Key takeaways

  • Xeljanz and Xeljanz XR (tofacitinib) are prescription drugs taken to treat certain autoimmune conditions, including rheumatoid arthritis.
  • More common side effects of these drugs include infections, headache, and diarrhea.
  • Before starting Xeljanz or Xeljanz XR, it’s important to discuss any existing medical conditions and all medications with your doctor to assess potential risks and ensure proper monitoring during treatment.

Specifically, Xeljanz or Xeljanz XR are used in adults to treat:

Additionally, Xeljanz is used in certain children with juvenile idiopathic arthritis.

Xeljanz comes as an oral solution or a tablet that you take by mouth. This tablet is an immediate-release form. The extended-release tablet, Xeljanz XR, releases medication into your body slowly over time. Both Xeljanz and Xeljanz XR have the same risks of side effects.

Keep reading to learn about the common, mild, and serious side effects that Xeljanz can cause. For a general overview of the drug, including details about its uses, see this article.

Xeljanz and Xeljanz XR have boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “Boxed warnings for Xeljanz” section.

Some people may experience mild or serious side effects during Xeljanz or Xeljanz XR treatment.

Here are just a few of the more common side effects reported by people who took Xeljanz in studies. Both Xeljanz and Xeljanz XR have the same risks of side effects. Note that these effects can vary, depending on your condition.

More common side effects in people taking Xeljanz or Xeljanz XR for rheumatoid arthritis, psoriatic arthritis, or juvenile idiopathic arthritis may include:

More common side effects in people taking Xeljanz or Xeljanz XR for ulcerative colitis may include:

For more information about some of these side effects, see “Tips for managing side effects.”

You may have mild side effects while you’re taking Xeljanz or Xeljanz XR. If you have any that are bothersome, be sure to talk with your doctor. They may be able to recommend ways to decrease these side effects.

These side effects can vary depending on what condition you’re using the drug to treat.

Examples of mild side effects that may occur in people taking Xeljanz or Xeljanz XR for rheumatoid arthritis, psoriatic arthritis, or juvenile idiopathic arthritis include:

For more information about some of these side effects, see “Tips for managing side effects.”

Examples of mild side effects that may occur in people taking Xeljanz or Xeljanz XR for ulcerative colitis include:

In most cases, these side effects should be temporary. And some may be easily managed, too. But if you have any symptoms that are ongoing or that bother you, talk with your doctor or pharmacist. And don’t stop using Xeljanz or Xeljanz XR unless your doctor recommends it.

Xeljanz and Xeljanz XR may cause mild side effects other than the ones listed above. For more information, see the drugs’ prescribing information.

For more information about some of these side effects, see “Tips for managing side effects.”

Xeljanz and Xeljanz XR may cause serious side effects. The following list may not include all possible serious side effects of the drug. For more information, you can refer to the drugs’ prescribing information.

If you develop serious side effects while taking Xeljanz or Xeljanz XR, call your doctor right away. If the side effects seem life threatening or if you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported include:

  • heart or blood vessel problems, such as heart attack or stroke
  • gastrointestinal perforation (see “Tips for managing side effects”)
  • changes in levels of liver enzymes or certain blood cells (see “Tips for managing side effects”)
  • risk of serious infections (see “Boxed warnings for Xeljanz”)
  • risk of cancer and immune system disorders (see “Boxed warnings for Xeljanz”)
  • risk of blood clots (see “Boxed warnings for Xeljanz”)
  • risk of death in certain people (see “Boxed warnings for Xeljanz”)

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medication safer for everyone by giving doctors and researchers more information about how the drug works in real life. If you develop a side effect while taking Xeljanz or Xeljanz XR and want to tell the FDA about it, visit MedWatch or call 800-FDA-1088.

Allergic reaction

For some people, Xeljanz or Xeljanz XR can cause an allergic reaction.

In general, symptoms of an allergic reaction can be mild or serious.

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms and can determine whether you should continue treatment with Xeljanz or Xeljanz XR.

If you have symptoms of a severe allergic reaction, such as swelling or difficulty breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to Xeljanz or Xeljanz XR, they may have you switch to a different treatment.

Get answers to some frequently asked questions about Xeljanz’s side effects below.

