upadacitinib (Rx)

Brand and Other Names:Rinvoq

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet, extended-release

  • 15mg

Rheumatoid Arthritis

Indicated for moderately to severely active rheumatoid arthritis (RA) in adults who have had an inadequate response or intolerance to ≥1 tumor necrosis factor (TNF) blockers

15 mg PO qDay

Psoriatic Arthritis

Indicated for active psoriatic arthritis (PsA) in adults who have had an inadequate response or intolerance to ≥1 TNF blockers

15 mg PO qDay

Atopic Dermatitis

Indicated for refractory moderate-to-severe atopic dermatitis (AD) in adults whose disease is not adequately controlled with other systemic therapies or if those therapies are inadvisable

<65 years

  • 15 mg PO qDay initially; consider increasing to 30 mg qDay if an adequate response is not achieved
  • Discontinue if 30-mg dose if adequate response is not achieved
  • Use lowest effective dose needed to maintain response

Ulcerative Colitis

Indicated for moderate to severe active ulcerative colitis (UC) in adults who had inadequate response or intolerance to ≥1 TNF blocker

Induction: 45 mg PO qDay x 8 weeks

Maintenance

  • 15 mg PO qDay
  • Refractory, severe, or extensive disease: Consider 30 mg qDay
  • Use lowest effective dosage needed to maintain response
  • Discontinue if unable to achieve adequate therapeutic response with 30 mg/day

Ankylosing Spondylitis

Indicated for active ankylosing spondylitis (AS) in adults who have had an inadequate response or intolerance to ≥1 TNF blockers

15 mg PO qDay

Nonradiographic Axial Spondyloarthritis

Indicated for active nonradiographic axial spondyloarthritis (nr-axSpA) with objective signs of inflammation who have had an inadequate response or intolerance to TNF blocker therapy

15 mg PO qDay

Crohn Disease

Indicated for moderately-to-severely active Crohn disease in adults who have had an inadequate response or intolerance to ≥1 TNF blockers

Induction: 45 mg PO qDay x 12 weeks

Maintenance: 15 mg PO qDay; consider 30 mg qDay for patients with refractory, severe, or extensive disease

Discontinue if unable to achieve an adequate therapeutic response with 30-mg dosage

Use lowest effective dose needed to maintain response

Dosage Modifications

Coadministration of strong CYP3A4 inhibitors

  • RA, PsA, AD, AS, or nr-axSpA: 15 mg PO qDay
  • UC: 30 mg qDay x 8 weeks for induction, then 15 mg qDay for maintenance
  • CD: 30 mg qDay x 12 weeks for induction, then 15 mg qDay for maintenance

Infection

  • If serious infection (eg, serious opportunistic infections) develops, interrupt treatment until infection is controlled

Dose interruption for laboratory abnormalities

  • Absolute neutrophil count (ANC) <1000 cells/mm3: Interrupt; may restart once ANC >1000 cells/mm3
  • Absolute lymphocyte count (ALC) <500 cells/mm3: Interrupt; may restart once ALC >500 cells/mm3
  • Hemoglobin (Hb) <8 g/dL: Interrupt; may restart once Hb >8 g/dL
  • Hepatic transaminases: Interrupt if drug-induced liver injury suspected

Renal impairment

  • RA, PsA, AS, or nr-axSpA
    • Mild (eGFR 60 to <90 mL/min/1.73 m2), moderate (eGFR 30 to <60 mL/min/1.73 m2), severe renal impairment (eGFR 15 to <30 mL/min/1.73 m2): No dose adjustment necessary
    • ESRD: Not studied
  • AD
    • Mild or moderate (eGFR >30 mL/min/1.73 m2): No dose adjustment necessary
    • Severe (eGFR <30 mL/min/1.73 m2): 15 mg PO qDay
    • ESRD: Not studied
  • UC
    • Mild or moderate (eGFR >30 mL/min/1.73 m2): No dose adjustment necessary
    • Severe (eGFR 15 to <30 mL/min/1.73 m2): 30 mg qDay x 8 weeks for induction, then 15 mg qDay for maintenance
    • ESRD (eGFR <15 mL/min/1.73 m2): Not recommended
  • Crohn disease
    • Mild-to-moderate (eGFR ≥30 mL/min/1.73m2): No dosage adjustment necessary
    • Severe (eGFR 15 to <30 mL/min/1.73m2): 30 mg qDay for 12 weeks for induction; 15 mg qDay for maintenance
    • ESRD (eGFR ≥30 mL/min/1.73m2): Not recommended

