Rinvoq Interactions: Alcohol, Medications, and Others

Key takeaways

• Rinvoq can interact with a variety of medications, including other immunosuppressants, some antibiotics, and corticosteroids.
• Certain conditions or health factors may raise the likelihood of interactions with Rinvoq, such as infections, a history of cancer, or liver and kidney disease.
• Grapefruit and St. John’s wort can alter how your body metabolizes Rinvoq.

Rinvoq is prescribed to manage particular autoimmune disorders. Autoimmune diseases happen when the immune system mistakenly attacks healthy body tissues. Rinvoq is approved for use in some adults to treat:

• rheumatoid arthritis
• psoriatic arthritis
• ankylosing spondylitis
• non-radiographic axial spondyloarthritis
• atopic dermatitis (a form of eczema)
• ulcerative colitis
• Crohn’s disease
• giant cell arteritis

Rinvoq is also used in certain pediatric patients for:

• atopic dermatitis
• psoriatic arthritis
• polyarticular juvenile idiopathic arthritis

The active compound in Rinvoq is upadacitinib. It’s available in two formulations, which share the same interaction profile:

• an extended-release oral tablet that releases the drug slowly over time
• an oral solution marketed as Rinvoq LQ, typically used for some children

Rinvoq and Rinvoq LQ are not interchangeable. For details about the differences, consult your clinician.

An interaction happens when one substance changes the effect of another, or when your medical conditions alter how a drug works. Read on to learn about possible interactions with Rinvoq.

Does Rinvoq interact with other drugs?

Rinvoq can interact with certain medications.

Before you begin Rinvoq, tell your prescriber and pharmacist about all prescription, nonprescription, and other medicines you use. Sharing this information helps reduce the risk of interactions. (See the “Are there other interactions with Rinvoq?” section for information on herbs, vitamins, and supplements.)

If you’re concerned about medication interactions that may affect you, speak with your doctor or pharmacist.

The table below lists drugs and groups that can interact with Rinvoq. This list doesn’t include every possible interaction. See the “Drug interactions explained” section for more detail on some of these.

Drug interactions explained

Below are further details about key drug interactions with Rinvoq.

Interaction with biologic immunomodulators

Rinvoq can interact with biologic immunomodulators, which are treatments for some of the same autoimmune illnesses as Rinvoq. (Biologics are medications made from living cells; immunomodulators affect the immune system.)

Examples of biologic immunomodulators include:

• abatacept (Orencia)
• adalimumab (Humira)
• infliximab (Remicade)

What could happen

Both Rinvoq and biologic immunomodulators raise infection risk. Using them together can further increase that risk.

If you have diabetes, chronic lung disease, HIV, or a weakened immune system, combining Rinvoq with a biologic may raise your infection risk even more.

What you can do

Your prescriber will usually avoid giving Rinvoq with a biologic immunomodulator. If both are used, report any infection signs—such as fever, cough, or sore throat—to your clinician right away.

Ask your doctor or pharmacist if you have concerns about using Rinvoq with a biologic immunomodulator.

Interaction with corticosteroids

Rinvoq may interact with corticosteroids (steroids), which reduce inflammation and are used in some of the same conditions as Rinvoq, including rheumatoid arthritis, ulcerative colitis, and psoriatic arthritis.

Examples of corticosteroids include:

• methylprednisolone (Medrol)
• prednisolone
• prednisone

What could happen

Rinvoq and corticosteroids can both sometimes lead to tears in the stomach or intestinal lining. Taking them together can elevate that risk.

If you have a history of diverticulitis or stomach/intestine ulcers, your risk of this complication may be higher when combining Rinvoq with a corticosteroid. NSAID use (for example, ibuprofen) can further increase this risk.

What you can do

If you take Rinvoq with a corticosteroid like prednisone, contact your doctor promptly if you develop symptoms suggesting a gastrointestinal tear, such as new belly pain, fever, chills, nausea, or vomiting.

