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JAK Inhibitor (JAK1/JAK2 Inhibitor) Pregnancy: D

Baricitinib

Brand names: Olumiant

Adult dose

Dose: 4 mg once daily; reduce to 2 mg/day in elderly (≥75), moderate renal impairment, or risk factors for DVT/PE/infections
Route: oral
Frequency: once daily
Max: 4 mg/day
MHRA/FDA black box warning: serious infections, malignancy, MACE, thrombosis — use with caution; COVID-19 use: 4 mg OD × 14 days

Paediatric dose

Route:
Not licensed in children

Dose adjustments

Renal

2 mg/day if eGFR 30–60 ml/min; avoid if eGFR <30 ml/min

Hepatic

2 mg/day in severe hepatic impairment; avoid in very severe

Clinical pearls

  • RA-BEAM trial: superior to adalimumab on ACR70 response when added to MTX
  • COVID-19: WHO recommended for hospitalised patients with severe disease requiring supplemental O2
  • ORAL Surveillance trial raised MACE/malignancy concerns with tofacitinib (class effect warning)

Contraindications

  • Active tuberculosis
  • Pregnancy
  • Breastfeeding
  • Lymphocyte count <500/mm³ or ANC <1000/mm³

Side effects

  • Infections (URTI, UTI, herpes zoster)
  • DVT/PE
  • Dyslipidaemia
  • Elevated creatinine kinase
  • Malignancy
  • MACE (major adverse cardiovascular events)

Interactions

  • Strong OAT3 inhibitors (probenecid — double exposure)
  • Live vaccines (CI)
  • Immunosuppressants (infection risk)

Monitoring

  • FBC (lymphocytes, neutrophils)
  • LFTs
  • Lipid profile
  • Signs of infection/herpes zoster
  • DVT symptoms

Reference: BNFc; BNF 86; NICE TA466; RA-BEAM trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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