Does Xeljanz cause hair growth or hair loss?

It depends. A small study has shown that people with alopecia may benefit from taking tofacitinib, the active drug in Xeljanz and Xeljanz XR. It’s important to note that there was no control (placebo) group in this study to compare results to. Alopecia is an autoimmune disease that causes hair loss. At this time, Xeljanz is not approved to treat alopecia.

As for hair loss, you shouldn’t experience this as a side effect of Xeljanz or Xeljanz XR. Hair loss wasn’t reported in people who took Xeljanz in studies.

If you’re concerned about hair loss, talk with your doctor. They may be able to recommend medications to decrease hair loss.

Will I gain weight during Xeljanz treatment?

No, you shouldn’t experience weight gain while taking Xeljanz or Xeljanz XR. Weight gain wasn’t a side effect reported in studies of people taking Xeljanz.

If you’re concerned about weight gain, talk with your doctor. They’ll be able to recommend ways to help you manage your weight.

Does Xeljanz cause depression?

No, depression isn’t a side effect of Xeljanz or Xeljanz XR. Depression wasn’t reported in studies of people taking Xeljanz.

However, many people who have autoimmune conditions also have symptoms of depression. If you’re having symptoms of depression, see your doctor right away. They can work with you to find the best treatment options for your depression.

Will stopping Xeljanz treatment cause any side effects?

It’s possible for symptoms of your condition to return when stopping Xeljanz or Xeljanz XR. For example, if you’re taking Xeljanz or Xeljanz XR for rheumatoid arthritis (RA), discontinuing treatment may cause your RA symptoms to worsen. This is because the drug was working to decrease your symptoms.

This doesn’t happen to everyone who stops taking the drug. If your condition is mild, you may not have worsening symptoms when you stop Xeljanz or Xeljanz XR treatment.

If you want to discontinue Xeljanz or Xeljanz XR treatment, discuss the possibility of worsening symptoms with your doctor. They may recommend other medications to ease your symptoms. Do not stop taking Xeljanz or Xeljanz XR without talking with your doctor first.

Does Xeljanz cause eye side effects?

No, treatment with Xeljanz or Xeljanz XR doesn’t cause eye problems to occur. Eye problems weren’t reported as a side effect in studies.

However, in some rare cases, eye problems may be symptoms of other side effects.

For example, yellowing of your eyes can indicate liver problems, such as hepatitis reactivation. Though rare, hepatitis reactivation is a serious side effect that may occur from taking Xeljanz or Xeljanz XR. For more information about possible liver problems, see the “Tips for managing side effects” section.

Swelling of the area around your eyes may indicate an allergic reaction. If you have this side effect while taking Xeljanz or Xeljanz XR, tell your doctor immediately. Allergic reactions can be very serious and should be treated immediately. For more information about allergic reaction, see the “Tips for managing side effects” section.

If you notice yellowing of your eyes or swelling around your eyes, tell your doctor right away. Also tell your doctor if you notice any changes in vision or other eye side effects.

Xeljanz has several boxed warnings, which are mentioned in the following discussions. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

Risk of blood clots and death

Certain people taking Xeljanz or Xeljanz XR could be at higher risk of developing a blood clot. In some cases, blood clots may be life threatening.

Blood clots are generally a rare side effect. However, they may occur more often in people with rheumatoid arthritis who are:

Higher doses of Xeljanz or Xeljanz XR may increase the risk of developing a blood clot.

What might help

Blood clots can be life threatening. If you develop any symptoms of a blood clot, see a doctor right away.

Symptoms of a blood clot include:

  • severe pain in your chest or leg
  • swelling, redness, or skin discoloration that affects one leg

To prevent blood clots, your doctor will recommend the lowest dose of Xeljanz or Xeljanz XR possible to treat your condition. They’ll also monitor you for signs of a blood clot so that you can get quick treatment if needed.

If you have questions about blood clots and Xeljanz or Xeljanz XR, talk with your doctor.

Risk of serious infections

Although rare, it’s possible to develop a serious infection while taking Xeljanz or Xeljanz XR. This is because both forms may lower your immune system activity. Serious infections can be life threatening. If you have symptoms of an infection, such as fever, shortness of breath, or rash, tell your doctor right away.

