Formulary
Baricitinib: Indications, Dosing, Side Effects and Interactions
Baricitinib selectively and reversibly inhibits the Janus-associated tyrosine kinases JAK1 and JAK2.
MedNext Academy | 5 min read
Baricitinib: Indications, Dosing, Side Effects and Interactions
Baricitinib selectively and reversibly inhibits the Janus-associated tyrosine kinases JAK1 and JAK2.
Drug action
Baricitinib selectively and reversibly inhibits the Janus-associated tyrosine kinases JAK1 and JAK2.
Indications and dose
**Rheumatoid arthritis (initiated by a specialist)**
- **Adult** (By Mouth): 4 mg once daily, a reduced dose of 2 mg once daily is recommended for patients with certain risk factors-consult product literature, for dose adjustments due to clinical response or treatment interruption due to side-effects-consult product literature.
- **Elderly** (By Mouth): 2 mg once daily, for dose adjustments due to clinical response or treatment interruption due to side-effects-consult product literature.
**Atopic eczema (initiated by a specialist)**
- **Adult** (By Mouth): 4 mg once daily, a reduced dose of 2 mg once daily is recommended for patients with certain risk factors-consult product literature, consider discontinuation of treatment if no response after 8 weeks, for dose adjustments due to clinical response or treatment interruption due to side-effects-consult product literature.
- **Elderly** (By Mouth): 2 mg once daily, consider discontinuation of treatment if no response after 8 weeks, for dose adjustments due to clinical response or treatment interruption due to side-effects-consult product literature.
**Alopecia areata (initiated by a specialist)**
- **Adult** (By Mouth): 4 mg once daily, a reduced dose of 2 mg once daily is recommended for patients with certain risk factors-consult product literature, consider discontinuation of treatment if no response after 36 weeks, for dose adjustments due to clinical response or treatment interruption due to side-effects-consult product literature.
- **Elderly** (By Mouth): 2 mg once daily, consider discontinuation of treatment if no response after 36 weeks, for dose adjustments due to clinical response or treatment interruption due to side-effects-consult product literature.
**Atopic eczema (initiated by a specialist) for baricitinib**
- **Child 2-17 years (body-weight 10-29 kg)** (By mouth): 2 mg once daily, consider discontinuation of treatment if no response after 8 weeks, for dose adjustments due to clinical response or treatment interruption due to side-effects-consult product literature.
- **Child 2-17 years (body-weight 30 kg and above)** (By mouth): 4 mg once daily, consider discontinuation of treatment if no response after 8 weeks, for dose adjustments due to clinical response or treatment interruption due to side-effects-consult product literature.
**Enthesitis-related arthritis (initiated by a specialist), Polyarticular juvenile idiopathic arthritis (initiated by a specialist), Juvenile psoriatic arthritis (initiated by a specialist) for baricitinib**
- **Child 2-17 years (body-weight 10-29 kg)** (By mouth): 2 mg once daily, consider discontinuation of treatment if no response after 12 weeks.
- **Child 2-17 years (body-weight 30 kg and above)** (By mouth): 4 mg once daily, consider discontinuation of treatment if no response after 12 weeks.
Cautions
Active, chronic, or recurrent infection (interrupt treatment if no response to standard therapy); elderly (65 years and older); history of atherosclerotic cardiovascular disease or other cardiovascular risk factors; risk factors for deep-vein thrombosis or pulmonary embolism; risk factors for malignancy; risk of diverticulitis; risk of viral reactivation (consult product literature) Cautions, further information Tuberculosis Consider anti-tuberculosis therapy prior to initiation of baricitinib in patients with previously untreated latent tuberculosis. M Immunisation Patients should receive all recommended vaccinations before starting treatment; live vaccines are not recommended immediately before, or during, treatment. M
Contraindications
Absolute lymphocyte count less than 0.5 x 10 9 cells /litre (do not initiate); absolute neutrophil count less than 1 x 10 9 cells/litre (do not initiate); haemoglobin less than 8 g/dL (do not initiate); tuberculosis (active)
Side effects
Common or very common Abdominal pain; dyslipidaemia; headache; herpes zoster (interrupt treatment); increased risk of infection; nausea; skin reactions; thrombocytosis Uncommon Embolism and thrombosis; facial swelling; neutropenia; weight increased Frequency not known Cardiovascular event; gastrointestinal perforation; hypersensitivity (discontinue); malignancy; neoplasms; reactivation of infections
Interactions
**Severe interactions:**
- Gastric pH modifying agents Elevating gastric pH with omeprazole had no clinically significant effect on baricitinib exposure.
- Baricitinib may be a clinically relevant inhibitor of OCT1, however there are currently no known selective OCT1 substrates for which clinically significant interactions might be predicted.
**Other interactions (14):**
- In rheumatoid arthritis and juvenile idiopathic arthritis, use of baricitinib with potent immunosuppressive medicinal products such as azathioprine, tacrolimus, or ciclosporin was limited in...
- In atopic dermatitis and alopecia areata, combination with ciclosporin or other potent immunosuppressants has not been studied and is not recommended (see section 4.4).
- Potential for other medicinal products to affect the pharmacokinetics of baricitinib Transporters In vitro , baricitinib is a substrate for organic anionic transporter (OAT)3, P-glycoprotein (Pgp),...
- In a clinical pharmacology study, dosing of probenecid (an OAT3 inhibitor with strong inhibition potential) resulted in approximately a 2-fold increase in AUC (0-) with no change in t max or C max...
- Consequently, in patients taking OAT3 inhibitors with a strong inhibition potential, such as probenecid, the recommended dose of baricitinib should be reduced by half (see section 4.2).
- The prodrug leflunomide rapidly converts to teriflunomide which is a weak OAT3 inhibitor and therefore may lead to an increase in baricitinib exposure.
Pregnancy
Avoid (toxicity in animal studies). M
Breast feeding
Avoid (present in milk in animal studies). M
Hepatic impairment
Manufacturer advises avoid in severe impairment (no information available).
Renal impairment
Avoid if creatinine clearance less than 30 mL/minute. M Dose adjustments The recommended dose is 2 mg once daily if creatinine clearance 30-60 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Baricitinib in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary

