7 Rinvoq Side Effects and How to Manage Them
Rinvoq is a JAK inhibitor taken for certain autoimmune disorders. It may cause acne, upper respiratory tract infections, and other side effects.
Rinvoq
Used for Ankylosing Spondylitis, Crohn's Disease, Eczema, Non-radiographic Axial Spondyloarthritis, Psoriatic Arthritis, Rheumatoid Arthritis, Ulcerative Colitis
Used for Ankylosing Spondylitis, Crohn's Disease, Eczema, Non-radiographic Axial Spondyloarthritis, Psoriatic Arthritis, Rheumatoid Arthritis, Ulcerative Colitis
Rinvoq (upadacitinib) is a Janus kinase (JAK) inhibitor. It treats many inflammatory conditions. This includes rheumatoid arthritis (RA), ulcerative colitis (UC), Crohn's disease (CD), and eczema (atopic dermatitis). It's often used when other treatments haven't worked well. Rinvoq (upadacitinib) is taken by mouth, usually once a day. It comes as an extended-release pill (Rinvoq) and an oral solution (Rinvoq LQ). These formulations aren't the same and can't be swapped easily. Side effects include nausea and a higher risk of infection.
What is Rinvoq (upadacitinib)?
What is Rinvoq (upadacitinib) used for?
- Rheumatoid arthritis (RA) in adults
- Psoriatic arthritis (PsA) in people 2 years and older
- Eczema (atopic dermatitis) in people 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 children 2 years and older
- Giant cell arteritis in adults
How Rinvoq (upadacitinib) works
Rinvoq (upadacitinib) is a Janus kinase (JAK) inhibitor. It works by blocking the JAK protein. This protein is part of your immune system and plays a role in causing inflammation in the body.
By blocking JAK, Rinvoq (upadacitinib) lowers inflammation in the body. This helps relieve symptoms of arthritis and certain other inflammatory conditions.
When does Rinvoq (upadacitinib) start working?Time passed since treatment started:
Drug facts
| Common Brands | Rinvoq, Rinvoq LQ |
|---|---|
| Drug Class | JAK inhibitor |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
More on Rinvoq (upadacitinib) essentials
Side effects of Rinvoq (upadacitinib)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Upper respiratory tract infection (14%)
- Nausea (4%)
Less Common Side Effects
- Cough
- Fever
- Pneumonia
- Herpes simplex virus (HSV) infection
- Herpes zoster infection (shingles)
- Yeast infection in the mouth
Note: Side effects were from people with rheumatoid arthritis (RA). Side effects might differ for other conditions.
Rinvoq (upadacitinib) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious infection: fever, weakness, chills, night sweats, trouble breathing, cough, diarrhea, stomach pain, burning when you urinate, urinating more or less often
- Blood clot in the leg: leg swelling, leg pain, redness or warmth in the leg
- Blood clot in the lung: cough, chest pain, trouble breathing, racing heart
- Blood clot affecting the heart (heart attack): chest pain; pain that spreads to the jaw, neck, or arm; short of breath; cold sweat; nausea; indigestion; unexplained weakness or tiredness
- Blood clot affecting the brain (stroke): sudden severe headache, weakness on one side of your body, droopy face, trouble speaking, trouble walking, confusion
- Stomach damage: new stomach pain, blood in your stool, nausea, fever
- Severe allergic reaction: rash, feeling faint, swelling of the face or throat, trouble breathing
More on Rinvoq (upadacitinib) side effects
The following Rinvoq (upadacitinib) 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
- Change in vision
- 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
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- 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
- Cough
- Headache
- Nausea
- Runny or stuffy nose
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Pros and cons of Rinvoq (upadacitinib)
Pros
- Can treat many different inflammatory conditions
- Available as a tablet and a liquid
- Tablets are taken once a day
Cons
- Can raise your risk of infections
- Can interact with grapefruit
- Not the best option for people with severe liver or kidney problems
Pharmacist tips for Rinvoq (upadacitinib)
- You can take Rinvoq (upadacitinib) at any time of day, with or without food. Choose a time that works for you, whether it's in the morning or at night. Make sure to take it around the same time each day. This can help you remember to take the medication and help it work consistently.
- Don't eat grapefruit or drink grapefruit juice while taking Rinvoq (upadacitinib). Grapefruit can raise the amount of medication in your body. This can put you at higher risk of side effects like stomach upset.
