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Drug Interactions With Tofacitinib

More Detail on Drug Interactions With Tofacitinib

The following sections explain in detail the potentially negative interactions that can occur when tofacitinib is combined with any of the drugs listed above.
 
CYP 2C19 Inhibitor Medications
The liver breaks down tofacitinib using enzymes known as CYP 2C19 enzymes, and medications known as CYP 2C19 inhibitors can decrease the activity of these enzymes. Thus, combining tofacitinib with one of these drugs may increase the level of tofacitinib in your bloodstream, potentially increasing your risk for side effects.
 
Your healthcare provider may choose to give you a lower tofacitinib dosage if you take it with a CYP 2C19 inhibitor, especially for medications that inhibit CYP 3A4 and CYP 2C19 at the same time, such as fluconazole. The prescribing information for tofacitinib specifically suggests a lower dose for any person taking a medication that is both a potent CYP 2C19 inhibitor and a moderate CYP 3A4 inhibitor.
 
It may be difficult for your healthcare provider to decide which drugs interact with tofacitinib in a severe enough manner to require a dosage adjustment, as different sources often list conflicting information for CYP interactions, particularly about whether a medication has a weak, moderate, or potent effect on CYP enzymes.
 
CYP 3A4 Inhibitor Medications
The liver breaks down tofacitinib using enzymes known as CYP 3A4 enzymes, and medications known as CYP 3A4 inhibitors can decrease the activity of these enzymes. Thus, combining tofacitinib with one of these drugs may increase the level of tofacitinib in your bloodstream, increasing your risk for side effects.
 
For potent CYP 3A4 inhibitors and moderate CYP 3A4 inhibitors that are also potent CYP 2C19 inhibitors, a lower-than-normal tofacitinib dosage is recommended. There are currently no recommendations available for medications that are weak or moderate CYP 3A4 inhibitors.
 
It may be difficult for your healthcare provider to decide which drugs interact with tofacitinib in a severe enough manner to require a dosage adjustment, as different sources often list conflicting information for CYP interactions, particularly about whether a medication has a weak, moderate, or potent effect on CYP enzymes.
 
CYP 3A4 Inducer Medications
The liver breaks down tofacitinib using enzymes known as CYP 3A4 enzymes, and medications known as CYP 3A4 inducers can increase the activity of these enzymes. Thus, combining tofacitinib with one of these drugs may decrease the level of tofacitinib in your bloodstream, potentially making it less effective.
 
Your healthcare provider will monitor you closely if you take tofacitinib with a CYP 3A4 inducer. If an interaction appears to be occurring, your healthcare provider may recommend that you stop taking the CYP 3A4 inducer medication.
 
Immunosuppressants
Taking tofacitinib with medications that decrease the activity of the immune system may increase your risk for side effects, such as dangerous infections. Talk to your healthcare provider before taking these drugs together. Tofacitinib should not be taken with strong immunosuppressants, such as azathioprine, tacrolimus, or cyclosporine. In addition, it is not recommended for use in combination with biologic rheumatoid arthritis medications at this time.
 
Live Vaccinations
Live vaccines contain live viruses or bacteria. If you receive a live vaccine during tofacitinib treatment, you could become infected with the virus or bacteria from the vaccine. Also, live vaccines may be less effective in people taking tofacitinib. You should not receive any live vaccines while taking tofacitinib. It is important for your healthcare provider to double check that you are caught up with all your vaccines before starting treatment.
 
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