7 Rinvoq Side Effects and How to Manage Them

Excessive inflammation is responsible for many chronic health conditions. And the more pronounced it is, the more problematic these conditions can be.

Inflammation-fighting medications can help change these health outcomes. If you’re living with an autoimmune disorder, your healthcare provider might prescribe an oral medication such as Rinvoq (upadacitinib) to manage the discomfort you’re experiencing. Rinvoq is a Janus kinase (JAK) inhibitor that helps calm down your immune system to reduce inflammation.

Rinvoq is effective and beneficial for many people. But there are still some side effects to keep in mind. Some are mild and easily manageable, while others are more serious.

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Rinvoq side effects at a glance

Some of Rinvoq’s side effects are relatively common. These side effects were experienced by more than 3% of people in Rinvoq’s initial studies:

• Upper respiratory tract infections (URTI)

• Fever

• Acne

• Headache

• Nausea and upset stomach

• Elevated liver enzymes

• Increased blood creatine phosphokinase (a lab test)

• Low red blood cells

• Low white blood cells

• Rash

• Shingles

Serious, but rare, side effects have also been reported. They include:

• Blood clots

• Increased risk of heart attack and stroke

• Increased risk of cancer

• Increased risk of serious infections

• Increased risk of death in people with at least one heart-related risk factor

Here, we’ll detail how to manage or monitor for seven notable Rinvoq side effects.

1. Upper respiratory infections

Rinvoq intentionally suppresses your immune system. This is how it addresses inflammatory symptoms you may be experiencing. However, in turn, there’s a higher risk of picking up some kind of infection.

URTIs are the most common infection people experience while taking Rinvoq. Think sinus infections, the common cold, and strep throat. A sore throat, cough, and a runny or stuffy nose are all hallmark symptoms.

If you come down with symptoms like these, try to prioritize getting plenty of fluids and rest while you recover. Over-the-counter (OTC) medications such as pain relievers, nasal sprays, and antihistamines can offer some short-term relief, too.

If your symptoms don't go away within 7 to 10 days, let your healthcare provider know. This is important even if your symptoms still feel relatively mild. They can determine next steps to help you get feeling better.

Good to know: Let your healthcare provider know right away if you develop any serious or long-lasting symptoms of an infection while taking Rinvoq. Some infections can become life threatening if left untreated. Your provider can decide if you should temporarily stop taking Rinvoq while you recover.

2. Acne

Some people taking JAK inhibitors like Rinvoq develop new or worsening cases of acne. Since it’s relatively common, some healthcare providers light-heartedly refer to it as “JAKne.” But it isn’t very clear why it happens.

Standard acne treatments can help manage acne from Rinvoq. Your healthcare provider can help you choose the best acne treatment.

Go-to acne treatments often include medications that you apply to your skin. Benzoyl peroxide and topical retinoids are beneficial for many people. Short-term antibiotics can also help. In rare cases, oral treatment with isotretinoin (Absorica, Amnesteem, Claravis) may be necessary.

3. Nausea and stomach upset

Nausea is a common side effect associated with many medications. Thankfully, it's not too problematic with Rinvoq.

Still, there are things you can do to reduce your chances of experiencing an upset stomach. Taking your medication with food and staying hydrated are helpful preventative measures.

If you’re actively experiencing nausea, you may want to consider:

• Temporarily avoiding trigger foods that normally irritate your stomach, even if they sound appetizing

• Eating smaller, more frequent meals

• Testing out ginger or peppermint oil

• Trying an OTC nausea medication, such as bismuth subsalicylate (Pepto-Bismol)

4. Changes to your lab work

Rinvoq can negatively affect your blood work readings, including your cholesterol levels. Some people develop higher cholesterol after starting Rinvoq. It’s very manageable, but to be safe, your healthcare provider may occasionally monitor your cholesterol while you’re taking Rinvoq.

Immune system changes are also possible. Rinvoq may cause your white blood cells to decrease in number. This can lead to an immune system that’s weaker than normal. Your provider may pause your prescription if they fall too low.

What’s more, Rinvoq can affect your red blood cells. You may develop anemia if your red blood cell counts drop too low. It can also affect laboratory measurements related to your muscles (creatinine phosphokinase) and liver (liver enzymes).

Thankfully, you don’t need to worry about these changes on your own. Your provider will be in charge of monitoring your blood work. They’ll make any necessary adjustments based on what your lab results say.

5. Serious infections

Many infections are mild in nature, but others are more serious. Some can even be life-threatening. Rinvoq has a boxed warning — the most serious warning that the FDA gives a medication — about this risk. Infections from bacteria, viruses, and fungi have all been reported.

It’s important to notify your healthcare provider if you have any signs or symptoms of a potentially serious infection, such as a fever or shortness of breath. Your care team will assess your symptoms and give you further instructions. They’ll likely pause your Rinvoq prescription until the situation is addressed.

Because of these risks, your healthcare provider should screen for infections like tuberculosis and hepatitis B before you start taking Rinvoq. Rinvoq can activate or exacerbate conditions like these. In some cases, you may be asked to take medications to treat an infection before starting Rinvoq.

6. Higher risk of cancer

Rinvoq also has a boxed warning for an increased risk of cancer. But it’s exceptionally rare.

Lung cancer and lymphoma (a cancer of the lymphatic system) have been observed in some people taking JAK inhibitors. People that currently smoke or have smoked in the past are at greater risk. If you’re a current smoker and you’re interested in quitting, your pharmacist can recommend products and resources to help you on your smoking cessation journey.

Certain types of skin cancer have also been reported with Rinvoq. You can reduce your risk of skin cancer by wearing protective clothing and using sunscreen.

7. Heart problems and blood clots

People that take JAK inhibitors like Rinvoq have a higher risk of experiencing heart-related health problems (cardiovascular events). This includes heart attacks, strokes, and cardiovascular-related death. Blood clots in your lungs, veins, and arteries are also possible. Complications like these are rare, but they’re important boxed warnings to keep in mind.

Not everyone has the same degree of risk either. These blood-related issues are more likely among adults ages 50 and older with one or more of these health conditions or lifestyle traits:

• Diabetes

• High blood pressure

• High cholesterol

• Current or former smokers

• Chronic alcohol use

Go to the nearest emergency room if you think you’re having symptoms of a heart attack or a pulmonary embolism. This includes sudden breathing troubles and chest tightness. And if you develop symptoms such as weakness on one side of your body, a severe headache, or speech troubles, a stroke may be unfolding. Go to the nearest emergency room if you experience symptoms like these.

When to contact a healthcare provider about Rinvoq side effects

You should contact your healthcare provider any time you have questions or concerns about a side effect. Even if you feel like it’s mild, it’s still worth a call.

That being said, some Rinvoq side effects are riskier than others. It’s important to let your provider know if you’re experiencing signs or symptoms of an infection — especially if you’re seriously feeling sick.

You should call 911 or go to the nearest emergency room right away if you experience other symptoms, including:

• Difficulty breathing

• Sudden pain in the center of your chest

• One-sided facial or body weakness

• Severe headache or dizziness

• Slurred speech

• New onset confusion

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Written by:

Mandeep Sohal, PharmD

Mandeep Sohal, PharmD, has more than 7 years of experience in the pharmaceutical industry and is licensed in California. In his career, he’s had experience with specialty pharmacy, community pharmacy, pharmacy benefit management, and pharmaceutical manufacturers.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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