Hepatic impairment

  • RA, PsA, AS, nr-axSpA, or AD

    • Mild or moderate (Child-Pugh A or B): No dose adjustment required
  • RA, PsA, AS, nr-axSpA, UC, CD, or AD

    • Severe (Child-Pugh C): Not recommended

  • UC
    • Mild or moderate (Child-Pugh A or B): 30 mg qDay x 8 weeks for induction, then 15 mg qDay for maintenance
    • Severe (Child-Pugh C): Not recommended
  • Crohn disease
    • Mild-to-moderate (Child-Pugh A or B): 30 mg qDay for 12 weeks for induction; 15 mg qDay for maintenance
    • Severe (Child Pugh C): Not recommended

Dosing Considerations

ALC <500 cells/mm3, ANC <1000 cell/mm3, or Hb <8 g/dL: Do not initiate

  • Before initiating

    • Test for tuberculosis (TB) before initiating; initiate antitubercular treatment for previously untreated latent TB or active TB before initiating treatment
    • Verify pregnancy status in females of reproductive potential before initiating
    • Screen viral hepatitis in accordance with clinical guidelines
    • Update immunizations according to current immunization guidelines
  • Limitations of use

    • RA, PsA, AS or nr-axSpA: Use in combination with other JAK inhibitors, biologic disease-modifying antirheumatic drugs (DMARDs), or with potent immunosuppressants (eg, azathioprine, cyclosporine), is not recommended
    • AD: Not recommended in combination with other JAK inhibitors, biologic immunomodulators, or with other immunosuppressants
    • UC, CD: Not recommended in combination with other JAK inhibitors, biological therapies, or potent immunosuppressants (eg, azathioprine, cyclosporine)

Dosage Forms & Strengths

tablet, extended-release

  • 15mg

Atopic Dermatitis

Indicated for refractory moderate-to-severe atopic dermatitis (AD) in adults and pediatric patients aged ≥12 years whose disease is not adequately with other systemic therapies or if those therapies are inadvisable

≥12 years and >40 kg

  • 15 mg PO qDay initially; consider increasing to 30 mg qDay if an adequate response is not achieved
  • Discontinue if 30-mg dose if adequate response not achieved
  • Use lowest effective dose needed to maintain response

Dosage Modifications

Coadministration of strong CYP3A4 inhibitors: 15 mg PO qDay

Infection

  • If serious infection (eg, serious opportunistic infections) develops, interrupt treatment until infection is controlled

Renal impairment

  • RA, AS, and PsA
    • Mild, moderate, or severe: No dose adjustment necessary
    • ESRD: Not studied
  • AD
    • Mild or moderate (CrCl >30 mL/min): No dose adjustment necessary
    • Severe (CrCl <30 mL/min): 15 mg PO qDay
    • ESRD: Not studied

Hepatic impairment

  • RA, PsA, AS, AD
    • Mild or moderate (Child-Pugh A or B): No dose adjustment required
    • Severe (Child-Pugh C): Not recommended

Ulcerative Colitis (Orphan)

Orphan designation for treatment of pediatric ulcerative colitis

Sponsor

  • AbbVie; 1 North Waukegan Road; North Chicago, Illinois 60044

Dosing Considerations

  • Before initiating

    • Test for tuberculosis (TB) before initiating; initiate antitubercular treatment for previously untreated latent TB or active TB before initiating treatment
    • Verify pregnancy status in females of reproductive potential before initiating
    • Screen viral hepatitis in accordance with clinical guidelines
    • Update immunizations according to current immunization guidelines
  • Limitations of use