- Rinvoq (upadacitinib) can raise your risk of infection. Watch for signs like a fever, cough, trouble breathing, weakness, sweating, or chills. If you notice these signs, call your care team. They can check what could be going on and help you get the right care for any infections.
- Make sure to get the blood tests your prescriber orders. These tests help your care team check Rinvoq (upadacitinib) is safe for you. The medication can sometimes cause low blood counts, higher cholesterol, or higher liver enzyme levels. You might not feel symptoms, so testing is important to catch these problems. You can ask your care team to go over your lab results.
- Before getting any vaccines, tell the healthcare professional you're taking Rinvoq (upadacitinib). You can get most vaccines, like the flu shot, during treatment. But avoid live vaccines, like the FluMist nasal flu vaccine and MMR (measles, mumps, and rubella vaccine). Rinvoq (upadacitinib) might affect how your body responds to live vaccines. Your care team can check that the vaccine is safe for you.
- Give your care team a list of all the medications you take or plan to take. Rinvoq (upadacitinib) can interact with many medications. Some, like certain antifungals, can raise your risk of side effects. Taking other immunosuppressants can also make your risk of infection even higher. Other medications, like rifampin, can make Rinvoq (upadacitinib) work less well. Your care team can check that your medications are safe to take together. They can suggest changes if needed to keep you safe.
- If you can become pregnant: Use birth control, like condoms or birth control pills, while taking Rinvoq (upadacitinib) and for 4 weeks after your last dose. This medication might harm an unborn baby. Tell your prescriber right away if you become pregnant during treatment. They might suggest that you join the pregnancy registry with the manufacturer. It helps researchers learn more about how safe the medication is during pregnancy.
- If you plan to breastfeed: It's not recommended to breastfeed while taking Rinvoq (upadacitinib). Wait until it's been 6 days after your last dose to breastfeed. We don't know how the medication could affect your breastfed baby. But there could be a potential risk of side effects. Talk to your prescriber or a lactation expert about safe ways to feed your baby.
Tips for Rinvoq (upadacitinib) tablets:
- Swallow the Rinvoq (upadacitinib) tablet whole. Don't crush, cut, or chew them because it can damage them and affect how the medication works. If you have trouble swallowing the tablet, talk to your prescriber about your options.
- After taking Rinvoq (upadacitinib), you might see the whole tablet or parts of it in your stool. This might be more likely to happen if you have stomach or gut problems. If you notice this often, tell your prescriber. It could mean you're not absorbing the medication well, and you might need a different treatment.
Tips for Rinvoq LQ (upadacitinib) liquid:
- Read the instructions for use for the Rinvoq LQ liquid. The liquid is usually taken twice a day (this is different from the tablets). Ask a member of your care team if you have any questions.
- Once you open a new bottle of Rinvoq LQ liquid, it's good for 60 days. Write the 60-day date on the bottle when you open a new bottle. This helps you remember when it expires and when to throw it away (even if there's still some medication left).
- How to prepare the dose of Rinvoq LQ liquid: Insert the adapter into the new bottle. Use an oral syringe to measure the dose. Put the tip of the syringe into the adapter and turn the bottle upside down. Then, draw up the prescribed amount of medication. Check for air bubbles and get rid of any large ones. Don't use household spoons since they're not accurate.
- How to give the dose of Rinvoq LQ liquid: Give the dose within 1 hour of measuring it into the oral syringe. Place the syringe into the mouth, against the inside of the cheek. Then, slowly push the plunger to give the full dose. Drink some water afterwards to make sure you take the entire dose.
- You can store the Rinvoq LQ liquid at room temperature or in the refrigerator. Make sure the liquid stays between 36ºF and 86ºF. Keep it in the original container to protect it from light.
More on Rinvoq (upadacitinib) tips
Risks and warnings for Rinvoq (upadacitinib)
Rinvoq (upadacitinib) 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: Active, long-term, or recurrent infection | Taking other medications that weaken the immune system | Having other conditions that raise risk of infection | Older adults
Rinvoq (upadacitinib) can affect how well you can fight off infections. This can raise your risk of serious and sometimes life-threatening infections. In studies, the most common serious infections were pneumonia and cellulitis. Other infections include tuberculosis (TB) and oral thrush. Old infections, like hepatitis or shingles, can also come back.
