Can you take Xeljanz with antibiotics and antifungals?
Xeljanz (tofacitinib citrate) can interact with other medications, including certain antibiotics and antifungal medications. In some cases the interaction means that it is not recommended to take Xeljanz and the other drug at the same time, while in other cases it simply means that the dose of Xeljanz you take will need to be reduced.
Xeljanz is primarily metabolized - processed by the body - by CYP3A4, an enzyme in the liver.
Taking Xeljanz with other drugs that inhibit or induce CYP3A4 is likely to affect the way your body breaks down Xeljanz, meaning that you could get too much or too little of the drug. Xeljanz is also metabolized to a lesser extent by another enzyme called CYP2C19.
Taking Xeljanz and strong inducers of CYP3A4 is not recommended
Rifampin (Rifadin, Rimactane) is an antibiotic used to treat and prevent tuberculosis (TB). It is also a strong inducer of CYP3A4. It is not recommended to take Xeljanz and rifampin together because rifampin may reduce how well Xeljanz works as it decreases your exposure to the drug.
Adjusting your dose of Xeljanz is recommended when taking it with moderate or strong CYP3A4 inhibitors
The antifungal drugs itraconazole (Sporanox, Tolsura) and ketoconazole (Nizoral) are strong inhibitors of CYP3A4. Fluconazole is a moderate inhibitor of CYP3A4, but also a strong inhibitor of CYP2C19. The antibiotics clarithromycin (Biaxin XL) and erythromycin (E.E.S, Eryc, Erythrocin, Eryped) are also examples of strong inhibitors of CYP3A4.
Taking these drugs at the same time as Xeljanz can increase your exposure to the drug, meaning that the amount of Xeljanz you receive is increased, along with your risk of side effects.
It is recommended that you reduce your dose of Xeljanz while taking moderate or strong inhibitors of CYP3A4. Check with your doctor about what dose of Xeljanz you should take.
Xeljanz’s prescribing information recommends the following dosage adjustments (see table below) for patients taking strong CYP3A4 inhibitors, such as ketoconazole, or moderate CYP3A4 inhibitors that are also strong inhibitors of CYP2C19, such as fluconazole.
Condition that Xeljanz is being used to treat | Recommended Xeljanz dosage adjustment |
Rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis |
|
Ulcerative colitis |
|
Polyarticular course juvenile idiopathic arthritis |
|
Related questions
References
- Food and Drug Administration (FDA). Xeljanz. September 2020. [Accessed December 17, 2021. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/203214s028,208246s013,213082s003lbl.pdf.
- Drugs.com. Patient tips. Xeljanz: 7 things you should know. January 27, 2021. Available at: https://www.drugs.com/tips/xeljanz-patient-tips. [Accessed August 11, 2021].
Read next
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List of JAK inhibitors approved in the United States include:
- Cibinqo (abrocitinib)
- Inrebic (fedratinib)
- Jakafi (ruxolitinib)
- Litfulo (ritlecitinib)
- Ojjaara (momelotinib)
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How long does Xeljanz take to work?
Xeljanz can work in as little as three days for patients with ulcerative colitis. Some patients with rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis and ankylosing spondylitis will notice an improvement in their symptoms within two weeks, but others may have to wait up to three to four months for Xeljanz to work.
Xeljanz (tofacitinib citrate) is a Janus kinase (JAK) inhibitor and disease modifying anti-rheumatic drug (DMARD), which works by suppressing the immune system. Continue reading
Can I drink alcohol while taking Xeljanz?
Although the manufacturer of Xeljanz, Pfizer, does not warn of an interaction between alcohol and Xeljanz, you should not drink excessive amounts of alcohol while you are taking Xeljanz because both are metabolized by the liver and can cause liver damage. The risk may be higher if you take other immunosuppressants or medications that also affect the liver, such as methotrexate, or already have liver disease. There have already been numerous Xeljanz lawsuits filed by people who believe Pfizer should have warned them about the dangers of combining alcohol and Xeljanz. Continue reading
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Drug information
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