Overview
Tofacitinib is a JAK (Janus kinase) inhibitor — a small molecule oral medication that broadly suppresses multiple inflammatory pathways. Unlike biologics, it is taken as a tablet twice daily. It is approved for ulcerative colitis and acts quickly, making it useful for patients who need rapid disease control.
Key Uses
Moderate-to-severe ulcerative colitis
Patients who have failed or cannot tolerate anti-TNF therapy
Useful when rapid onset of action is needed
How It Works
Inhibits JAK1 and JAK3 enzymes, blocking intracellular signalling of multiple pro-inflammatory cytokines
Oral tablet: 10 mg twice daily for 8 weeks (induction), then 5 mg twice daily (maintenance)
Fast onset — noticeable improvement often within days to weeks
TB and hepatitis B screening required before starting — this applies to JAK inhibitors just as it does to injectable biologics
Safety & Self-Care
Increased risk of herpes zoster (shingles) — consider varicella vaccine before starting if not immune
Risk of deep vein thrombosis (DVT) and pulmonary embolism — discuss with your doctor if you have cardiovascular risk factors
Regular blood tests: complete blood count, lipids, liver enzymes
Avoid in patients over 65 or with high cardiovascular risk — discuss risk-benefit with your IMCC doctor
Avoid live vaccines; oral polio vaccine is not safe
Tell your doctor about all other medications — interactions are possible
Contact Your IMCC Team
Contact your IMCC team if you develop painful rash (possible shingles), leg swelling or pain, chest pain or shortness of breath, or if symptoms are not improving after 8 weeks of induction.
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