Can Beta Blockers Be Taken with Rinvoq (Upadacitinib)?
Yes, beta blockers can be safely taken concurrently with Rinvoq (upadacitinib), as there are no documented pharmacological interactions between these drug classes and no contraindications to their combined use.
Evidence for Safety of Concurrent Use
The available evidence demonstrates no clinically significant interaction between beta blockers and upadacitinib:
No documented drug-drug interactions exist between JAK inhibitors like upadacitinib and beta blockers in the published literature 1, 2
Major clinical trials of upadacitinib (SELECT-BEYOND and SELECT-NEXT) did not identify beta blockers as medications requiring dose adjustment, discontinuation, or special monitoring when used with upadacitinib 1, 2
Beta blockers are not metabolized through pathways that would interact with upadacitinib's pharmacokinetics, as upadacitinib does not significantly inhibit or induce the cytochrome P450 enzymes responsible for beta blocker metabolism 1
Clinical Context for Combined Use
Beta blockers are commonly prescribed for multiple cardiovascular indications that may coexist with rheumatoid arthritis or other conditions treated with Rinvoq:
Hypertension management: Beta blockers are recommended when there are compelling indications such as angina, post-myocardial infarction, heart failure with reduced ejection fraction, or heart rate control 3
Heart failure: Beta blockers remain foundational therapy for heart failure with reduced ejection fraction and can be safely combined with other cardiovascular medications 4
Post-MI and angina: Beta blockers are first-line therapy for these conditions and their use should not be interrupted when initiating upadacitinib 3
Monitoring Considerations
While no specific interaction exists, routine monitoring appropriate for each medication individually should continue:
Blood pressure monitoring is standard for patients on beta blockers, particularly when combined with other cardiovascular medications 3
Heart rate assessment should continue as beta blockers will reduce heart rate independent of upadacitinib use 3
Infection surveillance is important for upadacitinib regardless of beta blocker use, as JAK inhibitors increase infection risk including herpes zoster 1, 2
Important Caveats
The absence of interaction does not mean clinical judgment is unnecessary:
Cardiovascular risk assessment should be performed before initiating upadacitinib, as clinical trials reported rare major adverse cardiovascular events, though these were not attributed to drug interactions 1, 2
Avoid confusing beta blocker interactions with other drug classes—the documented interactions of beta blockers are primarily with other cardiovascular medications (calcium channel blockers, anti-arrhythmics) and certain antidepressants that inhibit CYP2D6, not with JAK inhibitors 3, 5, 6
Do not discontinue beta blockers when starting Rinvoq if they are prescribed for evidence-based cardiovascular indications, as this would deprive patients of proven mortality benefit 4