If you have a certain autoimmune disorder, your doctor may prescribe Xeljanz or Xeljanz XR for you. These prescription drugs are used in adults when certain other treatments haven’t worked to treat:

Additionally, Xeljanz is used in certain children to treat juvenile idiopathic arthritis that affects multiple joints.

To learn more about how Xeljanz and Xeljanz XR are used, see the “What is Xeljanz used for?” section below.

Xeljanz vs. Xeljanz XR

Xeljanz and Xeljanz XR come as tablets that you’ll take by mouth. Xeljanz XR is a long-acting form of Xeljanz. Xeljanz also comes as a liquid solution that’s taken by mouth.

The active drug in Xeljanz and Xeljanz XR is tofacitinib. There isn’t a generic version of tofacitinib available. Instead, it only comes as the brand-name drugs Xeljanz and Xeljanz XR.

In this article we’ll discuss the side effects, cost, and more of Xeljanz and Xeljanz XR.

Like most drugs, Xeljanz and Xeljanz XR may cause mild or serious side effects. The lists below describe some of the more common side effects that Xeljanz and Xeljanz XR may cause. These lists don’t include all possible side effects.

Your doctor or pharmacist can tell you more about the potential side effects of Xeljanz and Xeljanz XR. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a short list of some of the mild side effects that Xeljanz and Xeljanz XR can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Xeljanz and Xeljanz XR’s prescribing information.

Mild side effects of Xeljanz and Xeljanz XR can include:

Mild side effects of many drugs may go away within a few days or a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

* For more information about this side effect, see the “Side effect focus” section below.

Serious side effects

Serious side effects from Xeljanz and Xeljanz XR can occur, but they aren’t common. If you have serious side effects from Xeljanz and Xeljanz XR, call your doctor right away. However, if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects can include:

* For more information about these side effects, see the “Side effect focus” section below.
† Xeljanz and Xeljanz XR have a boxed warning about the risk of these side effects. These are serious warnings from the Food and Drug Administration (FDA).

Side effect focus

Learn more about some of the side effects Xeljanz and Xeljanz XR may cause.

Boxed warnings

Xeljanz and Xeljanz XR have a boxed warning for blood clots, serious infection, and certain cancers. A boxed warning is a serious warning from the Food and Drug Administration (FDA).

Risk of serious infections. Xeljanz and Xeljanz XR may increase your risk for serious infections. This risk is higher if you also take certain other immunosuppressant drugs, such as corticosteroids or methotrexate. Immunosuppressant drugs lower your body’s ability to fight infections. (Xeljanz and Xeljanz XR are immunosuppressant drugs, too.)

Infections reported in people taking Xeljanz or Xeljanz XR included certain types of bacterial infections, fungal infections, and viral infections like herpes zoster (shingles). Also, flare-ups of past infections, such as tuberculosis (TB), hepatitis B, and hepatitis C were reported.

The most commonly reported infections with Xeljanz and Xeljanz XR included pneumonia, skin infection, and urinary tract infection (UTI).

Symptoms of infections will vary, but they may include:

  • fever or chills
  • cough
  • fatigue (lack of energy)
  • muscle aches
  • rash

Risk of blood clots. If you’re age 50 years or older and have rheumatoid arthritis and at least one risk factor* for heart disease, Xeljanz and Xeljanz XR can increase your risk for blood clots. This includes clots such as:

In this case, Xeljanz and Xeljanz XR can also increase the risk of death.

In studies, these risks were higher with a 10 mg dose of Xeljanz taken twice daily compared with lower doses of Xeljanz.

Symptoms of blood clots can include:

  • chest pain
  • pain in your arm or leg
  • shortness of breath
  • swelling in your arm or leg
  • trouble breathing

* Risk factors for heart disease include having high blood pressure, high cholesterol, or obesity. Smoking is also a risk factor for heart disease.

Risk of cancer and problems with your immune system. Xeljanz and Xeljanz XR can increase your risk for certain types of cancer.

