ustekinumab
Stelara (ustekinumab) is an injectable medication used to treat autoimmune conditions like plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. As an interleukin antagonist, it works by blocking certain proteins that cause inflammation in your body, which helps reduce swelling and ease symptoms. You typically get it as an injection under your skin. Common side effects include common cold symptoms, headache, and feeling tired. This medication also has many biosimilars available.
What is Stelara (ustekinumab)?
What is Stelara (ustekinumab) used for?
Moderate-to-severe plaque psoriasis (Ps) - adults and children 6 years and older
Psoriatic arthritis (PsA) - adults and children 6 years and older
Moderate-to-severe Crohn's disease (CD) - adults only
Moderate-to-severe ulcerative colitis (UC) - adults only
How Stelara (ustekinumab) works
Stelara (ustekinumab) is an interleukin antagonist. It works by blocking two proteins in your immune system — interleukin-12 (IL-12) and interleukin-23 (IL-23) — that play a major role in inflammation. By targeting these proteins, the medication helps to lower inflammation and relieve symptoms from autoimmune conditions.
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What are the side effects of Stelara (ustekinumab)?
Common Side Effects
- Common cold symptoms (7-8%)
- Upper respiratory tract infection (4-5%)
- Headache (5%)
- Joint pain (3%)
- Nausea (3%)
- Common cold symptoms (11%)
- Redness at the injection site (5%)
- Yeast infection (5%)
- Bronchitis (5%)
- Common cold symptoms (24%)
- Headache (10%)
- Stomach pain (7%)
- Flu infection (6%)
- Fever (5%)
Other Side Effects
- Dizziness
- Diarrhea
- Back pain
- Muscle pain
- Depression
- Sore throat
- Itchiness
- Vomiting
Serious Side Effects
- Serious infection: fever, muscle aches, cough, trouble breathing, weight loss, sores on the body, diarrhea, stomach pain, problems with urination, tiredness
- Severe allergic reaction: feeling faint, facial swelling, chest tightness, rash
- Brain condition: headache, confusion, vision problems, seizures
- Lung conditions: trouble breathing, cough
Source: DailyMed
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The following 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
- Change in your skin, such as a new growth, a sore that doesn't heal, or a change in a mole
- Dry cough, shortness of breath or trouble breathing
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Sudden and severe headache, confusion, change in vision, seizures, which may be signs of posterior reversible encephalopathy syndrome (PRES)
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Diarrhea
- Dizziness
- Fatigue
- Headache
- Pain, redness, or irritation at injection site
- Runny or stuffy nose
- Sore throat
Pros and cons of Stelara (ustekinumab)
Pros
After the first few doses, only need a shot every 8 to 12 weeks
Available as a prefilled syringe or vial
Syringes can be stored at room temperature for up to 30 days
Approved for children as young as 6 years old
Cons
Can weaken your immune system and raise your risk of infection
Potential to cause serious allergic reactions
For CD and UC, the first dose must be given as an IV infusion
Can't receive live vaccines while taking this medication
Pharmacist tips for Stelara (ustekinumab)
Mark your injection dates on a calendar. You don’t use Stelara (ustekinumab) very often, so it can be easy to forget. Keeping track helps you stay on schedule.
Inject Stelara (ustekinumab) under the skin in your upper arms, thighs, buttocks, or stomach area. Pick a new spot each time to avoid skin irritation. Don’t inject into skin that’s red, bruised, sore, or hard.
Get medical help right away if you have signs of a serious allergic reaction after using Stelara (ustekinumab). These might include swelling of the face or throat, trouble breathing, or a rash.
Tell your prescriber if you have a latex allergy. The needle cover of the Stelara (ustekinumab) prefilled syringe contains latex which could cause a reaction if you're sensitive to it.
Stelara (ustekinumab) can weaken your immune system, making it harder to fight infections. Let your prescriber know if you have symptoms of an infection, such as a fever, cough, tiredness, muscle aches, or stomach pain.
Contact your care team right away if you notice symptoms like headache, confusion, vision problems, or seizures. These could be signs of a rare brain condition linked to Stelara (ustekinumab).
