Abatacept and Upadacitinib: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 16, 2026 · Source data updated Jul 16, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Upadacitinib
Abatacept
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Upadacitinib (Rinvoq) and abatacept (Orencia) both calm down your immune system to help control conditions like rheumatoid arthritis. The concern is that using them together may lower your body's defenses too much, which can raise your risk of catching infections.
To be honest, this is based more on caution than on hard proof, since the two haven't been well studied together. Because both quiet the immune system in overlapping ways, doctors generally don't recommend combining them. Please don't change anything on your own. Your care team can review your medicines and choose the safest plan for you.
Effect: Additive immunosuppression with an increased risk of serious infection when the JAK inhibitor upadacitinib is combined with the T-cell costimulation modulator abatacept.
- Mechanism: Unknown/undefined; presumed additive or synergistic immunosuppressive effect (PD interaction). Neither is a prodrug relevant here.
- Direction: Enhanced immunosuppressive effect, greater infection susceptibility.
- Evidence: Theoretical; insufficient data on combined safety/efficacy.
- Onset: Unspecified.
- Management: Concurrent use is not recommended. If unavoidable, monitor closely for signs of infection and reassess the regimen.
What happens
An increased risk of infection
Interaction Deep Dive
Data are lacking to assess how safe and effective abatacept is when given alongside janus kinase inhibitors. As a result, using these agents together is not advised1.
Why it happens (mechanism)
Unknown
How to manage this interaction
The key point: combining these two immune-lowering drugs is generally not recommended because it may raise your infection risk.
- Keep taking your medicines as prescribed and do not stop or adjust anything on your own.
- Let your prescriber know if you are taking both, so they can decide on the best single therapy or an alternative for you.
- Your team may monitor you more closely for infection.
- Watch for signs of infection (fever, chills, sore throat, cough, burning with urination, or wounds that won't heal) and report them promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Abatacept and Upadacitinib together?
Using upadacitinib and abatacept together may lower your immune defenses too much and raise your infection risk, so this combination is generally not recommended. Talk with your prescriber about choosing one therapy instead. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abatacept and Upadacitinib interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Abatacept and Upadacitinib interaction managed?
The key point: combining these two immune-lowering drugs is generally not recommended because it may raise your infection risk. Keep taking your medicines as prescribed and do not stop or adjust anything on your own. Let your prescriber know if you are taking both, so they can decide on the best single therapy or an alternative for you. Your team may monitor you more closely for infection. Watch f… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Abatacept or Upadacitinib need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: ORENCIA(R) intravenous, subcutaneous injection, abatacept intravenous, subcutaneous injection. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2020. DailyMed
Keep reading about Upadacitinib
Keep reading about Abatacept
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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