Xeljanz is available in a 10 milligram (mg) twice daily dose, and a 5 mg twice daily dose, depending on your condition. It can be used alone or in combination with certain other medications, and is typically prescribed for patients who haven’t had success with other classes of drugs.
While Xeljanz can be an effective treatment for some people, there are both mild and serious side effects associated with the drug that you should discuss with your healthcare provider before using.
Common Side Effects
Research suggests that RA patients using Xeljanz can experience a significant reduction of their symptoms—such as joint pain, inflammation, and stiffness—and an improvement in their ability to perform daily functions.
According to drug clinical trials, these results can be sometimes be seen in a matter of a few weeks. Despite these positive reports, there are some common side effects associated with taking Xeljanz, which may go away after your body has gotten used to the drug.
They include:
Upper respiratory infection, such as the common coldHeadacheDiarrheaStuffy or runny nose
In addition, Xeljanz has the potential to increase your cholesterol levels, so your healthcare provider will want to monitor your cholesterol closely while you’re taking this medication.
Other routine laboratory tests may also be recommended both before and periodically while taking Xeljanz, as it can cause changes to certain types of white blood cells, hemoglobin, liver enzymes, and lipids.
Serious Side Effects
You should be aware that there are some serious side effects that are linked to taking Xeljanz. This is why your healthcare provider will want to thoroughly go over your personal medical history along with the potential risks and benefits of Xeljanz before prescribing it.
Because Xeljanz is a medication that works on your immune system, it can decrease the body’s immune response, which weakens your ability to fight off certain types of fungal, bacterial, or viral infections that could be severe and require hospitalization.
These can range from seemingly minor infections like an open cut, wound, or cold sore to chronic infections like tuberculosis and hepatitis B or C. You will be tested for tuberculosis before and during therapy.
Here are the side effects and symptoms you should pay close attention to:
Severe fatigueFever or chillsYellowing of the skin or eyesLoss of appetiteStomach painDark urineClay-colored bowel movementsVomitingMuscle achesSkin rashPale skinShortness of breath or difficulty breathing and swallowingHives or swelling of the face, eyes, lips, or throat
Warnings
Black Box Warning
Xeljanz has a black box warning, which is the Food and Drug Administration’s (FDA) way of flagging that a drug can have serious and potentially deadly side effects. It’s the strongest type of federal safety warning that a medication can carry and still stay on the prescription drug market in the United States.
For Xeljanz, the boxed warning is based on findings from tofacitinib safety trials in RA patients. It alerts healthcare providers and patients to an increased risk of:
Serious bacterial, fungal, and viral infections, including tuberculosis Pulmonary embolism (blood clots in the lungs) and other types of blood clots Serious heart-related events such as heart attack and stroke Death Serious infections, including Epstein-Barr virus Lymphoma (type of cancer that starts in the blood cells) and lung cancer
Check with your healthcare provider if you have any questions about the specific warnings, dosages, and increased risks.
Interactions
When considering using Xeljanz, it’s especially important to communicate openly with your healthcare provider about all medications you’re currently taking and any other medical conditions you may have, as there are several potential interactions to keep in mind.
Make sure to inform your healthcare provider if you’re also taking medications for RA, psoriatic arthritis, and ulcerative colitis. You’ll probably be advised not to use Xeljanz if you’re also taking:
RA medications known as biologics Immune-suppressing medications Certain antibiotics and antifungals Non-steroidal anti-inflammatory drugs (NSAIDs)
You should know that Xeljanz could also pose more of a risk to people with certain conditions. In the drug’s clinical trials, scientists found that older RA patients with at least one cardiovascular (heart-related) risk factor were more at risk for death. That’s why it’s essential to tell your healthcare provider if you:
Are age 50 or olderAre a smoker or former smokerHave had a heart attack or other heart problemsHave had a stroke or been diagnosed with blood clotsHave ever been diagnosed with cancer, diabetes, high cholesterol, high blood pressure, HIV or AIDS, liver disease, kidney transplant, lung disease, and any condition that affects your immune system
In addition, Xeljanz use can interact with vaccinations, so you might want to plan ahead if you need to update any of your routine vaccines. Avoid getting any live-virus vaccines such as the shingles vaccine, nasal flu vaccine Flumist, MMR (measles, mumps, and rubella) vaccine, and yellow fever vaccine.
Experts say inactivated vaccines—such as the flu shot, polio, and hepatitis A vaccines—should be safe to get while taking Xeljanz.
A Word From Verywell
Finding the best medication for you to help manage your RA—or any other medical condition—can sometimes be a frustrating process of trial and error.
The decision to start Xeljanz should not be taken lightly. Your healthcare provider will seriously consider several factors, including how old you are, how severe your RA is, and if you have any other medical conditions that could impact its use.
Together, you can weigh whether the benefits Xeljanz override any potential serious side effects. Seek medical attention immediately if you experience any severe symptoms or complications while taking Xeljanz.