Stelara (ustekinumab) can affect how your body responds to vaccines. Avoid live vaccines during treatment. Talk to your prescriber before getting any type of vaccine.
Store Stelara (ustekinumab) in its original carton in the refrigerator. If you're using the prefilled syringes, you can keep them at room temperature (up to 30°C or 86°F) for up to 30 days, but don’t put them back once they've been out of the fridge. If you’re using a vial, it should stay refrigerated until it’s time for your dose.
How to inject Stelara (ustekinumab) from a prefilled syringe:
Make sure you know how to inject Stelara (ustekinumab) the right way. Ask your prescriber or pharmacist if you have questions.
Clean the spot on your skin with an alcohol wipe before you inject to help prevent infection.
When you're ready to inject, take off the needle cover from the syringe. Hold the syringe with one hand and pinch the cleaned skin with the other.
Insert the needle into the pinched skin at about a 45-degree angle and push the plunger down with your thumb until all the liquid is injected. Then take out the needle and let go of your skin.
Put the syringe into a sharps container. Never throw used syringes into the regular trash since it could harm someone.
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Frequently asked questions about Stelara (ustekinumab)
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What are the risks and warnings for Stelara (ustekinumab)?
Stelara (ustekinumab) 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.
Infections
Risk factors: Active, chronic, or recurrent infection | People with certain genetic mutations | Taking other medications that weaken your immune system
Stelara (ustekinumab) can raise your risk of infections, including serious ones that might need hospital care. These can be caused by bacteria, viruses, or fungi. Tell your prescriber about your medical history before starting Stelara (ustekinumab), especially if you've ever had tuberculosis (TB). Let your care team know right away if you have signs of infection, such as fever, chills, cough, or tiredness — your treatment might need to be paused until you recover.
Cancers
Risk factors: Older adults | Taking other medications that weaken your immune system | History of skin cancer
Stelara (ustekinumab) weakens your immune system and can raise your risk of certain cancers. Some people developed skin cancer while taking this medication, especially those with a higher risk. Your care team will check your skin regularly during treatment, particularly if you have a history of cancer or other risk factors. Let your prescriber know if you’ve had cancer before or if you notice any new or changing spots on your skin.
Severe allergic reaction
Serious allergic reactions, including anaphylaxis and angioedema, have been reported with Stelara (ustekinumab). If you have a severe reaction, your care team will stop the medication and treat you right away. Get medical help immediately if you have symptoms like trouble breathing, swelling of your face or throat, or a serious rash.
Brain condition
Rare cases of a brain condition called posterior reversible encephalopathy syndrome (PRES) have been reported in people taking Stelara (ustekinumab). Symptoms can include headache, seizures, confusion, or vision changes. These symptoms can appear anywhere from a few days to months after starting the medication, sometimes even after a year or more. If you have PRES, your care team will stop the medication and provide treatment. Let your prescriber know right away if you notice any of these signs.
Vaccines
Before starting Stelara (ustekinumab), you or your child should be up to date on all recommended vaccines. While you're being treated, avoid getting live vaccines. You should also avoid the BCG vaccine during treatment, as well as for one year before starting and one year after stopping the medication. Be careful if someone in your household gets a live vaccine since it can spread and pose a risk to you. Non-live vaccines are generally safe, but they might not work as well while you're taking Stelara (ustekinumab). Check with your care team before getting any vaccines during treatment.
Lung problems
Different types of pneumonia have been reported in people taking Stelara (ustekinumab), and in some cases, these conditions were serious. Symptoms can include cough and trouble breathing. Let your care team know right away if you have new or worsening breathing problems. You might have to stop taking the medication and receive the appropriate treatment.
Stelara (ustekinumab) dosage forms
Typical dosing for Stelara (ustekinumab)
Plaque psoriasis
Adults:
Weight 220 lbs or less: The typical dose is 45 mg injected under the skin once, then another 45 mg four weeks later. After the second dose, 45 mg is injected every 12 weeks.
Weight more than 220 lbs: The typical dose is 90 mg injected under the skin once, then another 90 mg four weeks later. After the second dose, 90 mg is injected every 12 weeks.