Studies of people taking Xeljanz reported several types of cancer, including:

Some cancer symptoms include:

The risk of cancer was also higher for people taking Xeljanz who’d had a kidney transplant and who were taking other certain immunosuppressant drugs. And certain people who are taking kidney transplant rejection drugs with Xeljanz may have increased risk for reactivation of certain immune system viruses such as Epstein-Barr virus.

Risk of death in certain people. Xeljanz and Xeljanz XR may increase the risk of death in some people. This includes people who have rheumatoid arthritis, who are ages 50 years or older, and who have at least one risk factor for heart or blood vessel disease.

Risk factors for heart disease include having high blood pressure, high cholesterol, or obesity. Smoking is also a risk factor for heart disease.

What might help

Your doctor will order blood tests to check you for infection before you start taking Xeljanz or Xeljanz XR. If you have an infection, your doctor may have you wait to start Xeljanz or Xeljanz XR until your infection has been treated. They’ll also monitor you for infections while you’re taking Xeljanz or Xeljanz XR and for a while after you stop treatment.

If you have heart disease or a history of blood clots, you shouldn’t take Xeljanz or Xeljanz XR. And if you develop blood clots during treatment, your doctor will have you stop taking the drug and monitor you to see if you need treatment for your blood clots.

Your doctor can evaluate your risk of these side effects and assess whether Xeljanz or Xeljanz XR is right for you. They can recommend a dosage of either drug and a treatment duration that’s safe for you.

Ask your doctor about all the risks and benefits of Xeljanz or Xeljanz XR, including the risk of cancer and immune system problems. Be sure to share your medical history and tell your doctor if you’ve had cancer in the past or are currently getting any cancer treatments.

Rash

Some people taking Xeljanz or Xeljanz XR may develop a rash. This was a common side effect during studies.

It’s possible to get a rash when past infections in your body flare up. For example, the chickenpox virus can flare up in your body causing shingles, which is a serious side effect of Xeljanz and Xeljanz XR. In addition, rash may also occur with an allergic reaction to Xeljanz or Xeljanz XR.

What might help

It’s important to call your doctor if you develop a rash while you’re taking Xeljanz or Xeljanz XR. Your rash could mean you’re having a flare-up of a past infection or an allergic reaction.

Your doctor will check to see what type of rash you have. And they’ll recommend appropriate treatment for it.

Headache

Headache is a common side effect of Xeljanz and Xeljanz XR. In studies, people taking Xeljanz twice a day for ulcerative colitis (UC) had more headaches than did people taking the drug for its other approved uses.

What might help

If you get headaches while you’re taking Xeljanz or Xeljanz XR, keep a record of them. This can help your doctor learn more about what may be causing your headaches.

If needed, your doctor can recommend treatment that’s safe and effective to help relieve your headache. But don’t take pain medications without first talking with your doctor or pharmacist.

Allergic reaction

Some people may have an allergic reaction to Xeljanz and Xeljanz XR.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth, swelling, redness, or discoloration in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Xeljanz and Xeljanz XR. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Xeljanz and Xeljanz XR manufacturer’s website to see if they have support options.

If you have certain autoimmune conditions, your doctor may prescribe Xeljanz or Xeljanz XR for you. These prescription drugs are used in adults and some children.

Xeljanz and Xeljanz XR are used in adults with:

  • Moderate to severe ulcerative colitis (UC). For UC, Xeljanz or Xeljanz XR is prescribed when another type of drug called a tumor necrosis factor (TNF) blocker didn’t work or caused bothersome side effects. An example of a TNF blockers includes adalimumab (Humira). With UC, you have inflammation in your digestive tract. And this can cause belly pain and abnormal bowel movements.
  • Moderate to severe rheumatoid arthritis (RA). For RA, Xeljanz or Xeljanz XR is prescribed when a TNF blocker didn’t work or caused bothersome side effects. With RA, you have pain, swelling, and possible deformities in your joints.
  • Psoriatic arthritis (PsA). For PsA, Xeljanz or Xeljanz XR is prescribed when a TNF blocker didn’t work or caused bothersome side effects. With PsA, you have pain and swelling in your joints. And you can also have patches of skin that are pink or darker in color and may become scaley in appearance.
  • Ankylosing spondylitis (AS). For AS, Xeljanz or Xeljanz XR is prescribed when a TNF blocker didn’t work or caused bothersome side effects. With AS, you have pain and swelling in your spine and back.

