Tofacitinib Print Page

What is Tofacitinib?

  • Tofacitinib (Xeljanz) is in a class of medications called disease modifying antirheumatic drugs (DMARDs)
  • DMARDs are a slow acting but effective treatment for rheumatoid arthritis and other form of inflammatory arthritis.

What is the typical dose for tofacitinib?

  • 5 mg twice per day given by mouth

How does tofacitinib work?

  • Tofacitinib is a relatively new DMARD, approved for use in Canada in 2014
  • Tofacitinib works by blocking the effect of an immune pathway called JAK-STAT.  By doing this, it can help decrease the body’s inflammatory response, thereby decreasing joint inflammation.
  • The benefit of Tofacitinib can be seen in patients as early as 2-4 weeks after starting it.
  • There is no clear data yet to suggest tofacitinib is a better medication than other new medications for rheumatoid arthritis called biologics.

If I start tofacitinib, can I stop my other DMARDs?

  • Most rheumatologists will suggest you continue with at least methotrexate, assuming you have not had side effects, in addition to tofacitinib. Studies have shown it works significantly better when combined with methotrexate.
  • Keep in mind: In most instances, your rheumatologist has recommended you start a new medication because your inflammatory arthritis has not been well controlled. It is important to try to control your disease as best as possible first, which may mean continuing all DMARDs for some time, before trying to decrease them.

What are the possible side effects of tofacitinib?

  • While generally well tolerated, tofacitinib can cause:
    • Upset Stomach
    • Increase your risk for serious infections
    • Lower blood counts
    • Raise cholesterol
    • Irritate the liver

What can I do to decrease my risk of side effects?

  • Stop tofacitinib any time you have a fever. It is usually safe to resume it once you are better.
  • Fevers and other severe illness should not be ignored and discussed with your doctor.
  • Follow your rheumatologist’s instructions for monitoring bloodwork regularly.
  • Let your physician know if you have any changes in your medical history.

What should I do if I miss my dose?

  • If you miss your dose, do not take an extra dose, but just resume your normal routine.  As long as this does not happen regularly, you will likely not feel any ill effects.

How can I safely stop tofacitinib?

  • It is safe to just stop tofacitinib; you do not need to slowly reduce the dose. However, keep in mind, if you were gaining any benefit, it will usually take a few weeks to lose it.


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Rheumatologists see over 100 different types of diseases. We are known for seeing arthritis, however, we also see many other conditions.

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