Xeljanz vs. Xeljanz XR: 8 Things to Know About These JAK Inhibitors
Key takeaways:
Xeljanz and Xeljanz XR are two forms of the same medication: tofacitinib. Xeljanz is an immediate-release formulation. Xeljanz XR is an extended-release formulation and lasts longer in the body than standard Xeljanz.
Xeljanz comes as oral tablets and an oral solution. Xeljanz XR only comes as oral tablets. Xeljanz is typically taken twice a day, while Xeljanz XR is usually taken once daily.
If you’re taking Xeljanz XR, you may notice an empty tablet shell in your stool. This is normal, since the shell slowly releases the medication as it passes through your digestive system. This shouldn’t happen with Xeljanz.
Both Xeljanz and Xeljanz XR are only available as brand-name medications. By using a manufacturer copay card, or qualifying for a patient assistance program, you could pay as little as $0 per month for your prescription.
Access savings on related medications
Table of contents
Xeljanz and Xeljanz XR are two different forms of the same medication: tofacitinib. They’re in the Janus kinase (JAK) inhibitor medication class. You take both medications by mouth. And they both treat various autoimmune disorders. But what are the differences between these two medications?
Aside from Xeljanz XR being longer-acting than Xeljanz, there are a few other things that set them apart. Here, we’ll cover eight things to know about the similarities and differences between Xeljanz and Xeljanz XR.
1. Xeljanz and Xeljanz XR have slightly different FDA-approved uses
Xeljanz and Xeljanz XR are FDA-approved to treat similar health conditions in adults. This is because they have the same active ingredient, tofacitinib. Like other JAK inhibitors, tofacitinib helps lower inflammation through its effects on the immune system.
Xeljanz tablets and Xeljanz XR are both FDA-approved to treat the following conditions in adults:
Moderate to severe rheumatoid arthritis (RA)
Moderate to severe ulcerative colitis (UC)
In addition to oral tablets, standard Xeljanz also comes as an oral liquid. Both Xeljanz tablets and oral liquid are FDA-approved to treat polyarticular course juvenile idiopathic arthritis (pcJIA) in children 2 and older. Xeljanz XR hasn’t been well studied in children, so it’s not approved to treat pcJIA.
Read more like this
Explore these related articles, suggested for readers like you.
2. Xeljanz and Xeljanz XR have different recommended doses
Xeljanz is usually taken twice a day, while Xeljanz XR is typically taken once a day. This is because Xeljanz XR is an extended-release version of tofacitinib. This means one dose lasts longer in your body than standard Xeljanz (the immediate-relief version).
Xeljanz oral tablets come in 5 mg and 10 mg doses. Xeljanz XR oral tablets come in 11 mg and 22 mg doses. Xeljanz oral solution is available as a 1 mg per mL liquid.
For most health conditions, the typical Xeljanz dosage is 5 mg by mouth twice daily. The usual Xeljanz XR dosage is 11 mg by mouth once a day. If you’re treating UC, you might start out taking a higher dose. For pcJIA, Xeljanz dosages are based on a child’s body weight.
Good to know: Certain people may need to take lower or less frequent Xeljanz dosages. This includes people with kidney problems or liver problems, as well as people with a low number of white blood cells (immune cells). This also includes people who take certain medications that interact with Xeljanz (more on this later).
3. You may be able to switch from Xeljanz tablets to Xeljanz XR tablets
For adults, Xeljanz tablets and Xeljanz XR tablets are approved to treat the same health conditions. With the guidance of your healthcare provider, you may be able to switch from Xeljanz to Xeljanz XR. Many people may find once-daily dosing more convenient than twice-daily dosing.
If you’re taking Xeljanz 5 mg twice daily, you may be able to switch to Xeljanz XR 11 mg once a day. If you take Xeljanz 10 mg twice a day, you might be able to switch to Xeljanz XR 22 mg once a day. When switching, you should start Xeljanz XR the day following your last dose of Xeljanz. Avoid taking Xeljanz and Xeljanz XR on the same day.
Good to know: It’s not as straightforward to change from Xeljanz oral liquid to Xeljanz XR. Check with your provider about whether this is an option. And keep in mind that Xeljanz XR isn’t approved for children.
4. You may notice what looks like a pill in your stools when taking Xeljanz XR
Some extended-release tablets have an outer shell that regulates how fast medication is released into the body. The shell doesn’t dissolve in the stomach or intestines. So it leaves the body in the stool. This is the case for Xeljanz XR.
You may notice what looks like a tablet in your stool if you take Xeljanz XR. Keep in mind that all of the active medication has been absorbed by the body and will work as intended. So it’s normal to have this empty shell in your stool. Xeljanz tablets shouldn’t have this effect.