In addition, Xeljanz can be prescribed for children ages 2 years old and older with polyarticular course juvenile idiopathic arthritis. This condition is a type of arthritis that affects children. And being polyarticular, it affects many joints in their body.

With autoimmune conditions, your immune system attacks tissues in your own body and causes inflammation. Xeljanz and Xeljanz XR work to treat certain autoimmune conditions by blocking inflammatory responses inside your body.

Note: Xeljanz and Xeljanz XR should not be used together with other strong immunosuppressant drugs. This includes azathioprine and cyclosporine. In addition, Xeljanz and Xeljanz XR should not be used with biologic disease-modifying antirheumatic drugs (DMARDs). Talk with your doctor about which medications are safe to use with Xeljanz or Xeljanz XR.

Find answers to some commonly asked questions about Xeljanz and Xeljanz XR.

Can Xeljanz be used for alopecia such as alopecia areata?

No, Xeljanz and Xeljanz XR aren’t approved to treat alopecia or alopecia areata. Alopecia is also simply called hair loss. With alopecia areata, you have hair loss in small patches.

Doctors may prescribe Xeljanz or Xeljanz XR off-label for this purpose. With off-label use, a drug is used for another purpose than what it’s approved for.

Some studies have shown that tofacitinib (the active drug in Xeljanz and Xeljanz XR) may be effective for treating hair loss. But people taking tofacitinib who then stopped it had hair shedding within 4 to 5 weeks of stopping the drug.

If you’d like to know more about using Xeljanz or Xeljanz XR for hair loss, talk with your doctor. They can help you learn about the risks and benefits of treatment. Keep in mind, though, your insurance may not cover off-label use of Xeljanz or Xeljanz XR.

Does Xeljanz cause weight gain or weight loss?

No, Xeljanz and Xeljanz XR don’t lead to weight gain or weight loss. But serious side effects of these drugs or your condition itself may cause unexplained weight loss.

For example, weight loss can be seen with diarrhea, serious infection, and cancer. And these side effects can occur with Xeljanz and Xeljanz XR. (For more information about serious infection and cancer risks, see the “What are side effects of Xeljanz?” section above.)

In addition, other medications you’re taking for your condition may cause weight changes.

It’s important to let your doctor know if you have any changes in your appetite or body weight while you’re taking Xeljanz. Your doctor will order tests to make sure you’re not having certain serious side effects from treatment. And your doctor can discuss ways to help you manage a body weight that’s healthy for you.

How does Xeljanz compare with Rinvoq?

Xeljanz, Xeljanz XR, and Rinvoq all belong to the same group of medications called Janus kinase (JAK) inhibitors. This means they have some similar uses and side effects. But they also have some differences, too.

Xeljanz and Xeljanz XR contain the active drug tofacitinib, while Rinvoq contains the active drug upadacitinib.

Xeljanz, Xeljanz XR, and Rinvoq are all approved to treat some conditions in adults when certain other drugs haven’t worked. Specifically, they’re used for:

Xeljanz is also approved to treat a type of juvenile idiopathic arthritis in some children. And Rinvoq treats atopic dermatitis in certain adults and children.

Xeljanz, Xeljanz XR, and Rinvoq have similar serious side effects as well. To learn more about Xeljanz and Xeljanz XR’s side effects, see the “What are side effects of Xeljanz?” section above. And to learn more about Rinvoq’s side effects, see the drug’s medication guide.

