Avoid live vaccines like the nasal spray flu vaccine, and others such as the measles, mumps, rubella, and yellow fever vaccines. Be sure to talk with your doctor before receiving any vaccines or undergoing any surgeries while taking this medication. If you develop symptoms of an infection such as a fever or cough or think you are having any side effects (especially abdominal pain, bloody bowel movements, or allergic reactions), contact your rheumatologist. Tell your doctor if you become pregnant or are planning pregnancy, or if you are breastfeeding. Ask your doctor about getting appropriate vaccines before starting the drug, including the shingles vaccine. Let your doctor know if you have a history of diverticulitis and other serious infections. Lymphoma and other malignancies have been observed in patients treated with tofacitinib. In patients over 65 years of age, Tofacitinib has been linked to heart attacks, strokes, and blood clots. Tofacitinib increases your chance of getting shingles. Patients should also be screened for hepatitis B and C prior to starting tofacitinib, since this medication may increase risk of reactivation of these infections. All patients should be tested for tuberculosis before starting on tofacitinib. The most common side effects of tofacitinib are upper respiratory tract infections, headache, diarrhea, and nasopharyngitis. Blood tests will be used to monitor for increases in cholesterol or liver enzymes and for reductions in blood cell counts while taking tofacitinib. Some patients will start to see improvement within a few weeks, but it may take several months to take full effect. Tofacitinib should not be given in combination with another biologic drug or other potent immunosuppressants such as azathioprine or mycophenolate. Tofacitinib may be used alone or in combination with methotrexate or other disease modifying antirheumatic drugs (DMARDs). People with moderate to severe kidney or liver problems should take a lower dose. You may take tofacitinib with or without food. Tofacitinib is a pill that is taken either as 5 mg twice a day (Xeljanz) or as 11 mg once per day (Xeljanz XR). This medication is commonly used after methotrexate and tumor necrosis factor inhibitors. JAKs play a role in joint inflammation in RA, which can cause pain, swelling, and stiffness. It works by blocking enzymes called Janus kinases (JAKs). Tofacitinib Citrate (Xeljanz) is an oral drug used to treat adults with moderate to severe active rheumatoid arthritis (RA), active psoriatic arthritis, ankylosing spondylitis, moderate to severe ulcerative colitis, and children ages 2 and older with active polyarticular juvenile idiopathic arthritis.
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