Olumiant
Olumiant (baricitinib) is a Janus kinase (JAK) inhibitor. It's used to treat rheumatoid arthritis (RA) and severe hair loss (alopecia areata) in adults. It can also be prescribed for adults hospitalized with COVID-19 who need breathing support. Olumiant (baricitinib) is taken by mouth once daily. The most common side effect of this medication is a higher risk of infections.
What is Olumiant (baricitinib)?
What is Olumiant (baricitinib) used for?
Moderate-to-severe rheumatoid arthritis (RA) in adults
COVID-19 in hospitalized adults who need oxygen or support from machines to help breathe
Severe hair loss (alopecia areata) in adults
How Olumiant (baricitinib) works
Olumiant (baricitinib) is a Janus kinase (JAK) inhibitor. JAK kinases are proteins in the body that play an important role in immune signaling. When JAK kinases are active, your body experiences more inflammation. Olumiant (baricitinib) dampens down the immune system by blocking JAK kinases.
Drug Facts
More on Olumiant (baricitinib) essentials
What are the side effects of Olumiant (baricitinib)?
Common Side Effects
- Upper respiratory infection (up to 16%)
- Raised liver enzymes (9-18%)
- Infections (up to 9%)
- Upper respiratory infection (18-21%)
- Headache (6-7%)
- Acne (6%)
- High cholesterol (4-6%)
- Urinary tract infection (4%)
Other Side Effects
- Nausea
- Herpes simplex infection
- Shingles
- Blood clots
- Stomach pain
- Nausea
- Lower respiratory tract infections
- Tiredness
Serious Side Effects
- Stroke: sudden weakness in your body, trouble speaking, confusion, dizziness
- Arterial thrombosis (blood clot in the heart): chest pain; short of breath; pain in the jaw, neck, or back; feeling weak or light-headed
- Pulmonary embolism (blood clot in the lung): cough, chest pain, trouble breathing, racing heart
- Deep vein thrombosis (blood clot in the leg): leg cramp, swelling, pain, muscle tightness
- Severe allergic reaction: rash, trouble breathing, feeling faint, swelling of the face or throat
- Serious infections: fever, difficulty breathing, diarrhea, weakness, cough, stomach pain, sweating, chills, burning when you urinate, urinating more often
- Stomach tear: stomach pain, bloating, change in bowel movements, bleeding
- Liver damage: nausea, stomach pain, yellowing of the skin or whites of the eyes
Source: DailyMed
More on Olumiant (baricitinib) side effects
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Stomach pain that is severe, does not go away, or gets worse
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Acne
- Headache
- Nausea
- Runny or stuffy nose
- Sinus pain or pressure around the face or forehead
- Sore throat
- Stomach pain
Pros and cons of Olumiant (baricitinib)
Pros
Works well for rheumatoid arthritis, COVID-19, and alopecia areata
The only JAK inhibitor FDA-approved for COVID-19
Taken once per day
Can be taken with or without food
Cons
Not a good option for people with severe liver and kidney problems
Can cause low blood cell counts and raise the risk of infection
It's not clear how safe it is when taken during pregnancy or breastfeeding
Pharmacist tips for Olumiant (baricitinib)
Take Olumiant (baricitinib) once per day with or without food. If it's hurting your stomach, taking it with food might help.
Let your provider know if you're having trouble swallowing Olumiant (baricitinib) tablets. They can instruct you on how to make it into a liquid preparation.
You should be up-to-date on all your vaccinations before starting Olumiant (baricitinib). Most people can still get most vaccines, including the flu shot, while taking Olumiant (baricitinib). But you shouldn't get live vaccines, such as the live nasal flu vaccine and MMR (measles, mumps, and rubella vaccine) because it's not known how your body will react to the vaccine.
Mark your appointments on your calendar to see your provider and get any tests done so they can make sure Olumiant (baricitinib) is safe and working well for you. Olumiant (baricitinib) can cause changes to your lab tests, such as cholesterol and red blood cells.
Olumiant (baricitinib) can raise your risk of getting a serious or life-threatening infection. If you develop symptoms of an infection (e.g., fever, cough, difficulty breathing, diarrhea, weakness, sweating, chills) while taking Olumiant (baricitinib), get medical help right away. You might have to stop taking Olumiant (baricitinib) so your body can fight the infection.
Make sure to tell your provider about all the medications you're taking before and during treatment with Olumiant (baricitinib), especially if you're taking probenecid or other medications that weaken your immune system.
Tell your provider if you're pregnant or thinking of becoming pregnant because Olumiant (baricitinib) can potentially cause harm to unborn babies.
Frequently asked questions about Olumiant (baricitinib)
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What are the risks and warnings for Olumiant (baricitinib)?
Olumiant (baricitinib) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious infections
Risk factors: Current infection | Past infections that keep coming back | Other conditions that raise your risk of infection | Living in or traveling to places with high rates of TB infections | Taking medications that weaken your immune system
Olumiant (baricitinib) can affect your body's ability to fight off infections. This can raise your risk of serious bacterial (e.g., tuberculosis (TB)), viral (e.g., herpes, hepatitis), or fungal infections. Your provider will routinely monitor you for infections before and during treatment with Olumiant (baricitinib). If you notice any signs of infection during treatment like fever, chills, body aches, pain when urinating, or cough, let your provider know right away.