If you’d like to know more about these drugs, talk with your doctor.

You may wonder how Xeljanz and Xeljanz XR compare with Humira.

Both types of Xeljanz contain the active drug tofacitinib, while Humira contains the active drug adalimumab. Humira is given as an injection under the skin. But Xeljanz and Xeljanz XR are taken by mouth. Xeljanz comes as tablets and a liquid solution, and Xeljanz XR comes as tablets.

These medications have some shared uses and some unique ones. They’re both used in adults with:

They’re also both used for juvenile idiopathic arthritis in certain children.

Humira is also approved to treat Crohn’s disease, plaque psoriasis, hidradenitis suppurativa, and uveitis in certain people.

To learn more about how these drugs compare, check out this side-by-side comparison. Also, ask your doctor if either medication is right for your condition.

Your doctor will explain how you should take Xeljanz or Xeljanz XR. They’ll also explain how much to take and how often. Be sure to follow your doctor’s instructions.

Generally, you’ll start on the lowest dosage of Xeljanz or Xeljanz XR, and your doctor will see how you do with the drug. Your doctor may adjust your dosage if needed. But that’ll depend on how the treatment is working to manage your condition.

Below are commonly used dosages, but always take the dosage your doctor prescribes.

Taking Xeljanz

Xeljanz and Xeljanz XR come as tablets that you’ll take by mouth.

Xeljanz is an immediate-release form of the drug, which means it’s released into your body all at once when it’s taken. Xeljanz XR is an extended-release form of Xeljanz. It’s released into your body over an extended period of time after it’s taken.

Xeljanz also comes as a solution that can be taken by mouth in children.

You can take Xeljanz or Xeljanz XR at any time of day. There’s not a time of day that’s best to take it. But try to take the drug at the same time every day to avoid missing doses.

If your doctor prescribes Xeljanz to be taken twice a day, take your two doses about 12 hours apart, once in the morning and once in the evening.

Dosage

How often you’ll take a dose of Xeljanz or Xeljanz XR depends on your condition and which type of the drug your doctor prescribes. For example:

  • Xeljanz may be taken twice each day
  • Xeljanz XR may be taken once each day

Your doctor will recommend the dosage that’s right for you depending on:

  • your age
  • medical conditions you may have
  • other medications you may be taking

In some cases, your dose of Xeljanz may be adjusted based on your liver or kidney function.

Questions about taking Xeljanz

Below, we answer some common questions related to taking Xeljanz or Xeljanz XR.

  • What if I miss a dose of Xeljanz and Xeljanz XR? Take the missed dose as soon as you remember. But if it’s close to the time you’ll take your next dose, don’t take two doses together. Instead, just take your next scheduled dose like usual. And try setting a reminder to help you remember to take your doses on a regular schedule.
  • Will I need to use Xeljanz and Xeljanz XR long term? As long as the drug is working well to manage your symptoms, your doctor may have you keep taking it regularly. Ask your doctor if taking Xeljanz or Xeljanz XR long term is right for you.
  • Can Xeljanz and Xeljanz XR be chewed, crushed, or split? You may be able to crush or chew Xeljanz (immediate-release) tablets. But don’t split, crush, or chew Xeljanz XR (extended-release) tablets. Doing so can alter how they work. If you have trouble swallowing pills, ask your pharmacist or doctor about other options.
  • Should I take Xeljanz and Xeljanz XR with food? Food doesn’t change how Xeljanz and Xeljanz XR work. So, you can take Xeljanz or Xeljanz XR with or without food.
  • How long does Xeljanz and Xeljanz XR take to work? Xeljanz and Xeljanz XR start to work soon after you take a dose. But keep in mind, it may take a few weeks to see improvements in your symptoms. Ask your doctor when you can expect to see Xeljanz relieving your symptoms. When you start taking the drug, your doctor will monitor you to make sure the drug is working.
Questions for your doctor

You may have questions about Xeljanz and Xeljanz XR and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

  • Before your appointment, write down questions like:
    • how will Xeljanz and Xeljanz XR affect my body, mood, or lifestyle?
  • Bring someone with you to your appointment if doing so will help you feel more comfortable.
  • If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare providers are available to help you. And they want you to get the best care possible. So don’t be afraid to ask questions or offer feedback on your treatment.

