Rinvoq Side Effects Explained

Rinvoq (upadacitinib) is an oral medication approved for treating several autoimmune conditions, particularly in patients who do not respond adequately to other therapies. While its efficacy in reducing inflammation and improving quality of life has been well-documented, it’s important to be aware of the potential side effects that may come with its use.

This article explains Rinvoq’s common and serious side effects and provides strategies for managing them and protecting your health.

What is Rinvoq Used to Treat?

Rinvoq is classified as a Janus kinase (JAK) inhibitor, a type of medication that interferes with specific enzymes known as JAK enzymes. These enzymes are essential in cell signaling, especially in the pathways that regulate immune responses.

By inhibiting JAK enzymes, Rinvoq disrupts the communication processes that trigger inflammation. The drug is approved for various conditions, including:

• Rheumatoid arthritis
• Psoriatic arthritis (for adults and children aged 2 years and older)
• Crohn’s disease
• Ulcerative colitis
• Atopic dermatitis (for adults and children aged 12 years and older)
• Non-radiographic axial spondyloarthritis
• Ankylosing spondylitis
• Polyarticular juvenile idiopathic arthritis (for children aged 2 years and older)

Since JAK enzymes influence numerous biological functions, their inhibition by Rinvoq can impact other bodily systems, leading to various side effects.

Common Side Effects of Rinvoq

These side effects are generally mild and often improve as your body adjusts to the medication.

1. Respiratory Infections

These side effects, shared across all conditions treated with Rinvoq, are likely due to its immune-modulating effects. They include:

• Upper respiratory tract infections
• Bronchitis
• Cough
• Influenza
• Influenza-like illness

To help alleviate respiratory symptoms, prioritize rest, maintain good hygiene practices, and stay well-hydrated. OTC medications such as cough suppressants and decongestants can also provide relief.

Additionally, consider getting the flu shot, which is an inactive vaccine and safe during treatment. On the other hand, the nasal spray flu vaccine contains a live virus and should be avoided.

2. Gastrointestinal Reactions

These Rinvoq side effects, like nausea and abdominal pain, are typically seen in patients treated for rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis. They affect the digestive system and may cause discomfort in the gastrointestinal tract.

To manage nausea, try eating small, bland meals and avoid spicy or greasy foods to prevent abdominal discomfort. Medications like meclizine and bismuth subsalicylate (Pepto-Bismol), along with natural remedies such as ginger and peppermint oils, can also be helpful.

3. Skin Reactions

Similar to respiratory infections, skin reactions are also common across all conditions treated by Rinvoq, leading to visible and sometimes painful changes. These include:

• Acne
• Rash
• Allergic reactions like hives, itching, or swelling
• Folliculitis

You may notice new or worsening acne, a condition informally dubbed “JAKne” by some medical professionals. In a study comparing three JAK inhibitors, Rinvoq was most frequently associated with acne, affecting roughly one in five patients.

Acne was primarily seen on the face, but some patients also had it on their back, chest, and scalp. The types of acne included inflamed pimples, pustules, and in some cases, nodules and cysts.

Common treatments often involve topical applications such as benzoyl peroxide or retinoids, which work well for many people. In some instances, a short course of antibiotics might be recommended, and in rare cases, oral isotretinoin may be necessary to control severe acne.

4. Neurological and Musculoskeletal Reactions

These side effects of Rinvoq affect the nervous system and muscles, frequently reported in patients with joint-related conditions, such as rheumatoid arthritis and psoriatic arthritis. Among them are:

• Headache
• Myalgia
• Fatigue
• Pyrexia (fever)

Make sure to get plenty of rest and drink adequate fluids to help with headaches and fatigue. OTC analgesics like ibuprofen or acetaminophen can also ease headaches, muscle pain, and fever.

