Lisraya (brepocitinib) is a daily tablet used to treat dermatomyositis in adults, an autoimmune disease that affects the muscles and skin.
Like all medicines, Lisraya can cause side effects and may interact with other medicines, supplements, or substances such as tobacco.
Keep reading to learn about the possible side effects of Lisraya, how to manage them, and which medicines and habits may interact with Lisraya.
This article does not include all possible side effects or interactions. Tell your health care provider about any symptoms that concern you or do not improve.
Lisraya Side Effects
Common side effects
The most common side effects reported with Lisraya include:
- Infections, including the common cold, sinus infections, or sore throat (upper respiratory infections), bronchitis, urinary tract infections, and the flu
- Headache
- Tiredness or lack of energy (fatigue)
- Stomach-related side effects, such as nausea or diarrhea
- Joint pain or back pain
- Falls
- Acne
Serious side effects
Lisraya has a boxed warning, which is the FDA’s strongest warning, because of the following risks:
- Serious infections, including tuberculosis (TB), fungal infections, and shingles
- Blood clots in the legs, lungs, or arteries
- Major heart-related events, such as heart attack and stroke
- Certain cancers, including lymphoma, lung cancer, and skin cancer
Other potentially serious side effects of Lisraya may include:
- Tears (perforation) in the stomach or intestines
- Serious allergic reactions
- Low blood sugar in people with diabetes
- Changes in lab tests, such as low blood cell counts, higher cholesterol, and raised liver enzymes
If you have symptoms that feel serious or life-threatening, such as chest pain, trouble breathing, swelling in a leg or arm, sudden weakness or slurred speech, or signs of a severe allergic reaction, seek medical care right away.
How to Manage Lisraya Side Effects
While not a complete guide, the following tips can help you prevent or manage six common or important side effects of Lisraya.
1. Infections
Infections are the most common type of side effect with Lisraya. Because Lisraya calms the immune system, it can make you more likely to get infections. It can also make existing infections worse. Most are mild, such as colds, sinus infections, or urinary tract infections. But Lisraya also carries a boxed warning about serious infections, including TB, fungal infections, and shingles, which can be life-threatening.
Possible signs of an infection include:
- Fever, sweating, or chills
- Cough or shortness of breath
- Warm, red, or painful skin or sores
- Burning when you urinate or urinating more often
- Muscle aches, tiredness, or feeling generally unwell
To help prevent or manage infections:
- Wash your hands often, and try to avoid close contact with people who are sick.
- Make sure your vaccines are up to date before you start Lisraya. You should not get live vaccines during treatment, so ask your provider which vaccines you may need first.
- Get tested for TB before starting, as your provider will recommend.
- Learn the signs of infection so you can act quickly.
Contact your health care provider right away if you develop any signs of an infection. If you get a serious infection, your provider may pause your Lisraya treatment until the infection is under control.
2. Headache
Headache is one of the more common Lisraya side effects. It was reported by about 15% of people in the clinical study.
To help prevent or manage headaches:
- Rest in a quiet, dark room if needed.
- Drink enough fluids, and eat regular meals.
- Keep a regular sleep schedule.
- An over-the-counter (OTC) pain reliever may help, but check with your provider or pharmacist first to make sure it is safe for you.
If headaches happen often or feel severe, let your provider know. They may want to look for other causes.
3. Fatigue
Feeling tired or low on energy was reported by about 12% of people taking Lisraya in the study. Fatigue can also be part of dermatomyositis itself.
To help prevent or manage fatigue:
- Pace yourself, and take breaks throughout the day.
- Stay hydrated, and eat regular, balanced meals to support your energy.
- Stay as active as you comfortably can, as too little movement can add to tiredness.
- Ask family or friends for help with demanding tasks when you need it.
Contact your provider if fatigue is severe, comes on suddenly, or gets in the way of daily life, as it can sometimes point to another issue, such as anemia (low red blood cells).
4. Nausea or diarrhea
Some people taking Lisraya have stomach-related side effects such as nausea (about 11%) or diarrhea (about 9%).
To help prevent or manage nausea and diarrhea:
- Eat smaller, more frequent meals. Choose bland, easy-to-digest foods if your stomach is upset.
- Sip fluids often to stay hydrated, especially if you have diarrhea.
- Limit greasy, spicy, or very rich foods that can make symptoms worse.
- Ask your pharmacist before using an OTC anti-nausea or antidiarrheal product.
Get medical help right away if you have severe stomach pain, especially with fever, chills, nausea, or vomiting, because Lisraya carries a warning about tears in the stomach or intestines. This risk is higher if you also take nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, which are usually used to help with pain and inflammation. Also contact your provider if diarrhea is severe or does not go away.
5. Acne
Acne was reported in about 6% of people taking Lisraya in the study, compared with none in the placebo group.
To help prevent or manage acne:
- Wash affected skin gently with a mild cleanser, and avoid scrubbing.
- Choose skin, sunscreen, and makeup products labeled noncomedogenic (which won’t clog pores).
- Try not to pick or squeeze blemishes, which can lead to scarring.
- Ask your provider or pharmacist about OTC acne treatments that may be right for you.
If acne is bothersome or severe, your provider may suggest a prescription treatment or refer you to a dermatologist.
6. Joint or back pain
Joint pain and back pain were each reported by roughly 9%-10% of people taking Lisraya in the study.
