Skyrizi (Risankizumab) Drug Interactions: What to Avoid and What to Tell Your Doctor

Skyrizi (risankizumab-rzaa) has a relatively favorable drug interaction profile compared to some other biologics and systemic medications. However, there are important interactions to be aware of — especially with other immunosuppressive drugs and vaccines — that can affect safety during treatment.

This guide covers the key drug interactions for Skyrizi, organized by severity and type.

The Most Important Interaction: Live Vaccines (AVOID)

The single most critical interaction to avoid with Skyrizi is receiving a live vaccine. Live vaccines use weakened but active pathogens to stimulate immunity — but because Skyrizi suppresses the immune system, you may develop a real infection from the vaccine.

Live vaccines to avoid while on Skyrizi include:

MMR (measles, mumps, rubella)

Varicella (chickenpox) — Zostavax (live shingles vaccine). Note: Shingrix (recombinant, non-live) is preferred and safe to use.

Yellow fever vaccine

BCG (tuberculosis vaccine)

Adenovirus types 4 and 7 vaccine (oral, used in military populations)

Live-attenuated influenza vaccine (nasal spray — e.g., FluMist). Note: Injectable flu shots (inactivated) are safe.

Make sure all live vaccinations are up to date before starting Skyrizi. If you become pregnant while on Skyrizi, delay live-virus immunizations in your infant for at least 5 months after birth due to the drug's potential placental transfer.

Other Biologics and Immunosuppressants: Increased Infection Risk

Combining Skyrizi with other biologic medications or immunosuppressants significantly increases the risk of serious infections. These combinations should only be used when medically necessary and with close physician oversight.

Contraindicated Combination: Upadacitinib (Rinvoq)

The combination of risankizumab with upadacitinib (Rinvoq, a JAK inhibitor) is contraindicated. Both significantly suppress immune function, and their combination substantially raises the risk of serious and potentially fatal infections. Do not use Skyrizi and Rinvoq together.

Use with Caution: Other Immunosuppressives and Biologics

The following drug combinations should be discussed with your doctor — they are not automatically contraindicated, but carry increased risks requiring careful monitoring:

Ublituximab (Briumvi): Both increase immunosuppressive effects. Requires therapy modification and close monitoring.

CAR-T cell therapies (axicabtagene, brexucabtagene, ciltacabtagene, idecabtagene, lisocabtagene): Either drug increases immunosuppressive effects/infection risk. Avoid or use alternate therapy.

Methotrexate: Sometimes used in combination with biologics for PsA or IBD — discuss risks and benefits with your prescriber.

Corticosteroids (prednisone, etc.): Short-term use may be necessary during flares but should be minimized due to combined immune suppression.

Food, Alcohol, and Supplement Interactions

There are no known clinically significant interactions between Skyrizi and foods or alcoholic beverages. Skyrizi is a large protein molecule (monoclonal antibody) that is not processed through the liver's cytochrome P450 (CYP450) enzyme system — unlike many small-molecule drugs, it is unlikely to interact with common herbal supplements or other medications through metabolic pathways.

However, herbal supplements with immune-modulating properties (like echinacea, elderberry, or high-dose vitamin C) should be discussed with your doctor, as they could theoretically interfere with Skyrizi's immunosuppressive action.

What to Tell Your Doctor Before Starting Skyrizi

Before starting Skyrizi, provide your doctor with a complete list of:

All current prescription medications (especially other biologics, JAK inhibitors, or immunosuppressants)

All over-the-counter medications and supplements

Any vaccines you've received recently or have scheduled

History of TB, chronic infections, or recurrent infections

Pregnancy status or plans to become pregnant (call 1-877-302-2161 to enroll in the GLOW Pregnancy Registry if you become pregnant on Skyrizi)

See also: Skyrizi Side Effects: What to Expect and When to Call Your Doctor. Once you're ready to fill your prescription, medfinder can help you find a specialty pharmacy near you.