5 Stelara Interactions to Be Aware Of

If you’re living with an autoimmune condition, your healthcare provider may prescribe Stelara (ustekinumab). It’s an injectable biologic medication approved to treat psoriasis, psoriatic arthritis, and inflammatory bowel disease.

Stelara helps decrease inflammation and prevent long-term damage from these autoimmune conditions. But like all medications, it has some interactions that are good to be aware of before you start using it. Below, we'll review five Stelara interactions you should know about.

1. Warfarin

Warfarin (Coumadin, Jantoven) is a prescription blood thinner that helps stop blood clots from forming. It’s possible that Stelara may affect your warfarin levels if you’re already taking it.

Chronic inflammation from autoimmune conditions can lower the levels of certain liver enzymes (proteins) that break down and remove warfarin in the body. Stelara helps decrease inflammation, which may, in turn, increase the levels of these liver enzymes. As liver enzyme levels go up, warfarin levels may go down. This could put you at a higher risk of unwanted blood clots.

If you’re taking warfarin, you likely have regular blood tests to measure your international normalized ratio (INR). The INR level indicates how long it takes your blood to clot. Your warfarin dosage is based on keeping your INR levels within a certain range. When you start Stelara treatment, your healthcare provider may check your INR more often than usual. This helps them keep an eye on your INR and adjust your warfarin dosage if needed.

There’s less of a concern if you start taking warfarin after you’ve started Stelara treatment. That’s because your provider will determine your warfarin dosage based on your INR levels. But if you stop using Stelara while you’re taking warfarin, it may affect your warfarin levels. So, your provider will likely measure your INR levels more often and adjust your dosage if needed.

2. Cyclosporine

Cyclosporine (Sandimmune, Neoral) is a medication that helps prevent rejection after an organ transplant. It’s also used to manage certain autoimmune conditions. Like warfarin, cyclosporine levels in the body need to be within a certain range to work properly and avoid harmful side effects. Stelara may decrease inflammation, which can increase the levels of liver enzymes that remove cyclosporine from the body. This can lead to lower cyclosporine levels.

If you take cyclosporine, your healthcare provider may check your levels more often when you first start using Stelara. They’ll adjust your cyclosporine dosage as needed based on these levels. The same applies if you stop Stelara treatment while taking cyclosporine.

3. Live vaccines

Vaccines teach the body how to defend against an infection. Most vaccines contain an inactive germ or a piece of a germ to stimulate an immune system response. But live vaccines contain a live, weakened germ. A live vaccine won’t cause an infection in most people. But if your immune system is weakened, a live vaccine could turn into a full-blown infection.

Stelara weakens your immune system, which is a good thing when treating autoimmune conditions. But it can also make it easier for you to get infections. So you shouldn’t receive live vaccines while you’re using Stelara. 

Examples of live vaccines include:

• Nasal flu vaccine (FluMist)

• Measles, mumps, and rubella (MMR, MMRV)

• Rotavirus

• Varicella (chickenpox)

• Smallpox

• Oral typhoid

• Yellow fever

Even though they’re safe to receive, non-live vaccines may not be as effective if you get them while you’re using Stelara. So, it’s best to make sure your vaccinations are up to date before starting it. If you’re unsure whether a vaccine is safe for you while you’re using Stelara, ask your pharmacist or healthcare provider before you receive it.

4. Other immunosuppressants

As mentioned, Stelara weakens your immune system. So, it increases your risk of infections while you’re using it. If you take Stelara with other medications that weaken your immune system (immunosuppressants), your infection risk could go up.

Immunosuppressants include:

• Other biologic medications, such as Enbrel (etanercept) and Remicade (infliximab)

• Corticosteroids, such as prednisone

• Methotrexate

• Imuran (azathioprine)

• Cyclosporine

• Chemotherapy medications such as paclitaxel

It’s best to avoid taking multiple medications that weaken your immune system at the same time. But if Stelara isn’t effective on its own, your provider may add another immunosuppressant medication to manage your symptoms. 

If you’re using Stelara with another medication that weakens your immune system, be sure to let your provider know if you develop any signs and symptoms of an infection. Symptoms can include a fever, persistent cough, or trouble breathing. Prompt treatment can help prevent more serious infections from developing.

5. Allergy shots

Allergy shots or immunotherapy tablets help you build up a tolerance to a substance you’re allergic to (an allergen). They start with a tiny bit of the allergen and gradually increase it to help your body get used to it.

Stelara may lower your tolerance to an allergen. So, it can increase the chance you’ll react to treatment with allergy shots or immunotherapy tablets. This could include a severe allergic reaction (anaphylaxis). So be sure the provider who treats your allergies is aware you’re using Stelara.

When should I contact my healthcare provider about a Stelara interaction?

To prevent medication interactions with Stelara, give your pharmacist and healthcare provider a list of your current medications. Make sure it also includes any over-the-counter (OTC) medications and supplements that you take regularly.

Contact your pharmacist or healthcare provider if you have any side effects that are bothersome or don’t go away. An interaction could be to blame. You shouldn’t start taking any new medications or supplements without checking to make sure they’re safe to take with Stelara first.

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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:

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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