    • RA or PsA: Use in combination with other JAK inhibitors, biologic disease-modifying antirheumatic drugs (DMARDs), or with potent immunosuppressants (eg, azathioprine, cyclosporine), is not recommended
    • AD: Not recommended for use in combination with other JAK inhibitors, biologic immunomodulators, or with other immunosuppressants

Atopic Dermatitis

Indicated for refractory moderate-to-severe atopic dermatitis (AD) in adults whose disease is not adequately with other systemic therapies or if those therapies are inadvisable

≥65 years: 15 mg PO qDay

Next:

Interactions

Interaction Checker

and upadacitinib

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (26)

            • abatacept

              abatacept, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • abrocitinib

              abrocitinib, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • adalimumab

              adalimumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • alemtuzumab

              alemtuzumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • antithymocyte globulin equine

              antithymocyte globulin equine, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • avacopan

              avacopan, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • azathioprine

              azathioprine, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • baricitinib

              baricitinib, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • basiliximab

              basiliximab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • belatacept

              belatacept, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • belimumab

              belimumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • brodalumab

              brodalumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • canakinumab

              canakinumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • certolizumab pegol

              certolizumab pegol, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • cyclosporine

              cyclosporine, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • eculizumab

              eculizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • efgartigimod alfa

              efgartigimod alfa, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • efgartigimod/hyaluronidase SC

              efgartigimod/hyaluronidase SC, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • emapalumab

              emapalumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • etanercept

              etanercept, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • fingolimod

              fingolimod, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • golimumab

              golimumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • guselkumab

              guselkumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • infliximab

              infliximab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • ozanimod

              ozanimod, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • rozanolixizumab

              rozanolixizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            Serious - Use Alternative (77)

            • adenovirus types 4 and 7 live, oral

              upadacitinib decreases effects of adenovirus types 4 and 7 live, oral by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • amobarbital

              amobarbital will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • anakinra

              anakinra, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • apalutamide

              apalutamide will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • axicabtagene ciloleucel

              upadacitinib, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • BCG vaccine live

              upadacitinib decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • bosentan

              bosentan will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • brexucabtagene autoleucel

              upadacitinib, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • butabarbital

              butabarbital will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • butalbital

              butalbital will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • carbamazepine

              carbamazepine will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • ceritinib

              ceritinib will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • cholera vaccine

              upadacitinib decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • ciltacabtagene autoleucel

              upadacitinib, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • dabrafenib

              dabrafenib will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • dengue vaccine

              upadacitinib decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • efavirenz

              efavirenz will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • enzalutamide

              enzalutamide will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • etrasimod

              etrasimod, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Risk of additive immune system effects with etrasimod has not been studied in combination with antineoplastic, immune-modulating, or noncorticosteroid immunosuppressive therapies. Avoid coadministration during and in the weeks following administration of etrasimod.

            • etravirine

              etravirine will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • fexinidazole

              fexinidazole will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • idecabtagene vicleucel

              upadacitinib, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • inebilizumab

              inebilizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • influenza virus vaccine quadrivalent, intranasal

              upadacitinib decreases effects of influenza virus vaccine quadrivalent, intranasal by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • ivosidenib

              ivosidenib will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • ixekizumab

              ixekizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • lisocabtagene maraleucel

              upadacitinib, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • lonafarnib

              lonafarnib will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

            • lorlatinib

              lorlatinib will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • lumacaftor/ivacaftor

              lumacaftor/ivacaftor will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • measles (rubeola) vaccine

              upadacitinib decreases effects of measles (rubeola) vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • measles mumps and rubella vaccine, live

              upadacitinib decreases effects of measles mumps and rubella vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • measles, mumps, rubella and varicella vaccine, live

              upadacitinib decreases effects of measles, mumps, rubella and varicella vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • mitotane

              mitotane will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • mycophenolate

              mycophenolate, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • nafcillin

              nafcillin will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • natalizumab

              natalizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • ocrelizumab

              ocrelizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • pacritinib

              pacritinib, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • pegcetacoplan

              pegcetacoplan, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • pentobarbital

              pentobarbital will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • phenobarbital

              phenobarbital will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • phenytoin

