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Tofacitinib Medication: Uses, Side Effects, Dosage & Costs
Summary of Key Points
Tofacitinib is a prescription medication used to treat several autoimmune conditions, including rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. It works by targeting specific enzymes that contribute to inflammation, helping to reduce symptoms such as pain, swelling, and joint damage. Always consult your healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist with managing your treatment plan.
Names of Medication
US Brand Name: Xeljanz
Generic Name: Tofacitinib
The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. In this case, Tofacitinib is the generic name, and Xeljanz is the brand name.
Pharmacologic Category
Tofacitinib belongs to a class of medications known as Janus Kinase (JAK) inhibitors. Other medications in this category include Baricitinib (Olumiant) and Upadacitinib (Rinvoq).
Tofacitinib Dosage
Tofacitinib is prescribed for various conditions, with dosing tailored to the specific condition being treated. Always follow your healthcare provider’s instructions and never adjust your dose without consulting them. If you need to discuss your treatment, our telemedicine providers are here to help.
Tofacitinib for Rheumatoid Arthritis
Dosage: 5 mg orally twice daily or 11 mg once daily (extended-release).
Frequency: Twice daily or once daily.
Length of Treatment: Long-term, depending on response and tolerance.
Tofacitinib for Psoriatic Arthritis
Dosage: 5 mg orally twice daily or 11 mg once daily (extended-release).
Frequency: Twice daily or once daily.
Length of Treatment: Long-term, depending on response and tolerance.
Tofacitinib for Ulcerative Colitis
Dosage: 10 mg orally twice daily for at least 8 weeks, followed by 5 mg or 10 mg twice daily depending on response.
Frequency: Twice daily.
Length of Treatment: Initial 8-week period, followed by maintenance dosing.
Tofacitinib for Ankylosing Spondylitis
Dosage: 5 mg orally twice daily or 11 mg once daily (extended-release).
Frequency: Twice daily or once daily.
Length of Treatment: Long-term, depending on response and tolerance.
Tofacitinib for Atopic Dermatitis
Dosage: 5 mg orally twice daily or 11 mg once daily (extended-release).
Frequency: Twice daily or once daily.
Length of Treatment: Long-term, depending on response and tolerance.
Tofacitinib for Crohn’s Disease
Dosage: 10 mg orally twice daily for 8 weeks, followed by 5 mg or 10 mg twice daily depending on response.
Frequency: Twice daily.
Length of Treatment: Initial 8-week period, followed by maintenance dosing.
Tofacitinib for Juvenile Idiopathic Arthritis
Dosage: 5 mg orally twice daily.
Frequency: Twice daily.
Length of Treatment: Long-term, depending on response and tolerance.
Tofacitinib for Gout
Dosage: 5 mg orally twice daily.
Frequency: Twice daily.
Length of Treatment: Long-term, depending on response and tolerance.
Tofacitinib for Osteoarthritis
Dosage: 5 mg orally twice daily.
Frequency: Twice daily.
Length of Treatment: Long-term, depending on response and tolerance.
Tofacitinib for Systemic Lupus Erythematosus
Dosage: 5 mg orally twice daily.
Frequency: Twice daily.
Length of Treatment: Long-term, depending on response and tolerance.
Dosage Forms and Strengths
Tablets: 5 mg
Extended-release tablets: 11 mg
Administration Instructions for Tofacitinib
Take Tofacitinib exactly as prescribed by your healthcare provider. It can be taken with or without food. Swallow the tablet whole; do not crush, chew, or break it. If you miss a dose, take it as soon as you remember, but skip it if it’s almost time for your next dose. Do not take two doses at once. If you have any questions about how to take your medication, our telemedicine providers are available to assist you.
Contraindications for Tofacitinib
A contraindication is a specific situation where a medication should not be used because it may cause harm. If you have any of the following conditions, Tofacitinib may not be safe for you. Always discuss your medical history with your healthcare provider before starting any new medication, including Tofacitinib.
- Severe liver disease: Tofacitinib is processed by the liver, and severe liver problems may prevent your body from breaking down the medication properly, leading to harmful effects.
- Active infections: Tofacitinib can weaken your immune system, making it harder to fight infections. If you have an active infection, taking Tofacitinib could worsen it.
- History of blood clots: Tofacitinib has been linked to an increased risk of blood clots, especially in patients with a history of clotting disorders. If you’ve had blood clots before, this medication may not be safe for you.
- Severe kidney disease: Tofacitinib is partially eliminated through the kidneys, and severe kidney disease may prevent your body from clearing the drug effectively, increasing the risk of side effects.
- Low blood cell counts: Tofacitinib can lower white blood cell, red blood cell, and platelet counts, which may worsen if you already have low blood cell levels.
Drug-to-Drug Interactions with Tofacitinib
Tofacitinib can interact with other medications, potentially leading to harmful effects or reducing the effectiveness of your treatment. Be sure to inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements. Here are some common medications that may interact with Tofacitinib:
- Rifampin (Rifadin): This antibiotic can decrease the effectiveness of Tofacitinib by speeding up how quickly your body breaks it down.
- Ketoconazole (Nizoral): This antifungal medication can increase Tofacitinib levels in your body, raising the risk of side effects.
