Rinvoq dosage, forms, and strengths

Rinvoq is a brand-name prescription drug used to treat a spectrum of autoimmune diseases including moderate to severe rheumatoid arthritis (RA), psoriatic arthritis (PsA), spinal arthritis, inflammatory bowel disease (IBD), and eczema. The active ingredient in Rinvoq, upadacitinib, belongs to a class of antirheumatic medications called Janus kinase inhibitors. JAK inhibitors block the immune system by interfering with the ability of immune cells to communicate with one another. Rinvoq is typically taken as a once-daily tablet, usually for a limited duration.

Rinvoq forms and strengths

• Extended-release tablets: 15 mg, 30 mg, 45 mg

Rinvoq dosage for adults

Rinvoq can help resolve active flare-ups of various types of autoimmune diseases including rheumatoid arthritis, psoriatic arthritis, spinal arthritis (ankylosing spondylitis or non-radiographic axial spondyloarthritis), inflammatory bowel disease (ulcerative colitis or Crohn’s disease), or atopic dermatitis (eczema). There are restrictions on its use based on age, other medical conditions, and other drugs being used.

Rinvoq dosage for rheumatoid or psoriatic arthritis

Rinvoq is FDA-approved to treat active flare-ups of moderate to severe rheumatoid or psoriatic arthritis, but only if the flare-ups are not improving with other immune-suppressing drugs called tumor necrosis factor blockers (TNF blockers). Rinvoq is not recommended for use with certain types of drugs that are also used to treat these conditions including other JAK inhibitors, biologic drugs (antibodies), and powerful immune suppressants such as cyclosporine or azathioprine.

• Standard Rinvoq dosage for active moderate to severe rheumatic arthritis or active psoriatic arthritis: One 15 mg tablet taken once per day 

Rinvoq dosage for spinal arthritis

Rinvoq is FDA-approved to treat ankylosing spondylitis and non-radiographic axial spondyloarthritis (nr-axSpA). Both are inflammatory arthritic conditions of the spine that may also show signs and symptoms in other parts of the body. Active non-radiographic axial spondyloarthritis has symptoms of inflammation but no evidence of arthritic damage in X-rays. Ankylosing spondylitis has both inflammatory symptoms and evidence of injury. Again, Rinvoq cannot be used with certain types of drugs that are also used to treat these conditions.

• Standard Rinvoq dosage for ankylosing spondylitis or nr-axSpA: One 15 mg tablet taken once per day 

Rinvoq dosage for inflammatory bowel disease (IBD)

Rinvoq is FDA approved to treat moderate to severe active ulcerative colitis or Crohn’s disease. Both are autoimmune inflammatory conditions of the digestive tract. Ulcerative colitis is more limited in its extent and damage, particularly in the large intestines, than Crohn’s. As with arthritic conditions, Rinvoq is only prescribed when TNF blockers are not enough to control a flare-up. It also is not recommended to be used with certain types of immune-suppressing treatments.

• Standard Rinvoq dosage for the initial treatment of ulcerative colitis: 45 mg taken once per day for eight weeks

• Standard Rinvoq dosage for the initial treatment of Crohn’s disease: 45 mg taken once per day for 12 weeks

• Standard Rinvoq dosage for the maintenance treatment of ulcerative colitis or Crohn’s disease: 15–30 mg taken once per day for unresponsive, severe, or extensive ulcerative colitis or Crohn’s disease

Rinvoq dosage for atopic dermatitis (eczema)

Rinvoq is FDA approved to resolve the symptoms of moderate to severe atopic dermatitis that isn’t improving with other immune-modulating drugs. Again, Rinvoq is not recommended to be used with other JAK inhibitors, biologic drugs, or powerful immunosuppressants. 

• Standard Rinvoq dosage for atopic dermatitis: 15–30 mg taken once per day (15 mg per day for people 65 years of age and older)

Rinvoq dosage for children

Rinvoq is FDA-approved for use in children 12 years of age and older (40 kg or more) to treat moderate to severe atopic dermatitis (eczema) that doesn’t respond well to other treatments. Dosages are the same as for adults.

Rinvoq dosage restrictions

Dosage restrictions for kidney disease or liver disease are required when Rinvoq is used to treat Crohn’s disease, ulcerative colitis, or atopic dermatitis. Treatment for ulcerative colitis and Crohn’s disease has two stages: a high-dose induction stage followed by a lower-dose maintenance stage. Both liver and kidney impairment will require dosage reductions in these cases:

• Severe renal impairment in patients with IBD (creatinine clearance 15-30 mL/min): 30 mg once per day induction dose and 15 mg once per day maintenance dose

• Severe renal impairment in patients with atopic dermatitis (creatinine clearance 15-30 mL/min): 15 mg once per day 

• End-stage kidney disease in patients with IBD or atopic dermatitis (creatinine clearance < 15 mL/min): Do not use

• Hepatic impairment in patients with IBD (Child-Pugh class A or B): 30 mg once per day induction dose and 15 mg once per day maintenance dose

Rinvoq is never used in any patient with severe liver disease (Child-Pugh class C).

How to take Rinvoq

• Use this medicine as directed. 

• Rinvoq comes with a Medication Guide. Please read it before starting this medicine.

• Only one dose is taken each day.

• Rinvoq can be taken with or without food.

• Swallow the extended-release tablet whole. Do not split, crush, or chew it.

• Avoid foods or drinks containing grapefruit.

