Is Finasteride Safe with Rinvoq (Upadacitinib)?
Yes, finasteride can be safely used concurrently with Rinvoq (upadacitinib) as there are no known drug interactions between these medications.
Drug Interaction Analysis
Finasteride and upadacitinib have distinct metabolic pathways that do not overlap:
- Upadacitinib undergoes hepatic oxidation with minor CYP metabolism 1
- Finasteride is metabolized primarily through hepatic pathways but does not significantly interact with the CYP450 system in a way that would affect upadacitinib
The FDA label for Rinvoq does not list finasteride as a contraindicated medication or one requiring dose adjustments 2. The limitations of use for Rinvoq specifically mention avoiding combination with other JAK inhibitors, biologic DMARDs, or potent immunosuppressants such as azathioprine and cyclosporine—finasteride falls into none of these categories 2.
Key Considerations
Drug metabolism compatibility: The 2025 expert consensus on JAK inhibitors emphasizes that dose adjustments are needed when upadacitinib is combined with drugs that significantly affect hepatic metabolism, specifically mentioning rifampicin as increasing hepatic metabolism of upadacitinib 1. Finasteride does not have this effect.
No immunosuppressive overlap: Finasteride is a 5-alpha reductase inhibitor used for androgenetic alopecia and benign prostatic hyperplasia—it has no immunosuppressive properties that would compound the immunosuppression from upadacitinib 3.
Monitoring Recommendations
While the combination is safe, monitor each medication independently for its own adverse effects:
- For upadacitinib: Follow standard monitoring including complete blood counts, liver enzymes, lipid levels, and screening for infections as recommended 1, 4
- For finasteride: Be aware of potential sexual side effects (erectile dysfunction, decreased libido), which occur in a small percentage of patients and typically reverse with discontinuation 5, 3
Clinical Pitfall to Avoid
Do not confuse the lack of drug interaction data with a contraindication. The absence of finasteride in the Rinvoq drug interaction warnings is reassuring—if there were concerns, it would be explicitly mentioned in the FDA label given the comprehensive nature of JAK inhibitor safety documentation 2.
The combination requires no dose adjustments for either medication and can be prescribed together when clinically indicated for their respective conditions.