
- Mild and Moderate Renal Dysfunction: No adjustment recommended
- Severe Renal Dysfunction (CrCl 15 to less than 30 mL/min):
- Induction: 30 mg once a day for 12 weeks
- Maintenance: 15 mg once a day
- End-stage renal disease (CrCl less than 15 mL/min): Not recommended
Liver Dose Adjustments
Rheumatoid Arthritis, Psoriatic Arthritis, Atopic Dermatitis, Ankylosing Spondylitis, and Non-radiographic Axial Spondyloarthritis:
Mild (Child-Pugh A) or moderate (Child-Pugh B) hepatic impairment: No adjustment recommended.
Severe (Child-Pugh C) hepatic impairment: Not recommended.
Ulcerative Colitis:
Mild (Child-Pugh A) or moderate (Child-Pugh B) hepatic impairment:
- Induction: 30 mg once a day for 8 weeks
- Maintenance: 15 mg once a day
Crohn's Disease:
Mild (Child-Pugh A) or moderate (Child-Pugh B) hepatic impairment:
- Induction: 30 mg once a day for 12 weeks
- Maintenance: 15 mg once a day
Dose Adjustments
PATIENTS RECEIVING STRONG CYP450 3A4 inhibitors:
Rheumatoid Arthritis, Psoriatic Arthritis, Atopic Dermatitis, Ankylosing Spondylitis, and Non-radiographic Axial Spondyloarthritis:
- Recommended dosage: 15 mg once a day
Ulcerative Colitis:
- Induction: 30 mg once a day for 8 weeks
- Maintenance: 15 mg once a day
Crohn's Disease:
- Induction: 30 mg once a day for 12 weeks
- Maintenance: 15 mg once a day
INFECTIONS:
- Interrupt treatment in severe infections, including serious opportunistic infections, until infection is treated and controlled.
RECOMMENDED DOSE INTERRUPTIONS FOR LABORATORY ABNORMALITIES:
- Absolute Neutrophil Count (ANC): Interrupt therapy if ANC is less than 1000
- Absolute Lymphocyte Count (ALC): Interrupt therapy if ALC is less than 500
- Hemoglobin (Hb): Interrupt therapy if Hb is less than 8 g/dL; restart when Hb is above 8 g/dL.
- Hepatic transaminases: Interrupt therapy if drug-induced liver injury is suspected.
Precautions
US FDA requires a medication guide to assure safe use. For additional information: www.fda.gov/drugs/drug-safety-and-availability/medication-guides
US BOXED WARNINGS:
SERIOUS INFECTIONS:
- Patients treated with this drug are at increased risk of serious infections that may lead to hospitalization or death.
- Most patients that developed infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.
- If a serious infection develops, interrupt therapy until the infection is controlled.
- Infections include:
- Active tuberculosis (TB) which may present with pulmonary or extrapulmonary disease. Test for latent TB before initiating and during therapy. Treatment for latent infection should be considered prior to initiating therapy.
- Invasive fungal infections (e.g., cryptococcosis, pneumocystosis)
- Bacterial, viral (e.g., herpes zoster), and other infections due to opportunistic pathogens.
- The risks and benefits of therapy should be considered prior to initiating therapy in patients with chronic or recurrent infection.
- Patients should be closely monitored for infection during and after completing therapy, including TB in patients who tested negative for latent TB prior to initiating therapy.
- Higher rate of all-cause mortality, including sudden cardiovascular death was reported with another Janus kinase (JAK) inhibitor vs. tumor necrosis factor (TNF) blockers in RA patients.
- Higher rates of lymphoma and other malignancies (lung cancers) have been reported with another JAK inhibitors vs. TNF blockers in RA patients.
- Thrombosis (e.g., deep venous thrombosis), pulmonary embolism, and arterial thrombosis has occurred in patients treated with JAK inhibitors used to treat inflammatory conditions vs other TNF blockers.
- Many adverse events were serious and fatal.
- Consider risk versus benefit prior to treating patients who may be at increased risk.
- Evaluate and treat patients with symptoms of thrombosis.
CONTRAINDICATIONS:
- Known hypersensibility to the active ingredient or any of the excipients
Safety and efficacy have not been established in patients younger than 18 years for rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, Crohn's disease, ankylosing spondylitis, and non-radiographic axial spondyloarthritis.
Safety and efficacy have not been established in patients younger than 12 years for atopic dermatitis.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Prior to treatment initiation:
- Consider evaluating for:
- Active and latent TB: If positive, treat prior to initiating treatment with this drug.
- Viral hepatitis: This drug is not recommended in patients with active hepatitis B or C.
- Complete blood count: Treatment initiation is not recommended in patients with an absolute lymphocyte count less than 500 cells/mm3, absolute neutrophil count less than 1000 cells/mm3, or hemoglobin level less than 8 g/dL.
- Baseline hepatic function: This drug is not recommended in patients with severe hepatic dysfunction.
- Pregnancy status: Verify the pregnancy status of females of reproductive potential prior to starting treatment. This drug is not recommended during pregnancy.
- Update immunizations according to immunization clinical guidelines.
Administration advice:
- This drug may be taken with or without food.
- Tablets should be swallowed whole, not split, crushed, or chewed.
- Therapy should be interrupted if a patient develops a serious infection until the infection is controlled.
Storage requirements:
- Store at 2C to 25C (36F to 77F).
- Store in the original bottle to protect from moisture.
General
- Limit exposure to sunlight and UV light, wearing protective clothing and using a broad-spectrum sunscreen.
Monitoring:
- Hematologic parameters (ANC, ALC, Hb levels)
- Development of signs and symptoms of TB, including in patients that tested negative prior to treatment initiation
- Lipids and cholesterol
- Liver enzymes, and reactivation of viral hepatitis
- Periodically perform skin examination in patients at risk of skin cancer.
Patient advice:
- Read the Patient Information and Instructions for Use.
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