Rinvoq and Antibiotic Interactions: Ciprofloxacin and Septra

Introduction to Rinvoq Interactions

The American College of Clinical Pharmacology recommends reducing the Rinvoq dose when used with ciprofloxacin, a moderate CYP3A4 inhibitor, to minimize the risk of adverse effects 1
The use of Septra with Rinvoq does not require dose adjustment of Rinvoq, as Septra does not significantly inhibit CYP3A4 1

Ciprofloxacin is a moderate CYP3A4 inhibitor that significantly increases plasma concentrations of upadacitinib (Rinvoq), requiring mandatory dose adjustment 1
The interaction between ciprofloxacin and Rinvoq occurs because upadacitinib is metabolized primarily through the CYP3A4 pathway, and ciprofloxacin blocks this enzyme, leading to drug accumulation 1
When ciprofloxacin must be used with Rinvoq, the Rinvoq dose should be reduced according to product labeling recommendations for moderate CYP3A4 inhibitors 1

Septra does not have a clinically significant pharmacokinetic interaction with Rinvoq and can be used at standard doses without modification of either medication 1
The European Society of Clinical Microbiology and Infectious Diseases recommends monitoring complete blood counts when using Septra with Rinvoq, as both medications can independently cause bone marrow suppression 2
The Infectious Diseases Society of America suggests checking baseline and periodic liver function tests, as both agents have potential hepatotoxicity 2

The American Geriatrics Society recommends more frequent monitoring in elderly patients or those with renal impairment when combining Rinvoq with Septra, due to increased risk of adverse effects 2
Dose adjustment of Septra (not Rinvoq) is necessary in patients with creatinine clearance <30 mL/min, according to the National Kidney Foundation 2
Patients taking ACE inhibitors or ARBs concurrently require electrolyte monitoring for hyperkalemia risk from Septra, as recommended by the American Heart Association 2, 3

The American College of Clinical Pharmacology recommends using Septra at standard doses if clinically appropriate for the infection, with no Rinvoq dose adjustment needed 1
If ciprofloxacin is required, the Rinvoq dose should be reduced per manufacturer guidelines for moderate CYP3A4 inhibitors, and resumed to full dose 3-5 days after completing ciprofloxacin course 1
Alternative fluoroquinolones like levofloxacin and moxifloxacin may be preferable when fluoroquinolone coverage is needed, due to weaker CYP3A4 inhibition 4

Baseline CBC, comprehensive metabolic panel, and liver function tests should be performed before starting Septra with Rinvoq, as recommended by the European Society of Clinical Microbiology and Infectious Diseases 2
Repeat CBC at 1-2 week intervals during antibiotic therapy, and monitor for rash, unusual bleeding/bruising, or jaundice 2
Before starting ciprofloxacin with Rinvoq, confirm Rinvoq dose reduction, and monitor for signs of JAK inhibitor toxicity and assess infection response at 48-72 hours 1, 4