Before starting treatment with Xeljanz or Xeljanz XR, talk with your doctor about any medical conditions you have.

If you have kidney or liver problems, your doctor may check how your liver and kidneys are working. In some cases, your dose of Xeljanz may be adjusted based on your liver or kidney function.

Also, let your doctor know if you:

In addition, tell your doctor about any medications or supplements you’re taking.

Below we describe a few risks and precautions of using Xeljanz or Xeljanz XR.

Interactions

Medications you take can interact with other medications, vaccines, and even foods. This can change how effective or safe the drug is for you.

Before taking Xeljanz or Xeljanz XR, be sure to tell your doctor about all medications you take (including prescription and over-the-counter types). Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Xeljanz and Xeljanz XR.

Note: The lists below do not contain all types of drugs that may interact with Xeljanz and Xeljanz XR. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of Xeljanz and Xeljanz XR.

Interactions with drugs or supplements

Xeljanz and Xeljanz XR can interact with several types of drugs. Your doctor or pharmacist can tell you more about these interactions.

Medications that interact with Xeljanz and Xeljanz XR can either increase or decrease the drugs’ effects.

For instance, certain drugs slow down the removal of Xeljanz and Xeljanz XR from your body. And this can raise your risk for side effects from Xeljanz and Xeljanz XR. Examples of these drugs include:

On the other hand, some kinds of drugs can speed up the removal of Xeljanz and Xeljanz XR from your body. And this can make Xeljanz and Xeljanz XR less effective for your condition. A few examples of these kinds of drugs include:

Interactions with immunosuppressant drugs

If taken with other immunosuppressant drugs, Xeljanz and Xeljanz XR can increase the risk of serious infection. (Immunosuppressant drugs lower your body’s ability to fight infections.)

Examples of immunosuppressant drugs include:

Boxed warnings

Xeljanz and Xeljanz XR have boxed warnings for the risks of certain health conditions. A boxed warning is a serious warning from the Food and Drug Administration (FDA). These warnings are described below.

Risk of serious infections. Taking Xeljanz or Xeljanz XR can increase your risk for serious infection. Taking either drug may increase your risk for serious bacterial, viral, and fungal infections.

Risk of blood clots. If you’re age 50 years or older and have rheumatoid arthritis and at least one risk factor for heart disease, Xeljanz can increase your risk for blood clots. This includes clots such as pulmonary embolism (blood clot in the lungs), arterial thrombosis (blood clot in an artery), and deep venous thrombosis (blood clot in a vein). In this case, Xeljanz and Xeljanz XR can also increase the risk of death.

Risk of cancer and problems with your immune system. Xeljanz and Xeljanz XR can increase your risk for certain cancers including lymphoma (cancer in your lymphatic system). These drugs can also increase the risk of immune system disorders in certain people.

Risk of death in certain people. Xeljanz and Xeljanz XR may increase the risk of death in certain people. This includes people ages 50 years and older who have rheumatoid arthritis and certain risk factors.

If you’d like to know more about these boxed warnings, see the “What are side effects of Xeljanz?” section for more information.

Other warnings

Xeljanz and Xeljanz XR may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Xeljanz and Xeljanz XR. Factors to consider include those in the list below.