5. Hematological and Metabolic Reactions

These reactions involve changes in blood cells and metabolism, and they are commonly seen in individuals treated for atopic dermatitis, ulcerative colitis, and Crohn’s disease. These changes may include the following:

• A decrease in neutrophil count, the white blood cells responsible for fighting infections
• Increased blood creatine phosphokinase
• Elevated liver enzymes
• Anemia
• Weight gain

Your physician will monitor your blood work and make any necessary adjustments based on the lab results.

Serious Side Effects of Rinvoq

Although less common, Rinvoq is associated with several serious side effects. These Rinvoq side effects require immediate medical attention and may necessitate medication discontinuation.

1. Serious Infections

Rinvoq can increase the risk of serious infections, including tuberculosis, fungal, viral, and bacterial infections. This is because JAK inhibitors suppress the immune system, making it harder for the body to fight off pathogens.

Before starting Rinvoq, you’ll typically be screened for tuberculosis, and you may need periodic screening during your treatment.

If you notice symptoms that suggest a serious infection, such as fever, chills, sweats, weight loss, or a persistent cough, it’s important to seek immediate medical attention. In some cases, managing the infection may require hospitalization and stopping Rinvoq temporarily.

2. Blood Clots

Blood clots, though rare, are a serious potential side effect of Rinvoq. These clots can form in the legs, known as deep vein thrombosis (DVT), or in the lungs, referred to as pulmonary embolism (PE), and can be life-threatening if not treated quickly.

Typical symptoms of a blood clot include leg swelling, pain, redness, shortness of breath, and chest pain.

If you have a history of blood clots or are at increased risk, discuss these concerns with your physician before starting Rinvoq. If you suspect a blood clot, stop taking Rinvoq immediately and seek urgent medical care.

3. Cardiovascular Events

Rinvoq may increase the risk of cardiovascular events, including heart attack and stroke, particularly in patients with the following conditions:

• Older adults
• Individuals with obesity
• A family history of heart disease
• Those with prior heart attacks, strokes, or other cardiovascular conditions
• High blood pressure
• High cholesterol
• Diabetes
• Those who smoke
• Those who have experienced DVT or PE

This risk is thought to be related to the medication’s effect on blood lipid levels and blood pressure. Symptoms of a cardiovascular event include chest pain, difficulty breathing, weakness on one side of the body, and difficulty speaking.

4. Cancer Risks

Rinvoq may elevate the risk of developing certain cancers, including lymphoma, lung, and skin cancer. This is thought to be related to the drug’s immunosuppressive effects, which may impair the body’s ability to detect and eliminate cancerous cells.

Regularly check your skin and report any unusual growths or changes in existing moles to your healthcare provider. Limit sun exposure and avoid artificial tanning methods like sunlamps and tanning beds.

While outdoors, wear protective clothing and apply a broad-spectrum sunscreen with SPF 30 or higher. This is particularly important if you are fair-skinned or have a history of skin cancer in your family, as these measures can help prevent skin damage and associated health issues.

5. Gastrointestinal Perforations

Rinvoq has been associated with gastrointestinal perforations (GI), which are holes that develop in the walls of the stomach or intestines. This is a serious medical emergency that could be life-threatening if not treated promptly.

Individuals at increased risk include those with:

• A history of diverticulitis
• A history of peptic ulcer disease
• Patients using nonsteroidal anti-inflammatory drugs
• A history of inflammatory bowel disease
• Concurrent use of corticosteroids

Signs of severe stomach pain, fever, or changes in bowel habits should be reported immediately, as these could indicate a GI perforation.

When to Contact Your Healthcare Provider

Reach out immediately if you experience signs of a serious infection, such as persistent fever, chills, or a lasting cough, as these can escalate quickly. Additionally, symptoms like sudden leg swelling, chest pain, or difficulty breathing may indicate a blood clot requiring urgent medical attention.

You should also inform your healthcare provider if you notice severe abdominal pain, unusual skin reactions like rashes or hives, or any changes in your vision. Staying proactive and communicating any unusual side effects can help you manage your treatment more safely and effectively.

Frequently Asked Questions