Before starting Rinvoq (upadacitinib), tell your prescriber about your full medical history. This includes any long-term or serious infections. You'll also get tested for TB and for hepatitis. Your prescriber can make sure it's safe for you. You can't take Rinvoq (upadacitinib) if you have an active infection. You'll likely need to get treated for it before you can start this medication.
During treatment, your prescriber will check for infections. It's a good idea for you to watch for signs too. This includes fever, weakness, chills, body aches, night sweats, or a cough. If this happens, let your prescriber know right away.
Possible higher risk of heart attack, stroke, or heart-related death in certain older adults with RA
- Risk factors: Age 50 years and older with at least one risk factor for heart disease (e.g., high blood pressure, high cholesterol) | Current or past smoker
In a study, people 50 years and older with RA who had a risk for heart disease had a higher risk of serious health problems when taking a similar JAK inhibitor. These problems included heart attack, stroke, and death from a heart-related issue. This risk was higher than in people taking another type of RA medication. Talk to your prescriber about the risks and benefits of taking Rinvoq (upadacitinib) before starting.
Call 911 right away if you have signs of a heart attack or stroke. A heart attack can look like sudden chest pain, nausea, or sweating. And signs of a stroke include a droopy face, sudden weakness on one side, a sudden headache, or trouble walking or talking.
Risk of cancer
- Risk factors: Currently have or previously had cancer | Current or previous smoker
Although rare, some people taking Rinvoq (upadacitinib) for RA have developed cancer, including skin cancer. In studies, people taking a different JAK inhibitor had a higher risk of cancer than those taking another RA medication. These cancers included lymphoma and lung cancer.
Because of this risk, your prescriber will monitor you for your risk of cancer during treatment. Tell them about any cancers you know about or if you smoke.
Be sure to get yearly skin checks. Wear protective clothing and use sunscreen if you're out in the sun, and avoid tanning beds. This helps lower your risk of skin cancer. Let your care team know if you notice any skin changes or any new, unusual symptoms.
Risk of blood clots
- Risk factors: Age 50 years and older | High blood pressure | High cholesterol | High blood sugar | People who smoke | Past blood clots
Some people taking Rinvoq (upadacitinib) have had blood clots. Blood clots can form in different parts of the body and block blood flow. This can be serious and life-threatening, especially if it affects the heart, brain, or lungs.
Before starting Rinvoq (upadacitinib), tell your prescriber about your medical history and the medications you take. They can check your risk and make sure Rinvoq (upadacitinib) is safe for you.
Be sure you know the signs of a blood clot to look out for.
- Blood clot in the leg (deep vein thrombosis, DVT): leg swelling, leg pain, redness or warmth in the leg
- Blood clot in the lung (pulmonary embolism, PE): cough, chest pain, trouble breathing, racing heart
- Blood clot affecting the heart (heart attack): chest pain; pain that spreads to the jaw, neck, or arm; short of breath; cold sweat; nausea; indigestion; unexplained weakness or tiredness
- Blood clot affecting the brain (stroke): sudden severe headache, weakness on one side of your body, droopy face, trouble speaking, trouble walking, confusion
Get medical help right away if you have any symptoms of a blood clot while taking Rinvoq (upadacitinib). It's important to get it treated as soon as possible.
Allergic reactions
Allergic reactions can happen with Rinvoq (upadacitinib). They can include life-threatening reactions like swelling of the face and anaphylaxis (closing of the throat).
Call 911 right away if you have a rash; trouble breathing; or swelling in your face, tongue, or throat. These can be signs of a serious allergic reaction.
Stomach damage
- Risk factors: History of tears in the gut | History of diverticulitis | Taking nonsteroidal anti-inflammatory drugs (NSAIDs) | Taking steroid medications
Rarely, a few people taking Rinvoq (upadacitinib) developed tears in their gut. Let your prescriber know if you've had any stomach or gut tears before. Also tell them if you have a history of diverticulitis. Make sure you let them know if you take any NSAIDs or steroids. These health conditions and medications can put you at risk of stomach damage. Your prescriber can help monitor you more closely to keep you safe.
Get medical help right away if you have new stomach pain, blood in your stool, nausea, or fever. These can be signs of a tear in your gut.