              phenytoin will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • ponesimod

              ponesimod, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • primidone

              primidone will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • ravulizumab

              ravulizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • rifabutin

              rifabutin will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • rifampin

              rifampin will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • rifapentine

              rifapentine will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • rilonacept

              rilonacept, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • risankizumab

              risankizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • rotavirus oral vaccine, live

              upadacitinib decreases effects of rotavirus oral vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • rubella vaccine

              upadacitinib decreases effects of rubella vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • sarilumab

              sarilumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • satralizumab

              satralizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • secobarbital

              secobarbital will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • secukinumab

              secukinumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • siponimod

              siponimod, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • sirolimus

              sirolimus, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • smallpox (vaccinia) vaccine, live

              upadacitinib decreases effects of smallpox (vaccinia) vaccine, live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • St John's Wort

              St John's Wort will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.

            • sutimlimab

              sutimlimab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • tacrolimus

              tacrolimus, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • tisagenlecleucel

              upadacitinib, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • tocilizumab

              tocilizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • tofacitinib

              tofacitinib, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • tucatinib

              tucatinib will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

            • typhoid polysaccharide vaccine

              upadacitinib decreases effects of typhoid polysaccharide vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • typhoid vaccine live

              upadacitinib decreases effects of typhoid vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • ustekinumab

              ustekinumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • varicella virus vaccine live

              upadacitinib decreases effects of varicella virus vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • vedolizumab

              vedolizumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • voclosporin

              voclosporin, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            • voxelotor

              voxelotor will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            • yellow fever vaccine

              upadacitinib decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • zoster vaccine live

              upadacitinib decreases effects of zoster vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            Monitor Closely (29)

            • atazanavir

              atazanavir will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • chloramphenicol

              chloramphenicol will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • clarithromycin

              clarithromycin will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • cobicistat

              cobicistat will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • conivaptan

              conivaptan will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • darunavir

              darunavir will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • elagolix

              elagolix decreases levels of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • idelalisib

              idelalisib will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • indinavir

              indinavir will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • isoniazid

              isoniazid will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • istradefylline

              istradefylline will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

            • itraconazole

              itraconazole will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • ketoconazole

              ketoconazole will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • lenacapavir

              lenacapavir will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

            • levoketoconazole

              levoketoconazole will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • lopinavir

              lopinavir will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • mifepristone

              mifepristone will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • nefazodone

              nefazodone will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • nelfinavir

              nelfinavir will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • posaconazole

              posaconazole will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • ribociclib

              ribociclib will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ritonavir

              ritonavir will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • rucaparib

              rucaparib will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • saquinavir

              saquinavir will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • stiripentol

              stiripentol will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • tazemetostat

              tazemetostat will decrease the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tipranavir

              tipranavir will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.

            • ublituximab

              ublituximab and upadacitinib both increase immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Owing to potential additive immunosuppressive effects, consider duration of effect and mechanism of action of these therapies if coadministered

            • voriconazole

              voriconazole will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            Minor (4)

            • acetazolamide

              acetazolamide will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • anastrozole

              anastrozole will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • cyclophosphamide

              cyclophosphamide will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • larotrectinib

              larotrectinib will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            RA

            • Upper respiratory tract infection (13.5%)

            AD

            • Upper respiratory tract infection (23-25%)
            • Acne (10-16%)

            1-10%

            RA

            • Nausea (3.5%)
            • Neutropenia (1.1-2.4%)
            • Lymphopenia (0.3-2.4%)
            • Cough (2.2%)
            • Elevated ALT (0.8-2.1%)
            • Increased creatine phosphokinase (0.3-1.6%)
            • Elevated AST (1-1.5%)
            • Pyrexia (1.2%)

            PsA

            • Bronchitis (3.9%)
            • Herpes simplex (1.4%)
            • Acne (1.3%)
            • Herpes zoster (1.1%)

