Key takeaways:
Stelara (ustekinumab) is an injectable medication that treats psoriasis, psoriatic arthritis, and inflammatory bowel disease. It’s safe to take with most medications, but has a few interactions to consider.
Stelara can weaken your immune system, so you shouldn’t receive live vaccines while you’re using it. And it can make allergy shots or immunotherapy tablets less effective. It’s also best to avoid combining it with other immunosuppressant medications unless your prescriber tells you to.
Avoid or limit alcohol, inflammatory foods, and raw or unpasteurized products while using Stelara. And check with your healthcare team before taking any over-the-counter herbs or supplements.
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Stelara (ustekinumab) is 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.
Stelara interactions at a glance
Stelara can interact with:
Live vaccines, such as the nasal flu vaccine (FluMist)
Allergy shots
Immunosuppressants (medications that can weaken the immune system), such as cyclosporine (Sandimmune, Neoral)
Supplements that affect the immune system, such as echinacea
Raw or unpasteurized foods and foods that increase inflammation
Let’s take a look at these five Stelara interactions in greater detail.
1. Live vaccines
Vaccines teach the body how to defend against an infection. Most vaccines contain an inactive (dead) 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
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 prescriber before you receive it.
2. 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)
Anti-rejection transplant medications, such as cyclosporine
Some chemotherapy medications, such as paclitaxel
Stelara (ustekinumab) dosages: Learn more about recommended Stelara dosages by health condition and how often you’ll receive the medication.
Stelara side effects: Review these possible Stelara side effects and what to do if they occur.
Skyrizi (risankizumab) vs. Stelara: Here’s how these two psoriasis treatments compare.
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 prescriber 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 prescriber know if you develop any signs and symptoms of an infection. These can include a fever, persistent cough, or trouble breathing. Prompt treatment can help prevent more serious infections from developing.
3. 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 healthcare professional that treats your allergies is aware you’re using Stelara.
4. Certain foods
Stelara doesn’t interact with any foods directly. But there are two types of foods that you should avoid or limit while taking it:
Raw meat or unpasteurized foods. Since Stelara weakens your immune system, you could be at a higher risk of infection if you consume raw or undercooked foods.
Foods that increase inflammation. Processed foods, trans-fats, and high-sodium foods can all worsen inflammation. Alcohol can also have this effect. This could make it harder for Stelara to treat your autoimmune condition.
5. Certain supplements
It’s a good idea to talk to your healthcare team before taking any over-the-counter herbs or supplements with Stelara. Many of the ingredients in these items can affect your immune system. This could worsen your underlying condition or increase your risk of infection while you’re receiving Stelara.
Supplements that can affect your immune system include:
Alfalfa
Spirulina
Elderberry
Frequently asked questions
Yes, it should be fine to use Ozempic (semaglutide) and Stelara at the same time. There isn’t an interaction between the two medications. But both medications can cause nausea, diarrhea, and fatigue. So these side effects may be more severe if you’re using them at the same time. Talk to your prescriber about spacing your doses apart from one another to help reduce the chance of side effects.
You should only take prednisone and Stelara together if your prescriber recommends it. Both medications can raise your risk of infections. So the combination can increase this risk. But in some cases, your prescriber may recommend taking prednisone with Stelara to help manage your autoimmune condition. Just be sure to report any signs or symptoms of an infection to your healthcare team if they occur.
It’s best to avoid or limit alcohol while you’re using Stelara. Alcohol doesn’t interact with Stelara directly. But it can worsen inflammation, which could make it harder for Stelara to manage your autoimmune condition. Your healthcare team can provide guidance on how much, if any, alcohol is safe for you based on your personal history.
Yes, it should be fine to use Ozempic (semaglutide) and Stelara at the same time. There isn’t an interaction between the two medications. But both medications can cause nausea, diarrhea, and fatigue. So these side effects may be more severe if you’re using them at the same time. Talk to your prescriber about spacing your doses apart from one another to help reduce the chance of side effects.
You should only take prednisone and Stelara together if your prescriber recommends it. Both medications can raise your risk of infections. So the combination can increase this risk. But in some cases, your prescriber may recommend taking prednisone with Stelara to help manage your autoimmune condition. Just be sure to report any signs or symptoms of an infection to your healthcare team if they occur.
It’s best to avoid or limit alcohol while you’re using Stelara. Alcohol doesn’t interact with Stelara directly. But it can worsen inflammation, which could make it harder for Stelara to manage your autoimmune condition. Your healthcare team can provide guidance on how much, if any, alcohol is safe for you based on your personal history.
The bottom line
Stelara (ustekinumab) is an injectable medication that treats certain autoimmune conditions. Stelara can increase your risk of infections, so it’s best to avoid live vaccines while you’re using it. And you shouldn’t combine Stelara with other immunosuppressant medications unless your prescriber tells you to. Stelara can also lower your tolerance to allergy shots or immunotherapy tablets.
It’s best to avoid or limit alcohol, inflammatory foods, and raw or unpasteurized products while using Stelara. And check with your healthcare team before taking any over-the-counter herbs or supplements.
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References
American College of Allergy, Asthma, & Immunology. (n.d.). Allergy immunotherapy.
Faden, D. F., et al. (2024). Prevalence and risk of immunostimulatory herbal supplement treatment among autoimmune dermatology patients. ACR Open Rheumatology.
Heinecke, G. M., et al. (2013). Combination use of ustekinumab with other systemic therapies: A retrospective study in a tertiary referral center. Journal of Drugs in Dermatology.
Janssen Biotech. (2025). Stelara- ustekinumab injection, solution, Stelara- ustekinumab solution [package insert].
Lee, A. N., et al. (2004). Activation of autoimmunity following use of immunostimulatory herbal supplements. JAMA Dermatology.
Ravishankar, A., et al. (2022). Frequency of immunostimulatory herbal supplement use among patients with autoimmune skin disease. Journal of the American Academy of Dermatology.
U.S. Department of Health and Human Services. (2022). Vaccine types.