To help prevent or manage joint and back pain:
- Apply heat or cold, whichever feels better, to sore areas.
- Stay gently active, and ask about stretches or exercises that may help.
- Pay attention to posture and support when sitting or lifting.
- Ask your provider or pharmacist before using an OTC pain reliever, as some (such as NSAIDs) may not be right for everyone taking Lisraya.
Let your provider know if the pain is severe, does not improve, or comes with swelling, redness, or warmth, which could be a sign of another problem.
Lisraya Interactions
Lisraya can interact with other medicines, vaccines, and tobacco.
An interaction happens when a substance changes how a medicine works or affects the body. Some interactions may raise the risk of side effects, while others may make Lisraya less effective.
Because Lisraya lowers the activity of the immune system and can affect how the body handles certain other medicines, there are some important interactions to know about. This is not a full list, but the following are important while taking Lisraya.
Medicines that affect the immune system
Taking Lisraya with other medicines that weaken or change the immune system can raise your risk of serious infections. For this reason, Lisraya is not recommended for use with:
- Other JAK inhibitors, such as abrocitinib or ruxolitinib
- Other TYK2 inhibitors, such as deucravacitinib
- Biologic DMARDs (biologic disease-modifying antirheumatic drugs), such as adalimumab or etanercept
These medicines are typically not combined with Lisraya. Tell your provider about any medicine that affects your immune system so they can check whether it is safe to use with Lisraya.
Certain vaccines
Live vaccines contain a weakened form of a germ. Because Lisraya lowers immune activity, a live vaccine could cause an infection in people who receive it.
You should avoid live vaccines right before and while taking Lisraya. Your health care provider can help make sure your vaccines are up to date and timed safely before you start treatment, including shingles or chickenpox vaccines if recommended for you. Non-live vaccines may still be given during treatment when your health care provider recommends them.
NSAIDs and corticosteroids
NSAIDs (such as ibuprofen and naproxen) and corticosteroids are common medicines used for pain and inflammation. Taking them with Lisraya may raise the risk of tears (perforation) in the stomach or intestines, a rare but serious side effect.
If you take these medicines with Lisraya, your provider may monitor you more closely. Get medical help right away if you have new or severe stomach pain, especially with fever, chills, nausea, or vomiting. Do not start or stop these medicines without talking with your provider first.
Tobacco and smoking
Smoking can make Lisraya less effective. Tobacco smoke speeds up how the body breaks down brepocitinib, which lowers the amount of medicine in your body. Smoking also adds to the risk of cancer and heart-related events, which are already higher with this type of medicine.
If you smoke, talk with your provider about resources to help you quit. Do not change your Lisraya dose on your own based on whether you smoke.
Medicines whose levels Lisraya may raise
Lisraya can increase the amount of certain other medicines in your body. It does this by slowing down some of the transport systems (called P-gp, BCRP, OCT2, and MATE) that the body uses to move medicines in and out of cells. When the level of another medicine rises, its side effects may become more likely.
Medicines that use these transport systems include some heart medicines (such as digoxin) and some cholesterol-lowering statins (such as rosuvastatin), among others.
If you take a medicine that could be affected, your provider may watch you more closely or adjust the dose of the other medicine. Always give your provider and pharmacist a full list of everything you take so they can check for interactions.
FAQs: Lisraya Interactions
Does Lisraya interact with alcohol?
The Lisraya labeling does not list a specific interaction between Lisraya and alcohol. However, Lisraya can raise liver enzymes, and heavy alcohol use can also stress the liver. It’s a good idea to talk with your health care provider about whether and how much alcohol is safe for you, especially because you’ll have regular liver blood tests during treatment.
Does Lisraya interact with food or supplements?
You can take Lisraya with or without food, so there are no food restrictions. A high-fat meal slightly lowers how much medicine your body absorbs, but not by an amount that matters for how well it works.
No specific supplement interactions are listed for Lisraya. Even so, some vitamins, herbs, and supplements can affect the immune system, the liver, or other medicines. Tell your provider and pharmacist about everything you take, and check with them before starting anything new.
What should I avoid while taking Lisraya?
While taking Lisraya, it’s best to:
- Avoid live vaccines.
- Avoid starting new prescription medicines, OTC medicines, or supplements without checking with your provider or pharmacist first.
- Avoid smoking. Smoking can make Lisraya less effective and add to certain risks.
- Avoid becoming pregnant. Use effective birth control during treatment and for three days after your last dose, and do not breastfeed during this time.
- Avoid too much sun. Limit time in the sun, skip tanning beds, and use sunscreen and protective clothing to help lower the risk of skin cancer.
Reducing Your Risk of Side Effects and Interactions
You can help reduce your risk of side effects and interactions by taking Lisraya exactly as prescribed and following all instructions from your health care provider.
Helpful tips include:
- Always tell your provider and pharmacist about all prescription drugs, OTC medicines, vitamins, herbs, and other supplements you use.
- Ask your provider before you start or stop any medicine, vitamin, or supplement.
- Keep all follow-up appointments and lab tests, including tests of your blood counts, cholesterol, and liver.
- Report any new or worsening symptoms to your provider.
- Do not stop taking Lisraya without talking with your provider first.
Your health care provider can review your treatment plan and make adjustments if needed to help keep this medicine safe for you