Possible higher risk of death
Risk factors: Age 50 years and older | High blood pressure | High cholesterol (fat) | High blood sugar
Though this hasn't been seen with Olumiant (baricitinib), use of JAK inhibitors for rheumatoid arthritis has been linked to higher risk of death for some people, such as older adults with at least one heart-related risk factor. Talk to your provider about the risks and benefits of using Olumiant (baricitinib) before you start treatment.
Possible risk of cancer
Risk factors: History of cancer | People who smoke
Some people who took JAK inhibitors reported they developed cancer during treatment. These cancers included lymphoma and skin cancer. Some cancers have been reported by people taking Olumiant (baricitinib) during clinical studies. Because of this, your provider will monitor you for your risk of cancer during treatment. Additionally, make sure you schedule yearly screenings for skin cancer and let your provider know if you notice changes to your skin. Wear protective clothing and use sunscreen if you're out in the sun, and avoid UV light (e.g., tanning beds) to lower your risk of skin cancer.
Risk of heart attack, stroke, and other blood clots
Risk factors: Age 50 years and older | High blood pressure | High cholesterol (fat) | High blood sugar | People who smoke | Past blood clots
Olumiant (baricitinib) can raise your risk for blood clots in different parts of your body. In a study of people taking another JAK inhibitor for RA who had at least one heart-related risk factor, more heart attacks and strokes happened in people who took the JAK inhibitor compared to another medication. Get medical help right away if you experience any of the following symptoms of a blood clots
Legs (deep vein thrombosis): leg cramp, swelling, pain, muscle tightness
Lungs (pulmonary embolism): cough, chest pain, trouble breathing, racing heart
Heart (arterial thrombosis): chest pain, short of breath, pain in the jaw, neck, or back, feeling weak or light-headed
Brain (stroke): sudden weakness in your body, trouble speaking, confusion, dizziness
Eyes: vision changes, pain.
Severe allergic reactions
Olumiant (baricitinib) can rarely cause serious allergic reactions. If you experience symptoms of an allergic reaction such as swelling in your face or throat, trouble breathing, or rash, get medical help right away.
Tears in the gut
During clinical studies, some people taking Olumiant (baricitinib) reported a tear in their gut. If you notice stomach pain or blood in your stool, get medical attention right away.
Changes in lab tests
Olumiant (baricitinib) can lower the number of red blood cells (RBCs) and white blood cells (WBCs) in your body. This can raise your risk for anemia and infections. Your provider might order blood draws to check your blood cell counts. Let your provider know if you experience possible symptoms of low blood cell counts, such as: Anemia (low RBC count): feeling tired, headache, pale skin, fast heart rate, trouble breathing; Infections (low WBC count): fever, chills, tiredness, cough, body aches, runny nose.
Additionally, Olumiant (baricitinib) can raise your liver enzymes and cholesterol levels. High liver enzymes can sometimes mean your liver has been damaged. Your provider will order cholesterol tests and liver tests regularly while you're taking Olumiant (baricitinib). Let your provider know if you have high cholesterol, or are taking medications for high cholesterol, before starting Olumiant (baricitinib).
Olumiant (baricitinib) dosage forms
Typical dosing for Olumiant (baricitinib)
Rheumatoid arthritis: The typical dose is 2 mg by mouth once daily.
COVID-19: The typical dose is 4 mg by mouth once daily for 2 weeks or until hospital discharge, whichever comes first.
Alopecia areata: The typical starting dose is 2 mg by mouth once daily. If needed, your provider might raise your dose to 4 mg daily.
Your provider will adjust your dose based on if you're taking a medication that interacts with Olumiant (baricitinib), your blood cell counts, and if you have kidney or liver problems.
More on Olumiant (baricitinib) dosage forms
What are alternatives to Olumiant (baricitinib)?
Moderate-to-severe rheumatoid arthritis (RA) in adults
COVID-19 in hospitalized adults who need oxygen or support from machines to help breathe
Severe hair loss (alopecia areata) in adults
Rheumatoid arthritis (RA)
Plaque psoriasis (PsO) and psoriatic arthritis (PsA)
Ankylosing spondylitis (AS)
Childhood arthritis (polyarticular juvenile idiopathic arthritis, JIA)
Rheumatoid arthritis (RA) in adults
Psoriatic arthritis (PsA) in adults and children ages 2 years and older
Eczema (atopic dermatitis) in adults and children ages 12 years and older
Ulcerative colitis (UC) in adults
Crohn's disease (CD) in adults
Ankylosing spondylitis (AS) in adults
Non-radiographic axial spondyloarthritis (nr-axSpA) in adults
Polyarticular juvenile idiopathic arthritis (pJIA) in adults and children ages 2 years and older
What is the latest news about Olumiant (baricitinib)?
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References
Best studies we foundAmerican Cancer Society. (n.d.). Lymphoma.
Centers for Disease Control and Prevention. (n.d.). Fungal diseases.
Eli Lilly and Company. (2022). FDA approves Lilly and Incyte's Olumiant® (baricitinib) for the treatment of certain hospitalized patients with COVID-19. PRNewswire.
Eli Lilly and Company. (2023). Olumiant- baricitinib tablet, film coated [package insert]. DailyMed.
Kaye, K.M. (2023). Herpes simplex virus (HSV) infections. Merck Manual Consumer Version.
Kwon, O., et al. (2023). Efficacy and safety of baricitinib in patients with severe alopecia areata over 52 weeks of continuous therapy in two phase III trials (BRAVE-AA1 and BRAVE-AA2). American Journal of Clinical Dermatology.
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