Live Vaccines
Contraindicated
Database
Immunosuppression — disseminated infection
Update vaccines before; avoid live vaccines during
Source: Kimi deep-research + Cla
Drug reference
Tofacitinib
Janus kinase (JAK1/JAK3) inhibitor · Immunosuppressant, Disease-modifying anti-rheumatic drug (DMARD)
Also known as Tofacitinib citrate, Xeljanz
START
RA/PsA 5 mg BID (or 11 mg XR daily); screen TB/hepatitis/lipids first
TYPICAL MAX
5 mg BID (RA/PsA); 10 mg BID UC induction only
STOP IF
Serious infection, MACE/thrombosis, malignancy, GI perforation, severe cytopenia
WATCH
TB/HBV screen pre-treatment, lipids 4–8 weeks, CBC/LFTs, infection/zoster, thrombosis (esp. ≥65/smokers)
CDSCO approvedSchedule HATC L04AF01
KDIGO 2024 + manufacturer label
- ONSET
- 11min · absorption onset
- PEAK
- 45min · Cmax
- t½
- 3h · plasma t½
- DURATION
- 12h · BID interval
EXCRETION
Hepatic CYP3A4; ~30% renal unchanged
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid — embryo-fetal toxicity in animals; effective contraception during and ≥until completion
FDA category + note
Top interactionssee all 12 →
- Live VaccinesContraindicatedDatabaseKimi deep-research + Cla
- AbemaciclibSevereDatabaseDDInter
- AcalabrutinibSevereDatabaseDDInter
- AfliberceptSevereDatabaseDDInter
Available in India
31 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
ATP-competitive inhibition of JAK1/JAK3 (and JAK2 to a lesser extent) blocking cytokine-receptor JAK-STAT signalling (IL-2/4/7/9/15/21, interferons), modulating immune/inflammatory responses.
Indications
Rheumatoid arthritis (moderate–severe, DMARD-inadequate)Psoriatic arthritisUlcerative colitisPolyarticular juvenile idiopathic arthritis; ankylosing spondylitis
Dosing
- Adult
- RA/PsA: 5 mg PO twice daily or 11 mg XR once daily. Ulcerative colitis: 10 mg BID induction (8–16 weeks) then 5 mg BID maintenance.
- Pediatric
- pJIA ≥2 years: weight-based per label.
- Renal adjustment
- Moderate–severe renal impairment: 5 mg once daily (RA/PsA).
- Hepatic adjustment
- Moderate hepatic impairment: reduce frequency (5 mg once daily). Severe: not recommended.
- Geriatric
- ≥65 years: higher infection/MACE/malignancy/VTE risk — use only if no alternative.
- Max dose
- 5 mg BID (RA/PsA); 10 mg BID (UC induction only)
Pharmacokinetics
Onset
Clinical response over weeks
Peak effect
Cmax ~0.5–1 h
Duration
BID (or XR once daily)
Half-life
~3 h
Bioavailability
~74%
Protein binding
~40%
Metabolism
Hepatic CYP3A4 (CYP2C19 minor); ~30% renal unchanged
Excretion
Renal (~30% unchanged) + hepatic metabolism
Contraindications
- Active serious infection (incl. TB)
- Severe hepatic impairment
- Concomitant strong immunosuppressants/biologic DMARDs
- Hypersensitivity to tofacitinib
Side effects
Common
Upper respiratory/nasopharyngitisHeadacheDiarrhoeaRaised LDL/cholesterolRaised transaminases
Serious
- Serious/opportunistic infections (incl. TB, herpes zoster)
- Major adverse cardiovascular events
- Malignancy (incl. lymphoma, lung cancer in smokers)
- Venous and arterial thrombosis (boxed)
- GI perforation; severe cytopenias
Pregnancy & lactation
Pregnancy
Avoid — embryo-fetal toxicity in animals; effective contraception during and ≥until completion
Lactation
Avoid breastfeeding during and for ~18 h after last dose
Drug interactions
Abemaciclib
Severe
Database
Drug interaction classified as: others
Source: DDInter
Acalabrutinib
Severe
Database
Drug interaction classified as: others
Source: DDInter
Aflibercept
Severe
Database
Drug interaction classified as: others
Source: DDInter
Aldesleukin
Severe
Database
Drug interaction classified as: others
Source: DDInter
Alefacept
Severe
Database
Drug interaction classified as: others
Source: DDInter
Alemtuzumab
Severe
Database
Drug interaction classified as: others
Source: DDInter
Altretamine
Severe
Database
Drug interaction classified as: others
Source: DDInter
Amprenavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Anakinra
Severe
Database
Drug interaction classified as: others
Source: DDInter
Antithymocyte Immunoglobulin (rabbit)
Severe
Database
Drug interaction classified as: others
Source: DDInter
Apalutamide
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Related guidelines
Ask House about Tofacitinib
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19