            AD

            • Herpes simplex virus (4-8%)
            • Headache (6%)
            • Increased blood creatine phosphokinase (5-6%)
            • Cough (3%)
            • Hypersensitivity (2-3%)
            • Folliculitis (2-3%)
            • Nausea (3%)
            • Abdominal pain (2-3%)
            • Pyrexia (2%)
            • Increased weight (2%)
            • Herpes zoster (2%)
            • Influenza (2%)
            • Fatigue (1-2%)
            • Neutropenia (1-2%)
            • Myalgia (1-2%)
            • Influenza like illness (1-2%)

            <1%

            RA

            • Pneumonia
            • Herpes zoster
            • Herpes simplex (includes oral herpes)
            • Oral candidiasis
            • Anemia (<0.1%)

            Frequency Not Defined

            RA

            • Tuberculosis
            • Malignancies, excluding nonmelanoma skin cancer
            • Venous thrombosis
            • Elevated LDL
            • Elevated HDL
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            Warnings

            Black Box Warnings

            Serious infection

            • Increases risk for developing serious infections that may lead to hospitalization or death
            • Most patients with severe infections were also taking concomitant immunosuppressants (eg, methotrexate, corticosteroids)
            • If a serious infection develops, interrupt therapy until infection is controlled
            • Carefully consider risks and benefits before initiating upadacitinib in patients with chronic or recurrent infection
            • Closely monitor for signs and symptoms of infection during and after treatment, including possible development of TB in patients who tested negative for latent TB infection before initiating therapy
            • Reported infections include
              • Active tuberculosis (TB), which may present with pulmonary or extrapulmonary disease; test for latent TB before use and during therapy; consider treating latent infection before upadacitinib use
              • Invasive fungal infections, including cryptococcosis and pneumocystosis
              • Bacterial, viral (including varicella-zoster or prophylactic herpes zoster), and other infections due to opportunistic pathogens

            Mortality

            • Patients with RA aged ≥50 years with at least 1 cardiovascular risk factor comparing another Janus kinase (JAK) inhibitor to TNF blockers, showed a higher rate of all-cause mortality, including sudden cardiovascular death, was observed with the JAK inhibitor

            Malignancies

            • Lymphoma and other malignancies reported
            • Higher rate of malignancies (excluding non-melanoma skin cancer) observed
            • Current or past smokers are at additional increased risk

            Thrombosis

            • Thrombosis, including deep venous thrombosis (DVT), pulmonary embolism (PE), and arterial thrombosis have occurred in patients treated with JAK inhibitors used to treat inflammatory conditions
            • Many of these adverse events were serious and some resulted in death
            • Consider risks and benefits prior to treating patients who may be at increased risk
            • Avoid therapy in patients at risk
            • Promptly evaluate and treat patients with symptoms of thrombosis

            Major adverse cardiovascular events (MACE)

            • In patients with RA ≥50 years with at least 1 cardiovascular risk factor treated with another JAK inhibitor, a higher rate of MACE (defined as cardiovascular death, myocardial infarction, and stroke), was observed
            • Patients who are current or past smokers are at additional increased risk
            • Discontinue therapy in patients that have experienced a myocardial infarction or stroke

            Contraindications

            Hypersensitivity to upadacitinib or any of its excipients

            Cautions

            Malignancies reported; consider risks and benefits of treatment before initiating in patients with known malignancy, other than previously treated nonmelanoma skin cancer; screen for malignancies during treatment according to guidelines; periodic skin examination recommended for patients who are at increased risk for skin cancer

            Thrombosis reported, including DVT, PE, and arterial thrombosis; avoid therapy in patients that may be at increased risk of thrombosis

            Gastrointestinal perforation reported; monitor treated patients who may be at risk for gastrointestinal perforation (eg, patients with history of diverticulitis and those taking concomitant medications including NSAIDs or corticosteroids); evaluate promptly patients presenting with new onset abdominal pain for early identification of gastrointestinal perforation

            Higher rate of major adverse cardiovascular events (MACE; defined as cardiovascular death, myocardial infarction, and stroke) reported with another JAK inhibitor Vs TNF blockers in RA patients

            Patients with RA aged ≥50 years with at least 1 cardiovascular risk factor, a higher rate of all-cause mortality, including sudden cardiovascular death, was observed

