Rinvoq (upadacitinib)

Reviewed by: HU Medical Review Board | Last reviewed: March 2022 | Last updated: April 2022

Rinvoq (upadacitinib) is a drug that was approved for moderate to severe rheumatoid arthritis (RA) in August 2019. The drug is aimed at those who haven’t responded well to treatment withTNF inhibitors, or had no response at all to that drug.

There are a variety of drugs to help treat RA, and knowing about each drug can help empower you to discuss possible treatment options with your care team. Not every drug is right for every person with a condition, and it’s important to keep that in mind.

What are the ingredients in Rinvoq?

The active ingredient in Rinvoq is upadacitinib.1

How does Rinvoq work?

Rinvoq is a Janus kinase (JAK) inhibitor. These drugs help to block inflammation-causing enzymes called Janus kinases, reducing inflammation; this leads to symptom relief.

What are the possible side effects of Rinvoq?

If you experience significant side effects that interfere with your daily functioning or that don’t go away, call your doctor.

Common side effects seen of Rinvoq include nausea, cough, fever, and upper respiratory infections.1

Rinvoq can lower your immune system. FDA black box warning on side effects include serious infections while on the medication because of their lowered immune system, including tuberculosis (TB), thrombosis, deep vein thrombosis, pulmonary embolism, and arterial thrombosis. Black box also includes: Higher rate of MACE (defined as cardiovascular death, myocardial infarction, and stroke) with another JAK inhibitor vs. TNF blockers in RA patients.1

This medication may also increase your risk of certain cancers because of the lowered immune system effects, including lymphoma and skin cancers, among others.1 For more information on adverse effects, see the FDA black box warning for Rinvoq.

Other adverse effects can include blood clots, tears in the lining of the stomach or intestines, and changes in lab work like low white and red blood cell counts, increased cholesterol levels, and elevated liver enzymes.1 If you are taking Rinvoq, tell your doctor so they know that these changes may occur and that RInvoq may be the cause. You might also need regular blood work to monitor all of these levels.

Things to know about Rinvoq

Individuals on Rinvoq have presented with TB because of their lowered immune systems. Before going on this drug, tell your doctor if you’ve been exposed to TB recently. You will also be tested for TB before you start this medication.

If you’ve ever had a blood clot, are at higher risk for a blood clot, or have a clotting disorder, tell your doctor. Individuals on Rinvoq have had blood clots; if you’re predisposed to clots, this may not be the best medication for you.

If you have an infection, have had an infection recently, or get multiple infections, tell your doctor. Because this drug lowers your immune system, you may be more susceptible to infections while on this medication. People taking Rinvoq have had serious infections and died from them, especially if they were on other immune-suppressing drugs or steroids.2 Talk with your doctor about your history of infections and all other drugs and supplements you are taking. If you recently got a vaccine or are scheduled for vaccinations, tell your doctor, as those taking Rinvoq should not receive live vaccines.1

Those individuals who are pregnant, plan to become pregnant, or are nursing should tell their doctor. This medication may harm the fetus and is not safe to take while breastfeeding.1

Your healthcare provider should conduct blood tests before you start taking Rinvoq and while taking the medication to check:1

  • low neutrophil and lymphocyte counts
  • low red blood cell counts
  • increased cholesterol levels
  • elevated liver enzymes.

When taking Rinvoq, call your doctor if any of the following occurs. These can be signs of something serious:

  • Allergic reaction symptoms like rash, hives, itching, tightness in chest, hoarseness, swelling of mouth/face/lips/tongue, red or peeling skin
  • Signs of infection, ie, fever, chills, severe sore throat, pain with urinating, mouth sores, sinus pain, coughing
  • Weakness on one side of the body, blurry vision
  • Changes in bowel habits
  • Stomach pain that is new or worsening
  • Extreme fatigue or weakness
  • Warm, red, or painful skin or sores
  • Skin lumps
  • Swollen glands, night sweats, or weight loss
  • Chest pain or pressure, pain in a leg or arm, coughing up blood, trouble speaking or swallowing2,3

These are not all the possible side effects of Rinvoq. Patients should talk to their doctor about what to expect with treatment with Rinvoq.

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