What might help

Before you start taking Xeljanz or Xeljanz XR, your doctor will test you for tuberculosis (TB). It’s possible to have TB even if you don’t feel sick or show any symptoms. (This is called latent TB. It differs from active TB, also known as TB disease, which makes you feel sick and can be transmitted to others.)

If you have TB, they’ll recommend treating this infection before you start taking Xeljanz or Xeljanz XR. They’ll also recommend treating any other active infections you have prior to starting Xeljanz or Xeljanz XR treatment.

If you develop symptoms of a serious infection while taking Xeljanz or Xeljanz XR, tell your doctor right away. They may stop treatment with the drug until your infection goes away.

Risk of cancer and immune system disorders

Although rare, people taking Xeljanz or Xeljanz XR have developed cancer, such as skin cancer, or immune system disorders. This may be because Xeljanz and Xeljanz XR can lower your immune system activity. People who have had kidney transplants may be at higher risk for developing immune system disorders from taking Xeljanz or Xeljanz XR.

What might help

Your doctor will monitor you for symptoms of cancer, such as irregular blood test results or changes in your skin. If you notice any unusual physical changes, be sure to tell your doctor. They will be able to help you determine what is causing these changes.

If you have concerns about developing cancer or an immune system disorder from taking Xeljanz or Xeljanz XR, talk with your doctor.

Risk of death in certain people

Xeljanz and Xeljanz XR may increase the risk of death in some people, including people with all the following:

  • rheumatoid arthritis
  • age 50 years or older
  • at least one risk factor for heart or blood vessel disease

Risk factors for heart disease include having high blood pressure, high cholesterol, or obesity. Smoking is also a risk factor for heart disease.

What might help

Your doctor can evaluate your risks related to this treatment. And they’ll recommend if either type of the medication is right for you. Your doctor will prescribe a dosage of Xeljanz or Xeljanz XR and length treatment that’s safe for you.

There may be things you can do to help make certain Xeljanz and Xeljanz XR side effects more manageable. If you have ongoing, worsening, or bothersome side effects, talk with your doctor or pharmacist. They can suggest tips for managing them or recommend other available treatment options for your condition.

Gastrointestinal perforation

It’s possible to develop a gastrointestinal perforation (a tear in the digestive tract) while taking Xeljanz or Xeljanz XR. But this isn’t a common side effect.

Symptoms of gastrointestinal perforation may include:

  • pain in your abdomen or stomach area
  • change in your bowel movements
  • fever

In many cases, people who developed this side effect while using Xeljanz were also taking nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs include ibuprofen (Advil, Motrin), steroid drugs, and methotrexate (Xatmep, Rasuvo).

What might help

Be sure to talk with your doctor about any medications that you’re taking before you start Xeljanz or Xeljanz XR treatment. Also tell them about any stomach conditions you have. This will help your doctor determine if your medications or your other conditions increase your risk for gastrointestinal perforation.

If you develop any symptoms of gastrointestinal perforation, see your doctor right away. This condition could become very serious, so it’s important to be treated immediately.

Changes in blood levels of cholesterol, liver enzymes, or certain blood cells

It’s possible that taking Xeljanz or Xeljanz XR can cause changes in blood levels of certain substances. Your doctor will monitor you throughout your treatment with Xeljanz or Xeljanz XR to watch for such changes.

Increased cholesterol levels

Xeljanz or Xeljanz XR may cause an increase in your cholesterol levels. This side effect, if it occurs, usually happens within the first 6 weeks of treatment.

In studies, this was one of the more common side effects seen in people taking Xeljanz to treat ulcerative colitis.

What might help

Your doctor will monitor your cholesterol levels about 1 to 2 months after you begin Xeljanz or Xeljanz XR. If your cholesterol levels start to increase, they may recommend that you take medication to treat this side effect. Or they may monitor your cholesterol levels more often.

Increased liver enzymes

Although rare, your liver enzyme levels may increase while you’re taking Xeljanz or Xeljanz XR. This increase could indicate liver damage.

Symptoms of liver damage can include stomach pain or yellowing of the eyes or skin. You may be at even higher risk for developing liver damage if you’re also taking methotrexate (Xatmep, Rasuvo).

