Upadacitinib

What is upadacitinib?

Upadacitinib is a type of drug known as a JAK inhibitor. It is available under the brand name Rinvoq. Your healthcare team may give it to you if you have:  

JAK inhibitors, such as upadacitinib, work by reducing the activity of Janus kinase enzymes. These are natural chemicals that play a role in the inflammation that causes symptoms of inflammatory arthritis. 

Upadacitinib isn’t a painkiller, but it can reduce the symptoms and limit the joint damage that could be caused by your condition. If upadacitinib works for you, your symptoms should start to improve within 2–8 weeks after you start taking it, but you may not notice the full benefit for 3–6 months. If upadacitinib is effective and you tolerate it well, it may be continued as a long-term treatment. 

Who can take upadacitinib?

Whether upadacitinib is suitable for you depends on your condition and how active it is. 

Upadacitinib will not be started if:  

  • your condition isn’t active  
  • you haven’t tried other treatments for your condition first  
  • you have an infection.  

Your healthcare team may use a scoring system to assess how active your condition is, and how it makes you feel before you are started on upadacitinib. You may also need blood tests and a chest X-ray before treatment before starting to make sure upadacitinib is safe for you to take.  

These tests may include tests for tuberculosis, hepatitis and HIV. If any of these tests are positive, your doctor may refer you to another specialist to decide on an appropriate treatment plan. If you have had other immunosuppressant medicines for your condition in the recent past, you may have had all these tests previously and may not necessarily need to have them repeated. 

Your doctor may also decide not to prescribe upadacitinib if you:  

  • have repeated serious infections, now or in the past  
  • are pregnant or planning to become pregnant  
  • have problems with your lungs, liver or kidneys 
  • have heart problems, high blood pressure or high cholesterol 
  • have a history of blood clots, such as deep vein thrombosis or pulmonary embolism.  

Your doctor will discuss other treatment options with you if upadacitinib is not suitable for you. 

When and how do I take upadacitinib?

Upadacitinib is available as a tablet you take once per day. Make sure you swallow each tablet whole. You can take tablets with or without food. 

If you take more than the recommended dose by mistake, contact your doctor straight away. If you miss a dose, carry on with the usual dose the next day – do not double it. 

Because upadacitinib is a long-term treatment, it’s important to keep taking it: 

  • even if it doesn’t seem to be working at first  
  • even when your symptoms start to improve.  

But if you have severe side effects or symptoms of an infection, tell your healthcare team. They may recommend that you delay or stop your treatment. 

Side effects and risks of upadacitinib 

Most people don’t have any side effects with upadacitinib, and for those who do, they are rarely serious.  

You will normally need to have regular tests while you’re on upadacitinib to make sure it isn’t having any unwanted effects on your blood, liver or general health. 

It’s recommended that you avoid food or drink containing grapefruit while you’re on upadacitinib. Grapefruit can add to the effect of upadacitinib and therefore increase the risk of side effects. 

If you do have very bad side effects, or are worried about your symptoms, you should ask your healthcare team for advice. 

The most common side effects of upadacitinib include:  

  • tummy pain 
  • cough 
  • fatigue (extreme tiredness) 
  • headache 
  • nausea 
  • skin reactions 
  • weight gain 
  • body aches or pain. 

If your doctor thinks you are at higher risk of skin cancer, they may advise you to use sunscreen and to check your skin regularly for any new spots or changes to moles or freckles. 

Blood clots have been reported in some people taking upadacitinib. Get medical help straight away if you have painful swelling in an arm or leg, or if you develop chest pain or shortness of breath. These can be signs of a blood clot. 

You should also tell your doctor or healthcare team if you develop any of the following after starting upadacitinib: 

  • a sore throat, fever, or a cough that won’t go away 
  • unexplained bruising or bleeding 
  • a painful rash 
  • any new symptom that concerns you. 

Contact your healthcare team immediately if you come into contact with someone who has chickenpox or shingles. They may suggest a blood test to check your antibody levels. These illnesses can be more severe than usual if you’re on upadacitinib, and you may need anti-viral treatment if you develop either chickenpox or shingles.  

Because upadacitinib affects your immune system, you may be more likely to get infections. The risk is higher if you’re over 65, have other health conditions or take medicines that affect your immune system.   

Tips to reduce your risk of infection: 

  • Try to avoid close contact with people you know have an infection. 
  • Wash your hands regularly and carry around a small bottle of antibacterial hand gel.  
  • Keep your mouth clean by brushing your teeth regularly.  
  • Stop smoking if you’re a smoker. 
  • Make sure your food is stored and prepared properly.  
  • Try to keep your house clean and hygienic, especially the kitchen, bathrooms and toilets.  

Carrying an alert card

It’s recommended that you carry a biological therapy alert card so anyone treating you will know that you’re on upadacitinib. Ask your healthcare team for a card. 

Taking other medicines while taking upadacitinib

Most medicines are safe to take with upadacitinib. However, there are some medicines that interact with it. These include some of the drugs used to treat fungal or bacterial infections, tuberculosis, seizures or fits, and drugs that affect your immune system such as azathioprine, ciclosporin and tacrolimus. 

Check with your doctor before starting any new medicines and remember to mention you’re on upadacitinib if you’re treated by anyone other than your usual healthcare team. 

You can carry on taking non-steroidal anti-inflammatory drugs (NSAIDs) or painkillers, if needed, unless your doctor advises otherwise. 

Don’t use complementary treatments, such as herbal remedies, without discussing this first with your doctor or pharmacist as some of them could interact with upadacitinib.  

Vaccinations

It’s best to discuss vaccinations with your healthcare team before starting upadacitinib. You should avoid taking a live vaccine such as measles, mumps and rubella (MMR), chickenpox and yellow fever.  

If you need a live vaccine, it’s usually recommended that you have it at least 4 weeks before starting upadacitinib, as long as you’re not taking any other immunosuppressive medication. 

Non-live vaccines are safe and recommended while taking upadacitinib. These include the annual flu vaccine, COVID-19 vaccines, the pneumococcal vaccine (Pneumovax) and the shingles vaccine (Shingrix). 

Having an operation or dental treatment

If you’re going to have an operation or dental treatment, you should talk this over with your doctor or surgeon.  

Depending on the type of surgery, your doctor may recommend that you stop upadacitinib for a short period before and after the operation. This is because upadacitinib affects your immune system, which may increase your risk of infection after surgery.  

Alcohol

There is no need to avoid alcohol while taking upadacitinib.  

Guidelines state that adults shouldn’t have more than 14 units a week, and that they should spread them out over the course of the week. In some circumstances your doctor may advise lower limits. 

Fertility, pregnancy and breastfeeding while taking upadacitinib

Upadacitinib is not usually recommended during pregnancy. Because it’s a relatively new drug, we don’t yet know fully how it might affect pregnancy or an unborn baby. 

If you’re considering becoming pregnant, you should discuss this with your healthcare team in advance. 

Current UK guidance recommends that women who could become pregnant should use effective contraception while taking upadacitinib and for at least 2 weeks after stopping treatment before trying for a baby.  

Tell your healthcare team immediately if you become pregnant while taking upadacitinib. 

We don’t yet know whether upadacitinib passes into human breastmilk. For this reason, the current advice is that you should not breastfeed while taking upadacitinib.  

There is no evidence that upadacitinib affects fertility in men or women. Men can continue taking upadacitinib while trying for a baby. 

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Reviewers: Chris Holroyd, Mariam Malik and Sarah Bennett

Reviewed: May 2026

Next planned review: May 2029.