• Part of the Rinvoq tablet may pass into your stools. Report to your healthcare provider if you notice it repeatedly.  

• Store the medicine in a closed container at room temperature. Keep it in the original bottle protected from moisture.

• Limit sunlight exposure. Wear protective clothing and use sunscreen.

Rinvoq dosage FAQs

How long does it take Rinvoq to work?

It will depend on the condition being treated. In clinical trials, some people with atopic dermatitis, psoriatic arthritis, and IBD experienced significant symptom relief in as little as two weeks, including symptoms like itching, skin appearance, joint pain, swelling, and abdominal pain. However, it may take a few months of treatment for others to get noticeable symptom relief. 

What happens if I miss a dose of Rinvoq?

Ask the prescriber what to do if a dose is missed.

How long can you take Rinvoq?

Rinvoq can be taken for as long as necessary provided that it works and doesn’t cause serious problems. However, it’s intended as a limited treatment for most problems. For long-term use, healthcare professionals will try to use the lowest dose possible. Rinvoq may be immediately discontinued when it starts causing problems like a serious infection or abnormal blood tests.

How do I stop taking Rinvoq?

Rinvoq can be stopped immediately at any time without causing withdrawal. Immediate discontinuation may be necessary if serious side effects are experienced.

What is the maximum dosage for Rinvoq?

There is no maximum dosage specified for Rinvoq. For active IBD, the highest dosage is 45 mg. A 30 mg dose or 15 mg dose is the highest dose for most other indications. 

What interacts with Rinvoq?

Rinvoq has FDA-imposed limitations of use because of its power to shut down the immune system. When Rinvoq is prescribed for any reason, healthcare providers should not prescribe:

• Another JAK inhibitor

• A biologic disease-modifying antirheumatic drug (DMARD)

• Potent immunosuppressants such as cyclosporine and azathioprine.

These are all drugs commonly used to treat rheumatoid arthritis, psoriatic arthritis, IBD, and severe eczema, so these drugs are not recommended to be taken with Rinvoq.

Because of immune suppression and the risk of infection, live vaccines are contraindicated in people taking Rinvoq.

Other serious drug interactions involve drugs called CYP3A4 inhibitors that block the ability of the body to break down upadacitinib. This increases the risk of side effects. They’re not prohibited, but healthcare professionals have to be more vigilant about monitoring for side effects. Grapefruit and grapefruit juice are in this category, so they should be avoided.

Some drugs do the opposite: they speed up the body’s metabolism of upadacitinib. That makes the drug less effective, so these drugs may need to be discontinued.

Is it safe to take Rinvoq during pregnancy?

Based on animal studies, Rinvoq may harm an unborn baby. Although Rinvoq is not prohibited during pregnancy, the risk is considered high enough that healthcare providers must test women for pregnancy before prescribing this drug. Additionally, women of reproductive age will be asked to use contraception while taking Rinvoq and for four weeks after the final dose. If it’s prescribed to a pregnant woman, healthcare providers will report this to a pregnancy surveillance program.

Is it safe to take Rinvoq while breastfeeding?

There is no data available on the presence of upadacitinib in human milk, the effects on the breastfed infant, or the effects on milk production. Because of the risk of possible serious side effects in an infant, women should not breastfeed when taking Rinvoq. They should wait at least six days after the last dose before they begin breastfeeding.

What should I know about the side effects of Rinvoq?

Before you take Rinvoq, a healthcare professional will outline many of the risks and the boxed warnings of Rinvoq. The prescriber will also regularly visit with patients and perform blood tests to monitor the effects of the drug. That’s because Rinvoq can cause serious side effects including:

• Serious infections: Because Rinvoq blocks the immune system, people on Rinvoq treatment are more likely to get infections including upper respiratory tract infections (like colds), opportunistic infections, and even serious or fatal infections. 

• Reactivated infections: People with latent infections such as herpes zoster, herpes simplex, hepatitis B, or tuberculosis may find those latent infections developing into active infections. Doctors will need to test for these infections before prescribing Rinvoq.

• Death and cardiovascular emergencies: JAK inhibitors like Rinvoq increase the risk of cardiovascular events and heart attack in people with cardiovascular disease risk factors.

• Cancer: JAK inhibitors also increase the risk of cancers such as lymphoma, lung cancer, and skin cancer.

• Developing a hole in the digestive system: Gastrointestinal perforation is a serious and life-threatening side effect of Rinvoq treatment. It is more likely to happen in people who have intestinal problems like diverticulitis or who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.

• Anemia and low white blood cell counts: Rinvoq can interfere with the body’s ability to make blood cells, including white blood cells that fight off infections. Doctors will take a complete blood count before prescribing Rinvoq and then regularly monitor the blood during treatment to make sure this doesn’t escalate into a serious problem.

• Drug-induced liver injury: Upadacitinib can damage the liver, so doctors need to measure baseline liver enzymes before prescribing this drug and then take regular blood tests to make sure the liver is not being affected

• Blood clots (thrombosis)

• Elevated cholesterol and lipid levels

• Severe allergic reactions

Sources

• My Rinvoq routine, Abbvie Inc

• Rinvoq drug summary, Prescriber’s Digital Reference

• Rinvoq healthcare professional website, Abbvie Inc

• Rinvoq patient website, Abbvie Inc

• Rinvoq upadacitinib tablet prescribing information, DailyMed, NIH National Library of Medicine