  • Gastrointestinal (GI) tract problems. Xeljanz and Xeljanz XR can cause serious problems with your digestive tract. Such problems can include tears in your stomach and small or large intestine. This risk is higher for people taking other drugs that have GI-related side effects, such as nonsteroidal anti-inflammatory drugs (NSAIDs). Also, if you have any conditions that cause narrowing in your digestive tract, taking Xeljanz XR may cause a blockage. Ask your doctor for more information about your risks for GI issues with Xeljanz or Xeljanz XR.
  • Liver problems. If you have liver problems, your doctor may adjust your dosage of Xeljanz or Xeljanz XR. And they’ll monitor your liver while you’re taking either drug. If you have serious liver conditions, such as hepatitis B or hepatitis C, ask your doctor if Xeljanz or Xeljanz XR is safe for you.
  • Allergic reaction. If you’ve had an allergic reaction to Xeljanz and Xeljanz XR or any of their ingredients, you shouldn’t take Xeljanz and Xeljanz XR. Ask your doctor what other medications are better options for you.

Xeljanz and alcohol

Drinking alcohol can increase the risk of liver problems. And Xeljanz and Xeljanz XR may worsen liver function in some people. The drugs can also raise your levels of liver enzymes.

This risk may be higher if Xeljanz or Xeljanz XR is used with certain other immunosuppressant drugs. (Immunosuppressant drugs lower your body’s ability to fight infections.)

Ask your doctor if it’s safe for you to drink alcohol while you’re taking Xeljanz or Xeljanz XR. Your doctor may order liver function tests to see how your liver is working before and while you take Xeljanz.

Pregnancy and breastfeeding

It’s not known if Xeljanz or Xeljanz XR is safe to take if you’re pregnant. Ask your doctor about the risks and benefits of using either drug during pregnancy.

If you’ve taken Xeljanz or Xeljanz XR while pregnant or are planning to take them during pregnancy, ask your doctor about the Xeljanz pregnancy registry. Or you can visit the registry’s website or call 877-311-8972 to learn more about it.

Also, Xeljanz and Xeljanz XR may affect your ability to become pregnant while you’re taking either drug or after you’ve taken them. Be sure to talk with your doctor about your reproductive desires before starting this treatment.

Xeljanz and Xeljanz XR may pass into breast milk, so they’re not recommended for use while you’re breastfeeding. Ask your doctor for more information about the risks of using either drug while breastfeeding.

Don’t take more Xeljanz or Xeljanz XR than your doctor prescribes. Using more than this can lead to serious side effects.

What to do in case you take too much Xeljanz or Xeljanz XR

Call your doctor if you think you’ve taken too much Xeljanz or Xeljanz XR. You can also call 800-222-1222 to reach the American Association of Poison Control Centers or use their online resource. However, if you have severe symptoms, immediately call 911 (or your local emergency number) or go to the nearest emergency room.

Xeljanz and Xeljanz XR are prescription medications that can be used to treat certain autoimmune disorders. These drugs are used when certain other medications haven’t worked. And they can be taken alone or together with other medications.

Before starting Xeljanz or Xeljanz XR, talk with your doctor about other treatment options for:

You can also talk with your child’s doctor about other treatment options for juvenile idiopathic arthritis.

Also, ask your doctor what you can expect with Xeljanz or Xeljanz XR treatment. Here are a few questions to get you started:

  • What can I do to lower my risk for infections while taking Xeljanz or Xeljanz XR?
  • Will Xeljanz or Xeljanz XR help with pain?
  • Can I take Xeljanz or Xeljanz XR if I have a cold?

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Q:

Can I take ibuprofen (Advil) with Xeljanz?

Anonymous

A:

It’s not advised that you take ibuprofen (Advil) with Xeljanz or Xeljanz XR.

There’s not an interaction between the medications, but each of them increases your risk for gastrointestinal perforations. (With a gastrointestinal perforation, you have a tear in your stomach or intestines.)

So taking ibuprofen together with Xeljanz or Xeljanz XR may make your risk for having a perforation even higher.

If you feel like you need additional pain relief for your symptoms while you’re taking Xeljanz or Xeljanz XR, talk with your doctor. They may change up your current treatment plan. And always be sure to check with your doctor or pharmacist before taking any medications with Xeljanz or Xeljanz XR.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, 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 other 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.

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