Speak with your clinician or pharmacist if you have questions about using Rinvoq with a corticosteroid.

Interaction with certain antibiotics

Rinvoq can interact with some antibiotics used to treat bacterial infections.

Examples include:

• clarithromycin
• erythromycin (Ery-Tab)
• rifampin (Rifadin, Rimactane)

What could happen

Antibiotics such as clarithromycin and erythromycin can slow the breakdown of Rinvoq, causing it to accumulate and increasing the chance of side effects.

If you have liver or kidney impairment, your risk of adverse effects may be higher when Rinvoq is combined with one of these antibiotics.

Other antibiotics, like rifampin, can speed up Rinvoq metabolism, potentially reducing its effectiveness.

What you can do

Doctors will usually avoid prescribing certain antibiotics with Rinvoq. If you must take clarithromycin or erythromycin while on Rinvoq, your clinician may lower your Rinvoq dose or ask you to stop Rinvoq temporarily until the infection is treated. Never take higher doses than prescribed.

Ask your healthcare provider or pharmacist if you’re unsure about taking antibiotics with Rinvoq.

When should I avoid Rinvoq?

Some health conditions or factors increase the danger of harm from Rinvoq. These are contraindications, and in such cases your clinician may not recommend Rinvoq.

The primary contraindication for Rinvoq is an allergic reaction.

If you’ve had an allergic response to Rinvoq or any ingredient in the product, your clinician will likely avoid prescribing it. Ask about alternative therapies that may be safer for you.

Does Rinvoq interact with alcohol?

Rinvoq isn’t known to interact directly with alcohol. However, both alcohol and Rinvoq can cause overlapping side effects like nausea and liver injury. Drinking alcohol while taking Rinvoq could raise your risk of these issues.

If you have concerns about alcohol use during Rinvoq treatment, discuss them with your doctor or pharmacist.

Are there other interactions with Rinvoq?

Rinvoq may interact with supplements, foods, vaccines, or laboratory tests. The sections below cover some examples but aren’t exhaustive.

Does Rinvoq interact with supplements?

Before starting Rinvoq, tell your prescriber and pharmacist about any herbal remedies, vitamins, or supplements you use to help avoid potential interactions.

Ask your healthcare team if you’re unsure whether a supplement could interact with Rinvoq.

Rinvoq interactions with herbs

St. John’s wort, an herb some people use for depression, can speed up the breakdown of Rinvoq. This may make Rinvoq less effective. Your doctor will likely tell you to avoid St. John’s wort while on Rinvoq.

Rinvoq and vitamins

There are currently no documented interactions between Rinvoq and vitamins. That said, new interactions could be identified later, so check with your clinician or pharmacist before combining vitamins with Rinvoq.

Does Rinvoq interact with food?

Grapefruit and grapefruit juice can interfere with how your body metabolizes Rinvoq, slowing its breakdown and letting the drug accumulate. This raises the chance of side effects.

Your clinician will probably advise against consuming grapefruit products while taking Rinvoq.

If you have questions about other foods, consult your pharmacist or doctor.

Does Rinvoq interact with vaccines?

Avoid live vaccines shortly before starting Rinvoq and during treatment. Live vaccines contain weakened forms of the organisms they protect against, and receiving one while immunomodulated by Rinvoq can increase infection risk.

Examples of live vaccines include MMR (measles, mumps, rubella), rotavirus, chickenpox, and the nasal spray influenza vaccine. Discuss vaccination plans with your doctor to ensure safety.

Does Rinvoq interact with lab tests?

There are currently no reports of Rinvoq affecting lab tests. If you have concerns about specific tests while on Rinvoq, ask the healthcare professional ordering the test.

Does Rinvoq interact with cannabis or CBD? There are no current reports of interactions between Rinvoq and cannabis (marijuana) or cannabis-derived products like cannabidiol (CBD). However, as with any substance, consult your doctor before using cannabis while taking Rinvoq. Note: cannabis is still illegal federally, though laws vary by state.

