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Tofacitinib is a medication that comes with several important safety considerations and warnings. It is crucial to be aware of these to ensure safe use and to address any concerns with your healthcare provider.

• Increased Risk of Infections: Tofacitinib can compromise your immune system, making you more susceptible to serious infections, including pneumonia, skin infections, shingles, and urinary tract infections. This risk increases if you're also taking immunosuppressive drugs. Ensure you undergo a tuberculosis (TB) test before and during treatment. Notify your doctor immediately if you experience symptoms such as persistent sore throat, fever, chills, cough, breathing difficulties, painful urination, or non-healing sores.

• Cancer Risk: There is a potential, though unlikely, risk of developing cancers such as lymphoma, lung, and skin cancer while on this medication. The risk may be elevated for current or past smokers. Watch for symptoms such as unexplained weight loss, persistent fever or cough, unusual lumps, or changes in moles, and report them to your healthcare provider.

• Cardiovascular Events and Blood Clots: The use of tofacitinib is linked to a higher risk of blood clots, heart attack, and stroke. This is particularly concerning for individuals over 50, especially those with a history of smoking or heart disease risk factors. Seek immediate medical attention if you experience symptoms like sudden shortness of breath, chest pain, unusual sweating, dizziness, severe headaches, or sudden vision changes.

• Gastrointestinal Issues: Some users have reported gastrointestinal tears, particularly if they have a history of diverticulitis or are taking NSAIDs. Contact your doctor if you experience severe abdominal pain or notice blood in your stool.

• Allergic Reactions: Though rare, serious allergic reactions can occur. If you notice symptoms like swelling of the face or throat, difficulty breathing, or rash, seek medical help immediately.

• Blood Cell Counts: Tofacitinib can lower red and white blood cell counts, increasing the risk of anemia and infections. Routine blood tests will be conducted to monitor your blood cell levels. Report symptoms like fatigue, pallor, fast heart rate, or signs of infection to your healthcare provider.

• Liver Health: The medication may cause elevated liver enzymes, indicative of liver damage. Regular liver function tests will be conducted, and any signs of liver problems, such as nausea or jaundice, should be reported promptly.

Discuss the risks and benefits of using tofacitinib with your healthcare provider, especially if you have underlying health conditions or are using other medications. In case of any side effects or signs of overdose, seek immediate medical assistance.

When taking this medication, you may experience some common side effects that are generally mild and manageable. These include upper respiratory tract infections, nose and throat infections, diarrhea, and headaches. These effects are reported by a small percentage of users and usually do not require medical attention unless they persist or worsen.

In addition to the common side effects, there are other side effects that have been noted, such as high cholesterol, muscle damage, rash, stomach infection, and anemia. While these are less common, it's important to monitor your condition and consult a healthcare provider if they occur.

There are also rare but serious side effects associated with this medication that require immediate medical attention. These include symptoms such as unusual tiredness, a fast heartbeat, signs of liver disease like persistent nausea or vomiting, loss of appetite, stomach pain, yellowing of the eyes or skin, and dark urine. Additionally, a severe allergic reaction, though rare, necessitates urgent medical care if you notice symptoms such as rash, severe dizziness, or difficulty breathing. Being aware of these potential side effects can help you use this medication safely and effectively.

Tofacitinib, known by the brand name Xeljanz, can interact with various other medications or supplements. It is important to inform your doctor and pharmacist about all medications and supplements you are taking, including prescription, over-the-counter, vitamins, and herbal products. Some drugs, such as rifampin, may alter how tofacitinib is removed from your body, impacting its effectiveness.

Caution is advised when using tofacitinib alongside certain medications. For example, combining it with drugs such as abatacept, adalimumab, cyclosporine, etanercept, or infliximab, among others, is generally not recommended unless necessary. If these medications are prescribed together, your doctor may adjust the dosage or frequency.

Additionally, co-administration with fluconazole may increase the risk of specific side effects, though such combinations might be necessary depending on your treatment plan. In such cases, your healthcare provider may modify the dosage or administration schedule of the involved medications to ensure safety and efficacy.