Xeljanz interactions: Alcohol, medications, and other factors

Before you start treatment with Xeljanz, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Xeljanz interacts with supplements, herbs, or vitamins, see the “Xeljanz and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Xeljanz. Keep in mind that this table doesn’t include all drugs that may interact with Xeljanz. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* To learn about the side effects of Xeljanz, see this article.

There are no known interactions between Xeljanz and alcohol.

If you have questions about drinking alcohol while taking Xeljanz, talk with your doctor or pharmacist.

Here’s a closer look at certain drug interactions of Xeljanz.

Immunosuppressants

Immunosuppressants can be prescribed to treat autoimmune conditions such as rheumatoid arthritis (RA). They’re also prescribed to make the body less likely to reject a transplanted organ such as a kidney.

Interaction result. Taking Xeljanz with an immunosuppressant can increase your risk of side effects from either treatment. To learn about the side effects of Xeljanz, see this article.

Interaction explained. Both Xeljanz and immunosuppressants can lower the ability of your immune system to protect you against infection. When taken alone, either drug can increase your risk of serious infection. Taking these drugs together can further increase this risk.

In fact, Xeljanz has a boxed warning about the risk of serious infection. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warnings” at the beginning of this article.

Examples of immunosuppressants. Here are some immunosuppressants that may interact with Xeljanz:

• azathioprine (Azasan, Imuran)
• tacrolimus (Astagraf XL, Envarsus XR, Prograf)
• cyclosporine (Gengraf, Neoral, Sandimmune)

Steps you or your doctor may take. Before taking Xeljanz, tell your doctor about any immunosuppressants you take. They likely won’t prescribe these drugs together. Since Xeljanz and immunosuppressants are often prescribed for similar conditions, your doctor can recommend the one that’s right for you.

To learn more about Xeljanz and immunosuppressants, talk with your doctor or pharmacist.

Biologic disease-modifying antirheumatic drugs

Biologic disease-modifying antirheumatic drugs (DMARDs) are prescribed to treat autoimmune conditions such as RA. (Biologic drugs are made in a lab from living cells.)

Interaction result. Taking Xeljanz with a biologic DMARD can increase the risk of side effects from either drug. To learn about the side effects of Xeljanz, see this article.

Interaction explained. Both Xeljanz and biologic DMARDs can lower your immune system’s ability to protect you against infection. Taking either drug alone may lead to serious infection such as pneumonia. But taking these medications together can raise your risk of serious infection even more.

Keep in mind that Xeljanz has a boxed warning about the risk of serious infection. A boxed warning is the most serious warning from the FDA. For more information, see “Boxed warnings” at the beginning of this article.

Examples of biologic DMARDs. Here are some biologic DMARDs that may interact with Xeljanz:

• adalimumab (Humira)
• golimumab (Simponi and Simponi Aria)
• infliximab (Remicade)

Steps you or your doctor may take. Before starting Xeljanz treatment, tell your doctor if you take a biologic DMARD. They likely won’t prescribe these medications together. Since Xeljanz and biologic DMARDs are prescribed for similar conditions, your doctor can recommend the right drug for your condition.

To learn more about Xeljanz and biologic DMARDs, talk with your doctor or pharmacist.

Certain antidepressants

Antidepressants are prescribed to treat certain mental health conditions, including depression and anxiety.

Interaction result. Taking Xeljanz with certain antidepressants can increase your risk of side effects from Xeljanz. To learn about the side effects of Xeljanz, see this article.

Interaction explained. Xeljanz is broken down in the body by a certain enzyme. (An enzyme is a type of protein.) Certain antidepressants slow the activity of this enzyme. So taking Xeljanz with these drugs could raise the level of Xeljanz in your body. This can increase your risk of side effects from Xeljanz.

Examples of antidepressant drugs. Here are some antidepressants that may interact with Xeljanz:

• fluoxetine (Prozac)
• fluvoxamine (Luvox)
• nefazodone

Steps you or your doctor may take. Before starting Xeljanz treatment, tell your doctor if you’re taking an antidepressant. They can recommend whether it’s safe to take Xeljanz with it.

In some cases, your doctor may still prescribe Xeljanz with an antidepressant it interacts with. If so, they may give you a lower dosage of Xeljanz than is typical. Doing so can help lower your risk of side effects from the drug. To learn about the dosage of Xeljanz, see this article.

If you have other questions about Xeljanz and certain antidepressants, talk with your doctor or pharmacist.

Xeljanz may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Xeljanz.

Xeljanz interactions with supplements

Before you start treatment with Xeljanz, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Xeljanz interactions with herbs

Xeljanz has been reported to interact with St. John’s wort. This herb is used to ease symptoms of certain conditions, including depression.

If you take Xeljanz with St. John’s wort, your body may break down Xeljanz faster than is typical. This can lower the level of Xeljanz in your body, making the drug less effective. Due to this risk, your doctor may recommend avoiding St. John’s wort during Xeljanz treatment.

Be sure to talk with your doctor or pharmacist before taking any herbal supplements with Xeljanz.

Xeljanz and vitamins

There are no specific reports of vitamins interacting with Xeljanz. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, talk with your doctor or pharmacist before taking any vitamin product with Xeljanz.

Xeljanz food interactions

Xeljanz has been reported to interact with certain foods. These include grapefruit and grapefruit juice.

If you take Xeljanz with grapefruit products, your body may not break down Xeljanz as well as it should. This can raise the level of Xeljanz in your body, increasing your risk of side effects from the drug. To learn about the side effects of Xeljanz, see this article.

Due to this risk, your doctor may recommend avoiding grapefruit products during Xeljanz treatment.

If you have questions about Xeljanz interactions with food, talk with your doctor for more information.

Xeljanz interactions with vaccines

Xeljanz has been reported to interact with certain vaccines. These include live vaccines and vaccines for COVID-19 (Comirnaty, Spikevax) and cholera (Vaxchora). Live vaccines contain a weakened form of the bacterium or virus they’re meant to protect against.

Examples of live vaccines include:

• nasal spray version of the flu vaccine (FluMist)
• chickenpox
• yellow fever
• measles, mumps, rubella (MMR)

Live vaccines typically won’t cause infection in people with a healthy immune system. However, Xeljanz treatment may weaken your immune system. As a result, receiving a live vaccine during Xeljanz treatment may make the vaccine less effective. This can increase your risk of getting the infection the vaccine is meant to protect against.

Vaccines for cholera and COVID-19 aren’t live vaccines. But it’s still been reported that taking Xeljanz can lessen your body’s response to the vaccine.

Due to these risks, talk with your doctor about your vaccine needs before starting Xeljanz. They’ll typically recommend getting any live vaccines and vaccines for COVID-19 or cholera before starting Xeljanz. Your doctor can also tell you whether it’s safe to receive any other vaccines during Xeljanz treatment.

If you have questions about vaccines and Xeljanz, talk with your doctor or pharmacist.

Xeljanz and lab tests

There are no specific reports of lab tests interacting with Xeljanz. To learn more about getting certain lab tests while taking Xeljanz, talk with your doctor.

XELJANZ AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Xeljanz. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Xeljanz. The impact of cannabis may affect how well you stick to your Xeljanz treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Xeljanz. Before you take this drug, be sure to talk with your doctor about your health history. Xeljanz may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Xeljanz include:

Active infection. Before starting Xeljanz treatment, tell your doctor if you have an infection that’s causing symptoms. Taking Xeljanz may worsen your infection. The drug has a boxed warning about this risk.* Your doctor will treat the infection first before you start Xeljanz.

Low white blood cell level. Before starting Xeljanz treatment, your doctor may check your white blood cell level with a blood test. (White blood cells are part of your immune system.) If they find you have a low level of white blood cells, they may not prescribe Xeljanz. This is because having a low white blood cell level could increase your risk of serious infection. Xeljanz has a boxed warning about this risk.*

Heart-related risk factors. Before taking Xeljanz, talk with your doctor about any heart-related risk factors you may have. Examples include high blood pressure and smoking. These risk factors may increase your risk of blood clots, cancers, and even death. Note that Xeljanz has boxed warnings about these risks.*

Digestive system problems. Taking Xeljanz may cause gastrointestinal perforations (tears in your digestive tract). In addition, the drug may worsen any digestive system conditions you already have, such as diverticulitis. Before taking Xeljanz, tell your doctor about any digestive system problems you have. They can recommend whether Xeljanz is a safe treatment option for you.

Kidney or liver problems. If you have a kidney or liver problem, tell your doctor before taking Xeljanz. Examples include kidney failure and liver failure. Your doctor may give you a lower dosage of the drug. To learn about the dosage of Xeljanz, see this article.

Pregnancy. It’s not known whether Xeljanz is safe to take while pregnant. If you’re pregnant or planning a pregnancy, talk with your doctor before you start Xeljanz treatment.

If you take Xeljanz while pregnant, consider enrolling in the drug’s pregnancy registry. This registry keeps track of pregnancy-related issues that may occur during Xeljanz treatment. To learn more, call 877-311-8972 or talk with your doctor.

Breastfeeding. Xeljanz may cause side effects in a child who is breastfed. (To learn about the side effects of Xeljanz, see this article.) It’s recommended that you avoid breastfeeding while taking Xeljanz. This includes for a certain amount of time after your last dose.

With Xeljanz oral tablet and solution, wait to breastfeed until at least 18 hours after your last dose. With Xeljanz extended-release oral tablet, you’ll wait until at least 36 hours after your last dose. (Extended release means the drug is slowly released into your body over a long period of time.)

If you’re breastfeeding or planning to do so, talk with your doctor before taking Xeljanz.

Allergic reaction. If you’ve had an allergic reaction to Xeljanz or any of its ingredients, your doctor will likely not prescribe Xeljanz. Taking the drug could cause another allergic reaction. You can ask them about other treatment options that may be better choices for you.

* A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more about Xeljanz’s warnings, see “Boxed warnings” at the top of this article.

Here are some frequently asked questions about Xeljanz and possible interactions.

Is there an interaction between Xeljanz and prednisone?

Yes, there’s an interaction between Xeljanz and prednisone (Rayos), a corticosteroid. Both Xeljanz and prednisone carry a risk of certain side effects. These include serious infection* and gastrointestinal (GI) perforations (tears in your digestive tract). Taking Xeljanz with prednisone may further increase your risk of these side effects. (To learn more about the side effects of Xeljanz, see this article.)

Both Xeljanz and prednisone are prescribed to treat autoimmune conditions. In some cases, your doctor may prescribe Xeljanz with prednisone to treat your condition. If so, they’ll monitor you closely for symptoms of serious infection and GI perforations. They can also recommend what to do if you have them. If you have other questions about Xeljanz and prednisone, talk with your doctor.

* Xeljanz has a boxed warning about this risk. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warnings” at the beginning of this article.

Can you take turmeric with Xeljanz?

Yes, you can take turmeric with Xeljanz if your doctor recommends it. Xeljanz and turmeric don’t have a known interaction.

Turmeric is a spice thought to relieve pain and inflammation, including that of rheumatoid arthritis (RA). However, it isn’t known for certain whether turmeric is effective for treating RA.

Xeljanz is approved to treat certain autoimmune conditions, including RA. Your doctor can recommend whether taking Xeljanz with turmeric may be helpful for your condition.

If you’re interested in learning more about turmeric and Xeljanz for RA, talk with your doctor.

Is it safe to take Xeljanz and omeprazole?

Yes, it should be safe to take Xeljanz with omeprazole (Prilosec). These medications aren’t known to interact with each other.

Omeprazole is a proton pump inhibitor. It’s prescribed to treat conditions such as heartburn and gastroesophageal reflux disease.

If you have other questions about taking Xeljanz with omeprazole, talk with your doctor or pharmacist.

You can take certain steps to help prevent interactions with Xeljanz. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Xeljanz label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Xeljanz doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Xeljanz by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Xeljanz. These resources might help:

• Overview of Xeljanz. For a general overview of Xeljanz, you can see this article.
• Side effects. If you’re interested in the side effects of Xeljanz, see this article. Another option is to refer to the Xeljanz prescribing information.
• Dosage specifics. To learn about the dosage of Xeljanz, see this article.
• Cost. If you’d like to learn about Xeljanz and cost, see this article.
• Facts about your condition. To learn more about your condition, see our:
  • arthritis hub and rheumatoid arthritis hub
  • lists of rheumatology and psoriatic arthritis articles
  • list of ulcerative colitis articles

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.