Drug interactions
Tofacitinib + Voriconazole
Severity: Major
Tofacitinib and Voriconazole: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Voriconazole inhibits CYP3A4 and increases tofacitinib exposure, which raises the risk of infection, cytopenias and other dose-related adverse effects. Tofacitinib labeling requires a dose reduction with potent CYP3A4 inhibitors.
What this interaction means in plain words
Tofacitinib and Voriconazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Tofacitinib belongs to Musculoskeletal; Voriconazole belongs to Anti Fungals.
Why it happens
Inhibition of CYP3A4-mediated tofacitinib metabolism by voriconazole.
What to do
Reduce the tofacitinib dose per labeling (for example, 5 mg once daily if on 5 mg twice daily). Monitor for infection and cytopenias.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Tofacitinib
- Baricitinib + Tofacitinib Contraindicated
- Cladribine + Tofacitinib Contraindicated
- Tofacitinib + Upadacitinib Contraindicated
- Abatacept + Tofacitinib Major
- Anti-thymocyte + Tofacitinib Major
- Antithymocyte globulin equine + Tofacitinib Major
Other interactions of Voriconazole
- Avanafil + Voriconazole Contraindicated
- Butabarbital + Voriconazole Contraindicated
- Carbamazepine + Voriconazole Contraindicated
- Conivaptan + Voriconazole Contraindicated
- Dihydroergotamine intranasal + Voriconazole Contraindicated
- Dihydroergotamine + Voriconazole Contraindicated
Frequently asked questions
Can I take Tofacitinib with Voriconazole?
MediHelp rates the interaction as major. Tofacitinib and Voriconazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Voriconazole inhibits CYP3A4 and increases tofacitinib exposure, which raises the risk of infection, cytopenias and other dose-related adverse effects. Tofacitinib labeling requires a dose reduction with potent CYP3A4 inhibitors.
How serious is the interaction between Tofacitinib and Voriconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce the tofacitinib dose per labeling (for example, 5 mg once daily if on 5 mg twice daily). Monitor for infection and cytopenias.
What other medicines interact with Tofacitinib?
MediHelp also lists interactions of Tofacitinib with, for example, Baricitinib, Cladribine, Upadacitinib. The full list is on the Tofacitinib page.
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