Tofacitinib is an oral medicine that can control inflammation fast — often faster than some injections. Doctors use it for rheumatoid arthritis, psoriatic arthritis, and moderate to severe ulcerative colitis. It works by blocking JAK enzymes, which calms immune-driven inflammation. That sounds great, but this drug also brings real risks you need to know before starting.
For most adults with rheumatoid or psoriatic arthritis, the usual dose is 5 mg taken twice a day. For ulcerative colitis, induction often starts at 10 mg twice daily for a short period, then drops to a lower maintenance dose — or an 11 mg extended‑release pill once daily if prescribed. Follow your prescriber: doses change based on the disease, other meds, and kidney or liver health. If you miss a dose, take it when you remember unless it's almost time for the next one. Don't double up.
Before you start, your doctor should test for latent TB, check blood counts, liver tests, and lipids. During treatment, expect regular bloodwork — usually at baseline, after a few weeks, then periodically. Common side effects include upper respiratory infections, headache, and diarrhea. More serious issues reported include serious infections, blood clots, heart problems, and some cancers. The higher dose and some patient groups seem to have a bigger risk.
Stop and call your provider right away for fever, persistent cough, shortness of breath, sudden swelling or pain in a leg or chest, yellowing of the skin, or unexpected bleeding or bruising. Avoid live vaccines while taking tofacitinib and for a short time after. Tell your doctor about all medicines you take — especially strong CYP3A4 inhibitors (like ketoconazole) or inducers (like rifampin), since they change how much tofacitinib stays in your body.
Pregnancy and breastfeeding: data are limited. If you're pregnant, planning pregnancy, or breastfeeding, discuss alternatives with your clinician. Older adults and people with existing heart or cancer risk factors need extra caution.
Practical tips: take pills with or without food, keep a list of symptoms to report, and don't stop the drug suddenly without talking to your doctor. If cost or monitoring is an issue, discuss biologic options or other treatments — they work differently and may fit your situation better.
Bottom line: tofacitinib can be very effective, but it requires regular monitoring and clear communication with your medical team. Ask about TB screening, blood tests, vaccine timing, and what to do if you get an infection. That keeps the benefits high and the risks lower.
Apr, 20 2025