Drug Interaction Report

Consumer information for this interaction is not currently available.

MONITOR: The administration of SARS-CoV-2 (COVID-19) vaccines to immunosuppressed patients is generally safe, but may be associated with a diminished or suboptimal immunologic response due to antibody inhibition. Observational studies in adults who completed a 1 or 2 dose COVID-19 vaccine series revealed lower efficacy against SARS-CoV-2 infection and COVID-19 disease in immunocompromised adults when compared with the general population. Such patients may include those who have recently received or are receiving immunosuppressive agents, antilymphocyte globulins, alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (e.g., greater than or equal to 2 mg/kg/day or 20 mg/day of prednisone or equivalent for 14 consecutive days or more), or long-term topical or inhaled corticosteroids.

MANAGEMENT: In general, the U.S. Advisory Committee on Immunization Practices (ACIP) recommends administering SARS-CoV-2 (COVID-19) vaccines to moderately or severely immunosuppressed patients. However, depending on the patient's age, concurrent medical condition(s), medication(s), and prior receipt of a COVID-19 vaccine, additional doses, boosters, or revaccination may be appropriate to improve the patient's immune response and the vaccine's efficacy. Whenever possible, COVID-19 vaccine administration should be completed at least 2 weeks before initiation or resumption of immunosuppressive therapies. Revaccination is often recommended in patients who received 1 or more doses of a COVID-19 vaccine prior to or during hematopoietic cell transplantation (HCT) or chimeric antigen receptor (CAR) T-cell therapy and may be considered in patients who were treated with B-cell-depleting therapy over a limited period (e.g., as part of a treatment regimen for certain malignancies). The ACIP recommends that patients who receive B-cell-depleting therapies on a continuing basis receive their COVID-19 vaccine(s) approximately 4 weeks before the next scheduled therapy. COVID-19 vaccines may generally be administered to patients receiving corticosteroids as replacement therapy (e.g., for Addison's disease). Decisions to alter the schedule or frequency of immunosuppressive therapy in order to complete COVID-19 vaccination should consider the individual's risks relative to their underlying condition. Prescribing information and relevant guidelines should be consulted for the most up to date information.

Consumption of grapefruit, grapefruit juice, and supplements that contain grapefruit should be avoided during treatment with upadacitinib as they may increase the blood levels of upadacitinib, which may increase the risk and/or severity of side effects such as low blood cell counts, anemia, serious infections, and elevated blood lipid levels. Contact your doctor if you develop symptoms such as paleness, fatigue, dizziness, fainting, fever, chills, diarrhea, sore throat, muscle aches, shortness of breath, blood in phlegm, weight loss, red or inflamed skin, body sores, or pain or burning during urination.

Smoking during treatment with upadacitinib may increase your risk of serious cardiovascular events and of developing malignancies. Tell your doctor if you are a current or past smoker. Talk to your doctor if you have any questions or concerns. Get emergency help right away if you develop any symptoms of a heart attack or stroke during treatment with upadacitinib, including severe tightness, pain, pressure, or heaviness in your chest, neck, or jaw; weakness in one side of your body; slurred speech; shortness of breath or feeling lightheaded. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.