II. Indications
-
Rheumatoid Arthritis
- Refractory to non-biologic DMARD
III. Contraindications
- Severe hepatic Impairment (Child-Pugh Class C)
- Concurrent Immunosuppressants
- Biologic DMARDs
- Cyclosporine, azathoprine and other potent Immunosuppressants
- Probenacid (OAT3 transport inhibitor)
IV. Mechanism
V. Dosing: Adults
- Rheumatoid Arthritis: 15 mg orally daily
VI. Adverse Effects
- See Janus Kinase Inhibitor
- Serious infections (e.g. Sepsis)
- Opportunistic infections (e.g. invasive fungal)
- Infection Reactivation (e.g. Tb reactivation, Shingles reactivation)
- Screen for Latent Tuberculosis before starting
- Malignancy including Lymphoma
- Major cardiovascular events
- Venous Thromboembolism
- Hepatotoxicity
- Myelosuppression
- Lymphopenia
- Avoid starting if Absolute Lymphocyte Count <500
- Anemia
- Avoid starting if Hemoglobin <8 mg/dl
- Neutropenia
- Avoid starting if Absolute Neutrophil Count (ANC) <1000
- Lymphopenia
VII. Safety
- Avoid in pregnancy (Unknown safety)
- Use reliable Contraception during and for at least 4 weeks after stopping Upadacitinib
- Avoid in Lactation
- Wait at least 4 days after last dose to begin Breast Feeding
- Monitoring (obtain baseline and recheck periodically)
- Complete Blood Count
- Liver Function Tests
- Lipid panel (after 3 months of use)
VIII. Drug Interactions
IX. Resources
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