4 Skyrizi Interactions to Be Aware of

Skyrizi (risankizumab-rzaa) is an injectable medication that’s FDA approved to treat several autoimmune disorders in adults. This includes plaque psoriasis and psoriatic arthritis as well as Crohn’s disease and ulcerative colitis. These conditions put your immune system into overdrive, resulting in chronic inflammation.

Skyrizi blocks a cytokine (protein) in your immune system that helps cause inflammation. This helps reduce inflammation and improve your symptoms. The medication is usually well tolerated and is safe to take with most other medications. But there are four known interactions that you should be aware of before starting Skyrizi.

1. Live vaccines

Vaccines work by mimicking an infection without actually causing one. This causes your body’s natural defense mechanisms to kick in, including making antibodies. Antibodies allow your body to identify and get rid of viruses and bacteria before they cause an infection. There are different types of vaccines, but the ones that interact with Skyrizi are live vaccines.

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Live vaccines contain a weakened form of a live virus or bacteria. Injecting small amounts of a weakened live virus or bacteria into someone with a healthy immune system doesn’t cause an infection. But this may not be the case if you’re receiving Skyrizi.

Skyrizi lowers the activity of your immune system. So if you receive a live vaccine while you’re receiving it, there’s a chance you could develop the infection contained in the vaccine. Examples of live vaccines include the influenza nasal spray (FluMist), varicella (chickenpox) vaccine (Varivax), and the yellow fever vaccine (YF-VAX).

You should avoid receiving live vaccines while you’re receiving Skyrizi. So it’s best to make sure you’re up to date on your vaccines before starting it. If you need a vaccine and you’re unsure if it’s live, ask your healthcare team before receiving it. 

Good to know: Infants exposed to Skyrizi while in the womb may also need to delay getting live vaccines. The manufacturer suggests waiting at least 5 months after birth before giving any live vaccines to your baby. This is based on how long Skyrizi lasts in the body. But in some cases, the benefit of the vaccine may outweigh the risk. Your infant’s pediatrician can help you decide on the right vaccine schedule for their needs. Just be sure they’re aware that you were receiving Skyrizi while pregnant.

EXPERT PICKS: WHAT TO READ NEXT

• How do you inject Skyrizi? Learn the steps involved in injecting Skyrizi, plus more pharmacist-backed tips to get the most from your medication.

• Skyrizi dosages: Here’s a review of the approved Skyrizi dosages and how often you’ll need an injection.

• How does Skyrizi make you feel? These first-hand accounts from people using Skyrizi for inflammatory bowel disease can help you know what to expect.

2. Medications that weaken your immune system

As mentioned, Skyrizi weakens your immune system (immunosuppression). This helps control symptoms of autoimmune disorders, but it also puts you at a greater risk of developing infections. 

When you take Skyrizi with other medications that weaken your immune system, your infection risk goes up. Commonly prescribed immunosuppressants include:

• Corticosteroids such as prednisone

• Methotrexate

• Azathioprine (Imuran)

• Sulfasalazine

Keep in mind that in some cases, you’ll need to take one of these medications with Skyrizi to better control your symptoms. Your prescriber will help decide if the benefits outweigh the risk of infection. 

Be sure to let your prescriber know if you have any signs and symptoms of an infection while you’re receiving Skyrizi, including:

• Fever

• Cough

• Chills

• Trouble breathing

• Muscle aches

• Warm, painful, or red skin

Your prescriber will advise you on what to do if you develop symptoms like these. This may include holding off on your Skyrizi dose until you’re feeling better.

3. Supplements that can affect your immune system

Like prescription immunosuppressants, some supplements can also weaken your immune system. If you take them with Skyrizi, you are at a greater risk of developing infections. One example is glucosamine, a popular over-the-counter (OTC) supplement for joint pain. 

On the other hand, some supplements enhance the activity of your immune system. Echinacea, ginseng, and elderberry are common examples. While this may seem beneficial, supplements that ramp up your immune system could interfere with the effects of Skyrizi.

It’s a good idea to check in with your healthcare team before taking any OTC herbs or supplements with Skyrizi. They can make sure it’s a safe option.

Good to know: The FDA doesn’t regulate supplements for safety and effectiveness the same way as prescription medications. Studies have shown that supplement labels aren’t always accurate. And there could be contaminants or other ingredients in the product that aren’t listed. So shop carefully, and look for supplements with a third-party certification, such as a United States Pharmacopeia (USP) seal.

4. Other biologic medications

Biologics are complex medications made from living organisms. Skyrizi is a biologic medication. Other common biologics include:

• Humira (adalimumab)

• Cimzia (certolizumab)

• Enbrel (etanercept)

• Stelara (ustekinumab)

• Remicade (infliximab)

It’s not recommended to take Skyrizi with other biologics that treat autoimmune disorders. The risk of side effects, including infection, is too high. If Skyrizi isn’t working for you, your prescriber may switch you to a different biologic medication, but it’s not common to take more than one biologic at the same time.

When should you contact a healthcare professional about a Skyrizi interaction?

While Skyrizi doesn’t have many interactions, the best way to prevent any issues is to review your medication list with your healthcare team before you start receiving it. Be sure to include any OTC medications, vitamins, and supplements. And let your prescriber know if you begin taking another medication after you start Skyrizi.

The most common signs of a Skyrizi interaction are infections or an increase in your condition’s symptoms. So it’s best to let your prescriber know if you notice any changes in how you’re feeling. They’ll be able to determine if an interaction is the cause. 

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Written by:

Emilie White, PharmD

Emilie White is a clinical pharmacist with over a decade of hospital pharmacy experience. Her professional areas of interest include critical care as well as infectious and autoimmune diseases.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed 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.

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