Does my health history affect whether I should take Rinvoq?

Certain medical histories or health factors can increase the risk of interactions with Rinvoq. Discuss your medical background with your clinician before starting Rinvoq so they can decide if it’s appropriate for you.

Conditions and factors that may interact with Rinvoq include:

Infection: Rinvoq carries a boxed warning for serious, sometimes life-threatening infections. Your risk is higher if you have diabetes, chronic lung disease, HIV, or an impaired immune system. Tell your doctor about any active, recurrent, or past serious infections (for example, TB, hepatitis B, or hepatitis C). Your clinician may test for these infections and treat them before starting Rinvoq, and may recommend vaccinations.

Cancer: Rinvoq has a boxed warning about the potential risk of malignancies, including lymphoma, lung cancer, and skin cancer. If you’ve had cancer or are a current or former smoker, your cancer risk may be higher. Discuss the risks and benefits with your doctor.

Cardiovascular risk factors: There are boxed warnings for blood clots and cardiovascular events (such as heart attack and stroke). Age 50 or older and risk factors like smoking, obesity, high cholesterol, high blood pressure, and diabetes can raise your risk. Your clinician will evaluate cardiovascular risk before prescribing Rinvoq.

Diverticulitis or stomach ulcers: Rinvoq can occasionally cause tears in the stomach or intestinal lining. If you’ve had diverticulitis or ulcers, your risk may be increased. Talk with your doctor about suitability.

Conditions that shorten digestion time: Rinvoq tablets are extended-release. If you have a condition that shortens transit time (for example, a colostomy), the tablet may pass before fully releasing the medication, reducing effectiveness. Your doctor will monitor treatment response. If you frequently notice whole tablets or fragments in your stool, inform your clinician.

Low red or white blood cell counts: Rinvoq can worsen low blood cell counts. Your provider will probably monitor your blood work during treatment.

Liver problems: If you have liver disease, Rinvoq may worsen it. Clinicians typically monitor liver function while you’re taking the drug. Severe liver impairment may preclude Rinvoq use because the medication could accumulate and increase side-effect risk.

Kidney problems: Severe kidney impairment, such as renal failure, can cause Rinvoq to build up, raising side-effect risk. Your provider may prescribe a lower dose in this situation.

Pregnancy: Rinvoq is not safe during pregnancy; it can harm a developing fetus. If you’re pregnant or planning pregnancy, discuss other treatment options. If you can become pregnant, use effective contraception while taking Rinvoq and for 4 weeks after the final dose.

Breastfeeding: It’s unknown whether Rinvoq is safe during breastfeeding. The drug may pass into breast milk and affect a nursing infant. If you’re breastfeeding or plan to, talk with your doctor. They will likely advise against breastfeeding while on Rinvoq and for 6 days after the last dose.

Allergic reaction: A prior allergic reaction to Rinvoq or any ingredient is a contraindication. Ask your clinician about alternative therapies if you’ve had an allergy.

How can I prevent interactions?

You can take steps to lower the chance of interactions with Rinvoq. Before starting treatment, discuss the following with your doctor and pharmacist:

• Your use of alcohol and cannabis.
• All other medicines you take, including vitamins, herbs, and supplements. Your clinician or pharmacist can help you prepare a complete medication list.
• What to do if you begin a new medication while on Rinvoq.

Also review Rinvoq’s labeling and patient materials. Labels often include colored stickers about interactions, and the patient information leaflet (medication guide) contains important interaction details. If you didn’t receive these materials, ask your pharmacist for a copy.

If you have trouble reading or understanding the materials, your doctor or pharmacist can explain them.

Finally, take Rinvoq exactly as prescribed to help minimize interaction risks.

Disclaimer: Every effort has been made to ensure the accuracy and timeliness of the information in this article. However, it is not a substitute for professional medical advice. Always consult a licensed healthcare provider before starting or changing medications. Drug information may change, and this piece does not cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings does not mean a drug or combination is safe or appropriate for everyone.