Xeljanz Interactions: Other Medications, Alcohol, and More

Before you start taking Xeljanz, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Xeljanz interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Xeljanz?” section below.)

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

The table below lists drugs that may interact with Xeljanz. Keep in mind that this table does not include all drugs that may interact with Xeljanz. For more information about some of these interactions, see the “Drug interactions explained” section below.

Xeljanz is not known to interact with alcohol. But Xeljanz and alcohol may cause similar side effects and share certain risks. For example, both are known to cause nausea and headaches. And they can each increase the risk of certain kinds of cancer.

In addition, regular alcohol use can lead to liver problems. If you have liver problems, your doctor may prescribe a dosage of Xeljanz that’s lower than usual.

If you have questions about consuming alcohol during Xeljanz treatment, talk with your doctor or pharmacist.

Learn more about certain drug interactions that can occur with Xeljanz.

Interaction with certain antibiotics

Xeljanz can interact with certain antibiotics. Examples of antibiotics that can interact with Xeljanz include:

• clarithromycin
• erythromycin (Ery-Tab)

What could happen

Taking Xeljanz with certain antibiotics can raise your risk of experiencing side effects from Xeljanz.

Certain antibiotics can block or slow the activity of certain enzymes in your body. These enzymes help clear the drug from your body. As a result, this interaction may lead to a higher level of Xeljanz in your body and an increased risk of side effects.

What you can do

If you take Xeljanz with certain antibiotics, your doctor may prescribe a dosage of Xeljanz that’s lower than usual. You should not take a higher dose of either medication than your doctor prescribes.

If you take Xeljanz and certain antibiotics, tell your doctor right away if you have new or worsening side effects of Xeljanz. To learn more about Xeljanz’s side effects, see this article.

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

Interaction with certain seizure drugs

Xeljanz can interact with certain seizure drugs, which are prescribed to treat epilepsy and some mental health conditions.

Examples of seizure drugs that can interact with Xeljanz include:

• carbamazepine (Carbatrol, Tegretol, others)
• phenytoin (Dilantin)
• phenobarbital

These drugs are also referred to as antiepileptic drugs or anticonvulsants. When they’re prescribed to treat mental health conditions, they may be referred to as mood stabilizers.

What could happen

Some seizure drugs are known to speed up the activity of certain enzymes that help clear Xeljanz from your body. This may lead to a lower level of Xeljanz in your body, making the drug less effective for treating your condition.

What you can do

If you take Xeljanz with certain seizure drugs, your doctor may adjust your dosage of Xeljanz or the seizure drug. You should not take change your dose of either medication without first discussing it with your doctor.

If you take Xeljanz and seizure drugs, tell your doctor right away if your symptoms worsen. This could be a sign that the level of Xeljanz in your body is too low.

If you have questions about taking Xeljanz with antiepileptic drugs, talk with your doctor or pharmacist.

Interaction with certain immunosuppressants

Xeljanz XR should not be taken together with certain strong immunosuppressant drugs.

Examples of these medications are:

• azathioprine (Imuran)
• cyclosporine (Neoral)
• tacrolimus (Prograf)

What could happen

Both Xeljanz and strong immunosuppressant drugs lower the activity of your immune system. When your immune system is less active, you are at a higher risk of getting infections. It may also be harder for your body to overcome infections, even with treatment.

Because of this risk, the manufacturer of Xeljanz recommends that you do not take this medication with strong immunosuppressant drugs. Taking these drugs together can raise your risk of frequent or serious infections.*

What you can do

Tell your doctor about all of your current medications before starting Xeljanz. They’ll likely instruct you on when and how to stop taking any strong immunosuppressant drugs before you start Xeljanz. Or, they may have you continue taking the immunosuppressant drug and recommend a treatment other than Xeljanz for your condition.

If you develop symptoms of an infection during Xeljanz treatment, tell your doctor right away. Symptoms vary with the type of infection but may include fever or cough.

If you have questions about this, talk with your doctor or pharmacist.

* Xeljanz has a boxed warning for the risk of serious infections. To learn more, see “Boxed Warnings” above.

Xeljanz may have other interactions. They could occur with supplements, foods, or vaccines. See below for details. Note that the information below does not include all other possible interactions with Xeljanz.

Does Xeljanz interact with supplements?

Before you start taking Xeljanz, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

Xeljanz interactions with herbs

Xeljanz may interact with certain herbs.

While it isn’t known for sure, Xeljanz might interact with turmeric supplements. Curcumin, a compound in turmeric, may block or slow the activity of certain enzymes that help clear Xeljanz from your body. This may lead to a higher level of the drug in your body and increase the risk of side effects.

Xeljanz can also interact with St. John’s wort, an herbal supplement used to ease symptoms of depression and other conditions. St. John’s wort is known to speed up the activity of certain enzymes that help clear Xeljanz from your body. This may lead to a lower level of Xeljanz in your body, making the drug less effective for your condition.

Xeljanz may interact with other herbs. For this reason, it’s important to check with your doctor or pharmacist before taking any of these products while taking Xeljanz.

Xeljanz and vitamins

There are currently no reports of Xeljanz interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Xeljanz.

Does Xeljanz interact with food?

You should avoid consuming grapefruit and grapefruit juice while taking Xeljanz. This fruit is known to block or slow the activity of certain enzymes that help clear Xeljanz from your body. This interaction may lead to a higher level of the drug in your body and increase the risk of side effects.