Abnormal lab results (e.g., blood counts, cholesterol)
Although rare, some people taking Rinvoq (upadacitinib) have had low blood counts. Low white blood cells can make it easier to get infections. And low red blood cells can make you feel very tired and cause anemia.
Some people might also have higher cholesterol. This can often be managed with medications called statins.
In addition, some people can have higher liver enzyme levels. This can sometimes be a sign of liver injury.
Before starting Rinvoq (upadacitinib), your prescriber will order blood tests for you. They'll check your blood counts, cholesterol, and liver. This makes sure it's safe to start the medication. Then, your prescriber will check these labs regularly during treatment. They might pause treatment if there are concerns.
Harm to an unborn baby
Based on animal studies, Rinvoq (upadacitinib) might harm an unborn baby when taken during pregnancy. If you can become pregnant, your prescriber might ask you to take a pregnancy test before starting treatment. This double checks that you're not pregnant to lower the risk of harm.
During treatment, use a reliable method of birth control. Keep using this birth control method for 4 weeks after stopping Rinvoq (upadacitinib). Tell your prescriber right away if you become pregnant during this time.
Medication in stool
Some people have seen the whole tablet of Rinvoq (upadacitinib) or tablet pieces in their stool. Most times, this has happened in people with certain stomach or gut problems. It might mean that they're not fully absorbing the medication.
If you often see the whole tablet or pieces of the tablet in your stool, tell your care team. They can check if Rinvoq (upadacitinib) is working for you or suggest a different medication if needed.
Rinvoq (upadacitinib) dosage
The average cost for 30 tablets of 15mg of Rinvoq (upadacitinib) is $6,244.67 with a free GoodRx coupon. This is 29.44% off the average retail price of $8,850.61. 
Bottle of oral solution
Tablet
Bottle of oral solution| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 180ml of 1mg/ml | 1 bottle | $3,273.52 | $3,273.52 |
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 15mg | 30 tablets | $6,244.67 | $208.16 |
| 30mg | 30 tablets | $6,225.18 | $207.51 |
| 45mg | 28 tablets | $11,647.73 | $415.99 |
Typical dosage for Rinvoq (upadacitinib)
Your dose will depend on the health condition you're treating. Rinvoq extended-release tablets and Rinvoq LQ oral solution can't be swapped with one another easily.
-
Adults:
- Rheumatoid arthritis: The typical dose is 15 mg by mouth once a day.
- Psoriatic arthritis: The typical dose is 15 mg by mouth once a day.
- Eczema (atopic dermatitis): The typical dose is 15 mg by mouth once a day.
- Ulcerative colitis: The typical starting dose is 45 mg by mouth once a day for 8 weeks. After that, the dose is 15 mg by mouth once a day.
- Crohn's disease: The typical starting dose is 45 mg by mouth once a day for 12 weeks. After that, the dose is 15 mg by mouth once a day.
- Ankylosing spondylitis: The typical dose is 15 mg by mouth once a day.
- Non-radiographic axial spondyloarthritis: The typical dose is 15 mg by mouth once a day.
- Giant cell arteritis: The typical dose is 15 mg by mouth once a day.
-
Children
-
Psoriatic arthritis or pJIA (age 2 years and younger): The dose is based on your child's weight.
- Weigh 10 kg to less than 20 kg: The typical dose is 3 mg (3 mL) of Rinvoq LQ oral solution by mouth twice a day.
- Weigh 20 kg to less than 30 kg: The typical dose is 4 mg (4 mL) of Rinvoq LQ oral solution by mouth twice a day.
- Weigh 30 kg and greater: The typical dose is 6 mg (6 mL) of Rinvoq LQ oral solution by mouth twice a day, or 15 mg of Rinvoq tablet once a day.
-
Eczema (age 12 years and older weighing at least 40 kg): The typical dose is 15 mg by mouth once a day. Your child's prescriber might raise the dose to 30 mg once a day if needed.
-
Your dose might differ if you have liver or kidney problems. It might also differ if you take medications that can interact with Rinvoq (upadacitinib).
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How much does Rinvoq (upadacitinib) cost?
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Rinvoq (brand)
$3,273.52
What are alternatives to Rinvoq (upadacitinib)?
There are a number of medications that your doctor can prescribe in place of Rinvoq (upadacitinib). Compare a few possible alternatives below.
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Rinvoq (upadacitinib) images