5. Xeljanz liquid should be stored in its original container
Xeljanz oral liquid has different storage requirements compared with Xeljanz tablets or Xeljanz XR tablets. The oral liquid is packaged in a special bottle to help protect it from light. You should store the liquid in the original bottle and its carton to protect it from light.
Xeljanz liquid can be kept at room temperature (between 68℉ and 77℉) in a cool, dry place. It should be used within 60 days (2 months) of opening. Discard any remaining liquid if the bottle has been open for longer than this.
Xeljanz tablets and Xeljanz XR tablets can be stored in a cool, dry place at room temperature, too. But these can be stored in either the manufacturer’s bottle or a medication vial provided by your pharmacy. If preferred, you can place doses in a pill organizer to help you remember to take them.
6. Xeljanz and Xeljanz XR have similar side effects
Since Xeljanz and Xeljanz XR contain the same active ingredient, they have similar side effects. Common side effects include headache, diarrhea, and upper respiratory tract infections. Serious side effects such as blood clots, heart attack, and stroke are rare, but possible. Xeljanz and Xeljanz XR can also raise your risk of serious infections and certain cancers.
Although the types of side effects potentially experienced with Xeljanz and Xeljanz XR are similar, it’s possible that you could experience slight differences between forms. But there shouldn't be significant differences in side effects for most people.
7. Xeljanz and Xeljanz XR have similar interactions
As with side effects, potential interactions are similar with Xeljanz and Xeljanz XR. Both dosage forms interact with:
Oral antifungals, such as ketoconazole
Macrolide antibiotics, such as clarithromycin
Grapefruit juice
Seizure medications, such as carbamazepine (Tegretol)
Rifampin (Rifadin)
Certain biologic medications, such as Humira (adalimumab)
Methotrexate
Other immunosuppressants, such as cyclosporine (Sandimmune)
Live vaccines, such as the measles / mumps / rubella (MMR) vaccine
This isn’t a complete list of all possible interactions. Make sure to show your healthcare provider and pharmacist a current medication list when you’re starting Xeljanz or Xeljanz XR. This can help them screen for potentially dangerous interactions. In some cases, you may need to take a lower dosage of Xeljanz or Xeljanz XR to manage certain interactions. In others, you may need to switch medications to avoid issues.
8. You can save money on Xeljanz and Xeljanz XR
Whether you’re taking Xeljanz or Xeljanz XR, there are ways to save on your prescription. Both medications are made by the same manufacturer, which offers a copay savings card to make your prescription more affordable. If you’re eligible, you could pay as little as $0 per month for Xeljanz or Xeljanz XR.
The manufacturer also offers a patient assistance program for Xeljanz and Xeljanz XR. If you’re uninsured or underinsured, you may be eligible to receive your medication free of charge.
Good to know: Xeljanz and Xeljanz XR are considered specialty medications, so you may receive them in the mail from a specialty pharmacy. In this case, pharmacy staff at the specialty pharmacy will work with your insurer to figure out your coverage and prescription cost. They’ll also help you understand if you’re eligible for any financial assistance.
Some people can also fill Xeljanz or Xeljanz XR at retail or community pharmacy locations, just like you would with other prescriptions. Your insurance provider generally determines which type of pharmacy you can use for Xeljanz or Xeljanz XR.
The bottom line
Xeljanz and Xeljanz XR are different forms of tofacitinib. They’re both FDA-approved to treat autoimmune disorders, such as rheumatoid arthritis and ulcerative colitis, in adults. Xeljanz XR isn’t approved for use in children. Xeljanz oral liquid is approved to treat polyarticular course juvenile idiopathic arthritis in children ages 2 and older.
The standard Xeljanz dosage is 5 mg or 10 mg by mouth twice a day. The standard Xeljanz XR dosage is 11 mg to 22 mg once a day. With Xeljanz XR, you may notice what looks like a tablet in your stool. This is normal and is only the tablet’s outer, indigestible shell.
Potential side effects and interactions are similar with Xeljanz and Xeljanz XR. Your healthcare provider can help determine which one is right for you.
Why trust our experts?
References
Padda, I. S., et al. (2023). Tofacitinib. StatPearls.
Pfizer Laboratories Div Pfizer Inc. (2023). Xeljanz- tofacitinib tablet, film coated; Xeljanz XR- tofacitinib tablet, film coated, extended release; Xeljanz- tofacitinib solution [package insert].
Tungaraza, T. E., et al. (2013). Curse of the ghost pills: The role of oral controlled-release formulations in the passage of empty intact shells in faeces. Two case reports and a literature review relevant to psychiatry. Therapeutic Advances in Drug Safety.
U.S. Food and Drug Administration. (2022). FDA requires warnings about increased risk of serious heart-related events, cancer, blood clots, and death for JAK inhibitors that treat certain chronic inflammatory conditions.