Other foods aren’t known to interact with Xeljanz. While dietary supplements, such as turmeric, may interact with this medication, consuming turmeric as a cooking spice in foods shouldn’t cause an interaction. This is because the amount that’s used in recipes is much lower than the amount in turmeric supplements.

If you have more questions about eating certain foods during Xeljanz treatment, talk with your doctor.

Does Xeljanz interact with vaccines?

You should not receive live vaccines* during your Xeljanz treatment. This is because getting a live vaccine while you’re taking Xeljanz increases your risk of infection. Examples of live vaccines include measles, mumps, rubella (MMR), rotavirus, and the intranasal flu vaccine (given into the nose). If you need to receive a vaccine, talk with your doctor first to make sure it’s safe.

* Live vaccines contain weakened versions of the bacteria or virus that they’re meant to protect against.

Does Xeljanz interact with lab tests?

There are currently no reports of Xeljanz interacting with lab tests. If you have questions about having certain lab tests during your treatment with Xeljanz, talk with the healthcare professional ordering the test.

Does Xeljanz interact with cannabis or CBD?

There are currently no reports of Xeljanz interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Xeljanz.

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

Certain medical conditions or other health factors may raise the risk of interactions with Xeljanz. Before taking Xeljanz, talk with your doctor about your health history. They’ll determine whether Xeljanz is right for you.

Health conditions or other factors that might interact with Xeljanz include:

Diverticulitis. Perforation (holes) in the digestive tract have been reported in people taking Xeljanz. If you have a history of diverticulitis, you may have an increased risk of this side effect.

Kidney problems. Doctors may prescribe a lower dosage of Xeljanz for people with kidney problems. Your doctor may check your kidneys to determine whether the drug is safe for you.

Liver problems. Xeljanz may not be safe for people with liver problems. In some cases, doctors may prescribe a lower dosage of Xeljanz for people with liver problems that aren’t severe. Your doctor can check the health of your liver to determine whether the drug is appropriate for you.

Low levels of certain blood cells. Taking Xeljanz may decrease the levels of certain blood cells in your body, including red blood cells and white blood cells. This can increase the risk of complications from anemia, such as shortness of breath, and the risk of serious infections. If you already have low levels of these blood cells, your doctor will likely not prescribe Xeljanz until your blood cells return to healthy levels. They may prescribe treatments for this.

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

Breastfeeding. It’s not known whether it’s safe to take Xeljanz while breastfeeding. The drug passes into breast milk, but it isn’t known whether the drug may cause side effects in a child who’s breastfed. The drug’s manufacturer recommends that you do not breastfeed while taking Xeljanz.

It’s also recommended that you continue to avoid breastfeeding for at least 18 hours after your last dose of Xeljanz, and at least 36 hours after your last dose of Xeljanz XR. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.

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

Find answers to some frequently asked questions about Xeljanz and possible interactions.

Is there an interaction between Xeljanz and omeprazole?

No, there’s no known interaction between Xeljanz and omeprazole (Prilosec).

Omeprazole is prescribed to treat heartburn, acid reflux, and other digestive conditions. It belongs to a group of drugs called proton pump inhibitors (PPIs).

Doctors may prescribe Xeljanz to treat certain types of arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are sometimes prescribed to manage arthritis symptoms, such as joint pain or swelling. A possible side effect of NSAIDs is peptic ulcers. Because of this risk, doctors commonly prescribe PPIs to help prevent stomach ulcers. So it’s possible that your doctor may recommend that you take Xeljanz, an NSAID, and omeprazole together.

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

Is it safe to take Xeljanz if I’m also taking prednisone?

Usually, yes. It should be safe to take Xeljanz with prednisone as long as your prednisone dosage isn’t too high.

Xeljanz is prescribed to treat ulcerative colitis and certain types of arthritis. Prednisone is commonly prescribed to manage flare-ups in the symptoms of these conditions. So it’s not uncommon for doctors to prescribe these drugs together.

In fact, in Xeljanz’s studies, many of the participants took prednisone (or similar corticosteroids) together with Xeljanz. The usual dosage of prednisone in these studies was less than 25 milligrams (mg) per day.

However, high dose prednisone (40 mg or more per day) can decrease the activity of your immune system. Xeljanz isn’t recommended for use in combination with drugs that suppress the immune system. Doing so could increase the risk of infection*.

If you’re taking prednisone and Xeljanz, you should not increase your dose of prednisone. Take the exact dosage your doctor prescribes.

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

* Xeljanz has a boxed warning for the risk of serious infections. To learn more, see “Boxed Warnings” above.

Taking certain steps can help you avoid interactions with Xeljanz. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you start taking a new drug during your Xeljanz treatment.

It’s also important to understand Xeljanz’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Xeljanz, ask your pharmacist to print a copy for you.)

If you have trouble reading or understanding this information, your doctor or pharmacist can help.

Taking Xeljanz exactly as prescribed can also help prevent interactions.

If you still have questions about Xeljanz and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• Do any of the medications or supplements I take interact with Xeljanz?
• Should I check with you before taking any over-the-counter medications during Xeljanz treatment?
• Can you suggest the ideal schedule for taking Xeljanz and my other medications?
• Are there alternatives to Xeljanz that are less likely to interact with my other medications?

To learn more about Xeljanz, see these articles:

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

Disclaimer: 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.