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Treatment of moderate to severe rheumatoid arthritis; may also be prescribed for other immune-mediated inflammatory conditions as per specialist advice (e.g., psoriatic arthritis, ankylosing spondylitis, atopic dermatitis, ulcerative colitis) depending on approved indication and local labeling.

Upadacitinib is a Janus kinase (JAK) inhibitor (preferentially JAK1). It reduces inflammatory signaling by blocking cytokine pathways involved in immune activation, thereby decreasing pain, swelling and disease activity.

Oral tablet. Take exactly as prescribed, usually once daily, at the same time each day, with or without food. Swallow whole with water; do not crush/chew. If a dose is missed, take as soon as remembered on the same day; do not double the next dose.

Upper respiratory tract infection, nasopharyngitis, nausea, abdominal pain, headache, acne, cough, fever, increased liver enzymes, increased cholesterol, herpes zoster

Prescription-only immunosuppressant. Increased risk of serious infections (including TB, herpes zoster and opportunistic infections); screen for TB and viral hepatitis before starting and monitor. Risk of blood clots (DVT/PE), major cardiovascular events and malignancy reported with JAK inhibitors—use caution in patients with risk factors. Monitor CBC (low lymphocytes/neutrophils/hemoglobin), liver enzymes and lipids; stop/withhold in severe abnormalities. Avoid live vaccines during treatment; update immunizations before starting. Use caution in hepatic impairment; dose adjustments/avoidance may be needed as per label. Seek urgent care for signs of infection, chest pain, shortness of breath, leg swelling, severe abdominal pain or black stools.

Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin) may increase levels; strong CYP3A4 inducers (e.g., rifampicin, carbamazepine, phenytoin, St John’s wort) may reduce effect. Avoid combining with other potent immunosuppressants/biologics (e.g., other JAK inhibitors, TNF inhibitors, cyclosporine, azathioprine) unless directed by specialist. Live vaccines should be avoided.

Store below 30°C in a dry place, protected from light and moisture. Keep in original pack and out of reach of children.

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