            May cause neutropenia, lymphopenia, anemia, elevated lipids, or elevated liver enzymes; monitor for abnormal laboratory values and assess the need to interrupt dosing

            Exposure to sunlight and UV light should be limited by wearing protective clothing and using a broad-spectrum sunscreen

            Serious hypersensitivity reactions such as anaphylaxis and angioedema were reported; if a clinically significant hypersensitivity reaction occurs, discontinue therapy and institute appropriate therapy

            Based on findings in animal studies, may cause fetal harm when administered to pregnant females

            Serious and fatal infections

            • Serious and fatal infections reported
            • Most frequent infections reported included pneumonia and cellulitis
            • Opportunistic infections reported included TB, multidermatomal herpes zoster, oral/esophageal candidiasis, and cryptococcosis
            • Closely monitor for developing signs and symptoms of infection during and after treatment
            • Interrupt therapy if a serious or opportunistic infection develops
            • Initiate prompt and complete diagnostic testing appropriate for an immunocompromised patient if new infection develops; initiate appropriate antimicrobial therapy, closely monitor, and interrupt therapy if not responding to antimicrobial therapy; resume once infection controlled
            • Evaluate and test patients for latent and active tuberculosis (TB) infection prior to treating; patients with latent TB should be treated with standard antimycobacterial therapy before initiating treatment
            • Avoid use with an active, serious infection, including localized infections
            • Higher rate of serious infections reported with 30 mg dose compared to 15 mg
            • Consider risks and benefits of treatment before initiating in the following patients
              • With chronic or recurrent infection
              • Who have been exposed to TB
              • With history of serious or opportunistic infection
              • Who have resided or traveled in areas of endemic tuberculosis or endemic mycoses
              • With underlying conditions that may predispose them to infection
            • Viral reactivation
              • Viral reactivation, including cases of herpes virus reactivation (eg, herpes zoster) and hepatitis B virus reactivation, were reported
              • If herpes zoster develops, consider temporarily interrupting therapy until episode resolves
              • Screen for viral hepatitis and monitor for reactivation in accordance with clinical guidelines before starting and during therapy

            Increased risk of serious heart-related problems and cancer

            • On September 1st, 2021, FDA is requiring revisions to warnings for upadacitinib to include information about the risks of serious heart-related events, cancer, blood clots, and death
            • Revisions are based on results from completed trial show a higher occurrence of serious heart-related events and cancer in tofacitinib-treated group (both doses) compared to TNF inhibitor-treated group; results also showed an increased risk of blood clots and death with lower doses of tofacitinib
            • Not studied in trials, so risks have not been adequately evaluated; however, owing to similar mechanisms of action, FDA considers upadacitinib may have similar risks
            • A higher rate of all-cause mortality, including sudden cardiovascular death, was observed in patients treated with the JAK inhibitor compared with TNF blockers; consider benefits and risks for individual patient before initiating or continuing treatment, especially the following patients:
              • Who are current or past smokers
              • Who have other cardiovascular risk factors
              • Who have developed a malignancy
              • Who have a known malignancy other than a successfully treated nonmelanoma skin cancer
            • Reserve JAK inhibitors (eg, tofacitinib) if patients have an inadequate response or intolerance to ≥1 TNF blockers
            • Counsel patients about the benefits and risks of these medicines and advise them to seek emergency medical attention if they experience signs and symptoms of a heart attack, stroke, or blood clot

            Medication residue in stool

            • Reports of medication residue in stool or ostomy output reported; most reports described anatomic (eg, ileostomy, colostomy, intestinal resection) or functional gastrointestinal conditions with shortened gastrointestinal transit times
            • Instruct patients to contact their healthcare provider if medication residue observed repeatedly
            • Monitor patients clinically and consider alternative treatment if there is inadequate therapeutic response

