Tofacitinib (Xeljanz) and Ketamine Therapy | Tovani Health
Xeljanz (Tofacitinib) (also: Xeljanz XR) — JAK1/3 inhibitor (RA, PsA, UC, JIA, AS)
Verdict at Tovani Health
Fully compatible; the MACE/cancer/VTE black box is intrinsic to JAK inhibitors.
Tofacitinib and ketamine have no direct clinically significant interaction. The oral JAK inhibitor class (tofacitinib, baricitinib, upadacitinib) carries an FDA black-box warning for increased risk of serious infections, MACE, cancer, thrombosis, and mortality compared to TNF inhibitors — this is intrinsic to JAK inhibition and well known to rheumatology. None of those concerns are changed by KAP. Tofacitinib is metabolized partly by CYP3A4 (so strong inhibitors raise its level — a tofacitinib dose conversation).
If you take Xeljanz regularly and are considering at-home ketamine therapy, the combination is generally safe at therapeutic doses. This page covers the brief pharmacologic context and what we do at intake.
How Xeljanz interacts with ketamine
Tofacitinib inhibits JAK1 and JAK3, blocking signaling for multiple cytokines. CYP3A4 + CYP2C19 metabolism. Not a CYP modulator at therapeutic doses.
What we do at intake
Continue as prescribed. Tell us your full rheum regimen and recent CBC/lipid panel.
Bottom line
Tofacitinib and ketamine have no direct clinically significant interaction. The oral JAK inhibitor class (tofacitinib, baricitinib, upadacitinib) carries an FDA black-box warning for increased risk of serious infections, MACE, cancer, thrombosis, and mortality compared to TNF inhibitors — this is intrinsic to JAK inhibition and well known to rheumatology. None of those concerns are changed by KAP. Tofacitinib is metabolized partly by CYP3A4 (so strong inhibitors raise its level — a tofacitinib dose conversation).
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Xeljanz (Tofacitinib) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 22, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.