Children ages 6 and older:
Weight less than 132 lbs: The typical dose is 0.75 mg/kg of body weight injected under the skin once, then another 0.75 mg/kg four weeks later. After the second dose, 0.75 mg/kg is injected every 12 weeks.
Weight of 132 lbs to 220 lbs: The typical dose is 45 mg injected under the skin once, then another 45 mg four weeks later. After the second dose, 45 mg is injected every 12 weeks.
Weight more than 220 lbs: The typical dose is 90 mg injected under the skin once, then another 90 mg four weeks later. After the second dose, 90 mg is injected every 12 weeks.
Psoriatic arthritis
Adults:
Psoriatic arthritis only: The typical dose is 45 mg injected under the skin once, then another 45 mg four weeks later. After the second dose, 45 mg is injected every 12 weeks.
Psoriatic arthritis with plaque psoriasis and weighing more than 220 lbs: The typical dose is 90 mg injected under the skin once, then another 90 mg four weeks later. After the second dose, 90 mg is injected every 12 weeks.
Children ages 6 and older:
Weight less than 132 lbs: The typical dose is 0.75 mg/kg of body weight injected under the skin once, then another 0.75 mg/kg four weeks later. After the second dose, 0.75 mg/kg is injected every 12 weeks.
Weight of 132 lbs or more: The typical dose is 45 mg injected under the skin once, then another 45 mg four weeks later. After the second dose, 45 mg is injected every 12 weeks.
Psoriatic arthritis with plaque psoriasis and weighing more than 220 lbs: The typical dose is 90 mg injected under the skin once, then another 90 mg four weeks later. After the second dose, 90 mg is injected every 12 weeks.
Crohn's disease and ulcerative colitis:
Adults:
Weight less than 121 lbs: The typical dose is 260 mg infusion into the veins once, then 90 mg injected under the skin every 8 weeks.
Weight of 121 lbs to 187 lbs: The typical dose is 390 mg infusion into the veins once, then 90 mg injected under the skin every 8 weeks.
Weight more than 187 lbs: The typical dose is 520 mg infusion into the veins once, then 90 mg injected under the skin every 8 weeks.
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How much does Stelara (ustekinumab) cost?
What are alternatives to Stelara (ustekinumab)?
Moderate-to-severe plaque psoriasis (Ps) - adults and children 6 years and older
Psoriatic arthritis (PsA) - adults and children 6 years and older
Moderate-to-severe Crohn's disease (CD) - adults only
Moderate-to-severe ulcerative colitis (UC) - adults only
Rheumatoid arthritis (RA) - adults only
Juvenile idiopathic arthritis (JIA) - people age 2 and older
Psoriatic arthritis (PsA) - adults only
Ankylosing spondylitis (AS) - adults only
Crohn's disease (CD) - people age 6 and older
Ulcerative colitis (UC) - people age 5 and older
Plaque psoriasis - adults only
Hidradenitis suppurativa (HS) - people age 12 and older
Uveitis - people age 2 and older
Moderate-to-severe plaque psoriasis in adults
Psoriatic arthritis in adults
Moderate-to-severe Crohn's disease in adults
Moderate-to-severe ulcerative colitis in adults
What is the latest news about Stelara (ustekinumab)?
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References
Best studies we foundAggeletopoulou, I., et al. (2018). Interleukin 12/interleukin 23 pathway: Biological basis and therapeutic effect in patients with Crohn's disease. World Journal of Gastroenterology.
American College of Allergy, Asthma & Immunology. (n.d.). Latex allergy.
Feagan, B. G., et al. (2016). Ustekinumab as induction and maintenance therapy for Crohn’s disease. The New England Journal of Medicine.
Janssen Biotech, Inc. (2025). Stelara- ustekinumab injection, solution [package insert]. DailyMed.
Memon, R. J., et al. (2023). Angioedema. StatPearls.
Mishra, A., et al. (2018). Posterior Reversible Encephalopathy Syndrome following Ustekinumab Induction for Crohn's Disease. Case Reports in Gastroenterology.
Sands, B. E., et al. (2019). Ustekinumab as induction and maintenance therapy for ulcerative colitis. The New England Journal of Medicine.
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