            Drug interaction overview

            • Substrate of CYP3A4 (major) and CYP2D6 (minor)
            • Strong CYP3A4 inhibitors
              • Use caution; maintain upadacitinib dose to 15 mg qDay
              • Coadministration of upadacitinib 30 mg qDay with strong CYP3A4 inhibitors is not recommended
              • Upadacitinib systemic exposure is increased when coadministered with strong CYP3A4 inhibitors
            • Strong CYP3A4 inducers
              • Coadministration not recommended
              • Upadacitinib systemic exposure is decreased when coadministered with strong CYP3A4 inducers
            • Vaccines
              • Avoid use of live, attenuated, vaccines during or immediately prior to therapy initiation
              • Prior to initiating therapy, it is recommended that patients be brought up to date with all immunizations, including varicella zoster or prophylactic herpes zoster vaccinations, in agreement with current immunization guidelines
              • Ensure vaccinations are current before initiating upadacitinib
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            Pregnancy & Lactation

            Pregnancy

            Available data from the pharmacovigilance safety database and postmarketing case reports in pregnant women are not sufficient to evaluate a drug-associated risk for major birth defects or miscarriage; advise patients of reproductive potential and pregnant patients of potential risk to fetus

            Verify pregnancy status of females of reproductive potential before starting treatment

            Report pregnancies to the AbbVie Inc.’s Adverse Event reporting line at 1-888-633-9110, or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

            Animal data

            • In animal embryo-fetal development studies, oral administration to pregnant rats and rabbits at exposures equal to or greater than approximately 1.6 and 15 times the 15 mg dose, 0.8 and 7.6 times the 30 mg dose, and 0.6 and 5.6 times the maximum recommended human dose (MRHD) of 45 mg (on an AUC basis) resulted in dose-related increases in skeletal malformations (rats only), an increased incidence of cardiovascular malformations (rabbits only), increased post-implantation loss (rabbits only), and decreased fetal body weights in both rats and rabbits
            • No developmental toxicity was observed in pregnant rats and rabbits treated during organogenesis at exposures approximately 0.29 and 2.2 times the 15 mg dose, 0.15 times and 1.1 times the 30 mg dose, and at 0.11 and 0.82 times the MHRD (on an AUC basis)
            • In a pre- and post-natal development study in pregnant female rats, oral administration at exposures approximately 3 times the 15 mg dose, 1.4 times the 30 mg dose, and the same as the MRHD (on an AUC basis) resulted in no maternal or developmental toxicity

            Contraception

            • Females of reproductive potential: Use effective contraception during treatment and for 4 weeks after final dose

            Clinical considerations

            • Published data suggest that increased disease activity is associated with risk of developing adverse pregnancy outcomes in women with rheumatoid arthritis or ulcerative colitis
            • Adverse pregnancy outcomes include preterm delivery (before 37 weeks of gestation), low birth weight (less than 2500 g) infants, and small for gestational age at birth

            Lactation

            No data available on the presence of upadacitinib in human milk, the effects on the breastfed infant, or the effects on milk production

            Available data in animals have shown upadacitinib excreted in milk

            If a drug is present in animal milk, it is likely the drug will be present in human milk

            Because of the potential for serious adverse reactions in the breastfed infant, advise patients that breastfeeding is not recommended during treatment with upadacitinib, and for 6 days (~10 half-lives) after the last dose

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Janus kinase-1 (JAK1)-selective inhibitor; JAK1 is essential for certain cytokines to elicit signals from various interleukins, cardiotrophin, neurotrophin, and interferons

            These signals are crucial in maintaining the inflammatory condition in rheumatoid arthritis (RA); inhibition of JAK reduces production of and modulates proinflammatory cytokines central to RA

            Absorption

            Peak plasma time: 2-4 hr

            Steady-state reached within 4 days

            Distribution

            Protein bound: 52%

            Metabolism

            Metabolized by mainly CYP3A4 and potentially minor contribution from CYP2D6

            Elimination

            Half-life: 8-14 hr

            Excretion

            • Urine (24%); feces (38%)
            • ~34% of upadacitinib dose was metabolites
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            Administration

            Oral Administration

            Take orally with or without food

            Swallow tablet whole; do not split, crush, or chew

            Storage

            Store at 2-25ºC (36-77ºF)

            Store in original bottle to protect from moisture

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            Images

            No images available for this drug.
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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.