Stelara Drug Interactions: What to Avoid and What to Tell Your Doctor

Stelara (ustekinumab) has a generally manageable drug interaction profile compared to some other biologics, but there are important interactions you need to know about — particularly involving vaccines, immunosuppressants, and certain commonly used medications. Because Stelara works by modifying your immune system, the most significant interactions are with other substances that also affect immune function or that rely on a fully active immune system to work.

Interaction #1: Live Vaccines (Contraindicated)

This is the most important interaction to know. You must not receive live vaccines while taking Stelara. Because Stelara dampens your immune system, live vaccines — which contain weakened but active viruses or bacteria — could cause serious infection in immunocompromised patients.

Live vaccines to avoid include:

BCG (tuberculosis) vaccine: Avoid for 1 year before starting Stelara AND 1 year after stopping it

MMR (measles, mumps, rubella): Do not receive while on Stelara

Varicella (chickenpox/shingles ZOSTAVAX): Avoid. Note: Shingrix (recombinant shingles vaccine) is NOT a live vaccine and is generally safe.

Yellow fever vaccine: Do not receive while on Stelara

Live nasal influenza spray (FluMist): Avoid. Use the inactivated flu shot instead.

Also tell your doctor if anyone living in your household needs a live vaccine — the virus from some live vaccines can spread from the vaccinated person to immunocompromised individuals.

Interaction #2: Cyclosporine (Monitor Levels)

When you start or stop Stelara, it can affect how your liver metabolizes certain drugs through the CYP450 enzyme system. Specifically, starting Stelara may change the activity of liver enzymes that process drugs with a narrow therapeutic index — meaning medications where the difference between a therapeutic dose and a toxic dose is small.

Cyclosporine (Gengraf, Neoral, Sandimmune) is used to suppress the immune system in transplant patients and some autoimmune conditions. When taking Stelara with cyclosporine, blood levels of cyclosporine should be monitored, and dose adjustments may be needed.

Interaction #3: Warfarin (INR Monitoring)

Warfarin (Coumadin, Jantoven) is a blood thinner with a narrow therapeutic index. If you take warfarin and start or stop Stelara, your INR (a measure of how quickly your blood clots) may change. Your prescriber should monitor your INR more closely when initiating or discontinuing Stelara to ensure your warfarin dose is still appropriate.

Interaction #4: Other Immunosuppressant Medications

Combining Stelara with other immunosuppressant medications increases the overall degree of immune suppression and therefore raises your risk of serious infections. Common immunosuppressants that may be used alongside biologics include:

Methotrexate: Sometimes used with Stelara for psoriatic arthritis. Stelara pharmacokinetics are not significantly affected by methotrexate, but combined immunosuppression increases infection risk.

Azathioprine (Imuran) / 6-mercaptopurine (6-MP): Used in IBD management. May be continued alongside Stelara but increases infection risk.

Prednisone / other corticosteroids: Short-term steroids may be used with Stelara during flares or disease management, but combined immunosuppression increases infection risk.

Other biologics: Combining Stelara with other biologic medications (like adalimumab or infliximab) is not recommended due to the very high risk of infection.

Interaction #5: Allergy Immunotherapy (Allergy Shots)

Stelara may reduce the effectiveness of allergen immunotherapy (allergy shots or sublingual tablets used to desensitize your immune system to allergens). It may decrease your tolerance to allergen doses, potentially increasing the risk of an allergic reaction during immunotherapy. If you're receiving allergy immunotherapy, discuss this with both your allergist and your prescribing specialist before starting Stelara.

Interaction #6: Alcohol

Alcohol does not directly interact with ustekinumab at the molecular level. However, alcohol promotes systemic inflammation and may worsen the conditions Stelara is treating (especially psoriasis and IBD). It can also impair immune function independently. Most specialists recommend limiting or avoiding alcohol during Stelara treatment for these reasons.

Supplements and Herbal Products to Discuss with Your Doctor

Immunostimulating herbal supplements (e.g., echinacea, cat's claw, astragalus, turmeric in high doses) may counteract Stelara's immunomodulating effects. Case reports have documented autoimmune flares associated with these supplements.

Fish oil, vitamin D, and probiotics are generally considered safe to use during Stelara treatment and may even support the conditions being treated. Always disclose these to your prescriber.

What to Tell Every Healthcare Provider

Always tell every healthcare provider you see — doctors, nurses, dentists, pharmacists — that you are taking Stelara. This is especially important before:

Starting any new prescription medication

Getting any vaccine

Having surgery or a dental procedure (infection risk is elevated)

Starting new supplements or herbal products

For a complete guide to Stelara side effects, see: Stelara Side Effects: What to Expect and When to Call Your Doctor