- Cyclosporine (Neoral, Sandimmune): This immunosuppressant can increase the risk of infections and other side effects when taken with Tofacitinib.
- Azathioprine (Imuran): Taking this immunosuppressant with Tofacitinib can increase the risk of serious infections and low blood cell counts.
- Biologic medications for rheumatoid arthritis or other autoimmune diseases: Combining Tofacitinib with biologics like adalimumab (Humira) or etanercept (Enbrel) can increase the risk of serious infections.
Tofacitinib in Pregnancy
Is it Safe to Take Tofacitinib During Pregnancy?
Tofacitinib is generally not recommended during pregnancy. While research on its effects in pregnant women is limited, animal studies suggest it may pose risks to the developing fetus. If you are pregnant or planning to become pregnant, it is essential to discuss alternative treatment options with your healthcare provider. Together, you can carefully weigh the potential risks and benefits of continuing Tofacitinib during pregnancy. If you are currently taking Tofacitinib and discover you are pregnant, contact your healthcare provider immediately to explore your options.
Tofacitinib While Breastfeeding
Is it Safe to Take Tofacitinib While Breastfeeding?
It is not yet clear whether Tofacitinib passes into breast milk. However, due to the potential for serious side effects in a nursing infant, it is generally advised to avoid breastfeeding while taking this medication. If you are breastfeeding or planning to breastfeed, consult your healthcare provider to discuss the risks and benefits of continuing treatment. Your provider may recommend alternative medications or suggest temporarily stopping breastfeeding while on Tofacitinib.
Estimated Cost of Tofacitinib Medication
The cost of a 30-day supply of Tofacitinib can vary depending on the pharmacy and your location. Without insurance, the estimated cost using a GoodRx coupon ranges from approximately $4,500 to $5,000 for a 30-day supply of the 5 mg or 10 mg tablets. Be sure to check with your pharmacy for the most accurate pricing, and consider using a coupon or discount card to help reduce the cost. If you are concerned about the cost of Tofacitinib or insurance coverage, exploring financial assistance programs or generic alternatives may be beneficial.
Possible Alternatives to Tofacitinib
If Tofacitinib is not the right medication for you, there are several alternative treatments available for the conditions it treats. Always discuss any changes to your treatment plan with your healthcare provider. You may also consider scheduling a telemedicine appointment with one of our providers to explore your options.
Rheumatoid Arthritis
Alternatives to Tofacitinib for rheumatoid arthritis include methotrexate, sulfasalazine, or biologics such as adalimumab (Humira). In addition to medication, lifestyle changes like regular exercise, a balanced diet, and physical therapy can help manage symptoms.
Psoriatic Arthritis
For psoriatic arthritis, other options include biologics like etanercept (Enbrel) or secukinumab (Cosentyx). Maintaining a healthy weight and managing stress can also improve symptoms.
Ulcerative Colitis
Alternatives to Tofacitinib for ulcerative colitis include mesalamine (Asacol), corticosteroids, or biologics like infliximab (Remicade). Dietary adjustments and stress management may also help control flare-ups.
Ankylosing Spondylitis
Treatment options for ankylosing spondylitis include NSAIDs like ibuprofen, biologics such as adalimumab (Humira), and physical therapy to improve flexibility and reduce pain.
Atopic Dermatitis
For atopic dermatitis, topical treatments like corticosteroids or calcineurin inhibitors (e.g., tacrolimus) may be effective alternatives. Regular moisturizing and avoiding known triggers can also help manage symptoms.
Crohn’s Disease
Alternatives to Tofacitinib for Crohn’s disease include corticosteroids, biologics like ustekinumab (Stelara), or immunosuppressants such as azathioprine. Dietary changes and stress management can also be beneficial.
Juvenile Idiopathic Arthritis
For juvenile idiopathic arthritis, methotrexate or biologics like etanercept (Enbrel) are common alternatives. Physical therapy and regular exercise can also help manage symptoms.
Gout
Alternatives for gout include medications like allopurinol (Zyloprim) or febuxostat (Uloric). Lifestyle changes, such as reducing alcohol intake and avoiding purine-rich foods, can also help prevent flare-ups.
Osteoarthritis
For osteoarthritis, NSAIDs like ibuprofen or acetaminophen (Tylenol) are common alternatives. Weight management, physical therapy, and regular exercise can also help alleviate symptoms.
Systemic Lupus Erythematosus
Alternatives for systemic lupus erythematosus include hydroxychloroquine (Plaquenil) or corticosteroids. Lifestyle changes, such as sun protection and stress management, can also help manage symptoms.
Recent Updates on Tofacitinib Research
Recent studies have raised concerns about the long-term safety of Tofacitinib, particularly regarding the risk of blood clots and cardiovascular events. In 2021, the FDA issued a warning about an increased risk of serious heart-related problems and cancer in patients taking Tofacitinib, especially at higher doses. Ongoing research is focused on identifying which patients are most at risk and how to minimize these risks while still providing effective treatment for autoimmune conditions.
Additionally, researchers are exploring the potential use of Tofacitinib in other autoimmune diseases and conditions, such as alopecia areata and vitiligo, though these uses are still under investigation. If you have concerns about the safety of Tofacitinib or would like to learn more about the latest research, consider scheduling a telemedicine appointment with one of our healthcare providers to discuss your treatment options.