What might help

Your doctor will recommend liver function tests to monitor your liver throughout Xeljanz or Xeljanz XR treatment. If your liver enzyme levels begin to increase, your doctor may order more blood work. They may also order imaging tests, such as an ultrasound, to see what may be causing this side effect. Or your doctor may recommend you switch to a different medication to treat your condition.

Decreased levels of white blood cells or red blood cells

It’s possible, but rare, that the amount of red or white blood cells you have decreases while you take Xeljanz or Xeljanz XR. A decrease in levels of blood cells may cause certain symptoms, such as infections, feeling weak, or being more tired than usual.

What might help

Your doctor will monitor your blood cell levels 1 to 2 months after you start Xeljanz or Xeljanz XR treatment. Then they’ll check these levels every 3 months while you’re taking Xeljanz or Xeljanz XR.

If your red or white blood cell levels become too low, your doctor may have you temporarily stop Xeljanz or Xeljanz XR treatment. Or they may recommend that you try a different medication for your condition.

Headache

It’s possible to have headaches while taking Xeljanz or Xeljanz XR. Headache is a common side effect that can occur regardless of which condition you’re treating with Xeljanz or Xeljanz XR.

What might help

If you have headaches that are frequent or bothersome, talk with your doctor. They may be able to recommend ways to prevent your headaches from occurring. Steps you can take to manage symptoms associated with this side effect include:

  • staying hydrated
  • drinking caffeinated tea or coffee
  • taking over-the-counter medications, such as acetaminophen (Tylenol)

Diarrhea

You may have diarrhea while taking Xeljanz or Xeljanz XR. It can be a common side effect of either drug, regardless of the health condition you’re treating.

What might help

If you’re experiencing diarrhea, talk with your doctor. They may be able to determine if Xeljanz or Xeljanz XR is the cause. Steps you can take to manage symptoms associated with this side effect include:

  • staying hydrated
  • taking certain over-the-counter medications, such as loperamide (Imodium)
  • avoiding fried or greasy foods
Keeping track of side effects

During your Xeljanz treatment, consider keeping notes on any side effects you’re having. Then, you can share this information with your doctor. This is especially helpful to do when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things like:

  • what dose of drug you were taking when you had the side effect
  • how soon after starting that dose you had the side effect
  • what your symptoms were from the side effect
  • how it affected your daily activities
  • what other medications you were also taking
  • any other information you feel is important

Keeping notes and sharing them with your doctor will help your doctor learn more about how Xeljanz affects you. And your doctor can use this information to adjust your treatment plan if needed.

Xeljanz and Xeljanz XR have several warnings that may affect whether you can safely use it.

Xeljanz and Xeljanz XR have boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “Boxed warnings for Xeljanz” section.

Other warnings

Before taking Xeljanz or Xeljanz XR, discuss your health history with your doctor. Xeljanz and Xeljanz XR may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:

  • liver problems
  • kidney problems
  • digestive tract problems, such as a history of diverticulitis or ulcers
  • conditions affecting your blood cells
  • previous allergic reaction to this or a similar drug
  • pregnancy
  • breastfeeding

Q:

I’m worried about getting cancer or a blood clot from this medication. How can I prevent these side effects, and what symptoms should I watch for?

Anonymous

A:

While there is a risk of developing cancer or a blood clot while taking Xeljanz, these side effects are rare.

Before you start Xeljanz, tell your doctor if you were ever diagnosed or treated for cancer or a blood clot.

Your risk for developing a blood clot is increased if you have rheumatoid arthritis (RA), are 50 years of age or older, or have at least one risk factor for heart disease, such as high blood pressure. The risk was also increased for people who took higher doses of Xeljanz.

Severe blood clots can lead to death. If you have any symptoms of a blood clot, stop taking Xeljanz right away and tell your doctor. Symptoms include:

If you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Xeljanz can also increase your risk for certain cancers, such as lymphoma or skin cancer. This is because the drug can decrease how well your immune system works.

While being treated with Xeljanz, your doctor will monitor you for symptoms of cancer, such as atypical blood tests or any changes to your skin.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.