Shares of Johnson & Johnson turned negative as investors reacted to a lackluster sales growth outlook.

The company topped Wall Street's fourth-quarter earnings and revenue expectations with boosts from new cancer drugs and its acquisition of Swiss biotech company Actelion. In its earnings release, the company projected operational revenue growth of 3.5 percent to 4.5 percent.

Later, J&J Chief Financial Officer Dominic Caruso clarified the forecast included the benefit of acquisitions and divestitures. Without those, organic growth is expected to be in the range of 2.5 percent to 3.5 percent.

J.P. Morgan analyst Mike Weinstein called the guidance "disappointing" in a note to investors, saying it fell below his expectation of 3.5 percent to 4 percent heading into the release. In the third quarter, J&J reported 3.8 percent growth for this metric.

J&J's stock closed down 4.3 percent after rising as much as 1.9 percent in the premarket.

In the company's fourth quarter, sales of blood-cancer treatments Darzalex and Imbruvica surged in the quarter. Plaque psoriasis treatment Tremfya also posted strong growth, the company said, though it did not break out numbers in the earnings release.

Here's how J&J did compared with what Wall Street expected:

EPS: $1.74 vs. $1.72 per share expected by Thomson Reuters' survey of analysts.

Revenue: $20.2 billion vs. $20.1 billion.

The sprawling health company generated $20.2 billion in revenue for the quarter, an increase of 11.5 percent from the previous year. On an operational basis, J&J's revenue grew 9.4 percent. Excluding the impact of acquisitions, divestitures and currency, worldwide sales were up 4.2 percent. Included in the special items was $13.6 billion associated with the tax overhaul.

J&J expects its effective tax rate to fall 16.5 to 18 percent this year thanks to the new code.

"We are pleased with the passage of recent legislation modernizing the U.S. tax system, which enables Johnson & Johnson to invest in innovation at higher levels to help address the most challenging unmet medical needs facing health care today," CEO Alex Gorsky said in a statement.

In the fourth quarter, the company reported a net loss of $10.7 billion, or $3.99 per share. However, after stripping out amortization expenses and special items, the company earned $4.8 billion, or $1.74 per share, in the latest period, outpacing analyst estimates of $1.72 per share.

J&J's pharmaceutical business posted $9.7 billion in revenue, a 15.5 percent year-over-year operational increase.

Operational sales of J&J's multiple myeloma treatment Darzalex surged 82.3 percent in the quarter, hitting $371 million. Analysts polled by StreetAccount expected sales to reach $346.7 million.

Another blood-cancer treatment, Imbruvica, grew 46 percent on an operational basis but missed expectations. Worldwide sales grew 46 percent, reaching $522 million. Analysts polled by StreetAccount had predicted they would hit $537.2 million.

Sales of J&J's rheumatoid arthritis drug Remicade sagged to $1.5 billion, down 10.5 percent operationally from the year-ago quarter. The drug faces competition from Pfizer's Inflectra and Merck and Samsung Bioepis' Renflexis. A U.S. appeals court on Tuesday upheld a ruling that invalidated a crucial Johnson & Johnson patent for Remicade.

Operational sales of diabetes drug Invokana fell 29 percent to $267 million. It's faced pressure from Eli Lilly and Boehringer Ingelheim's Jardiance. The diabetes market got even more crowded in December when the Food and Drug Administration approved Merck and Pfizer's type 2 diabetes drug, Steglatro.

Blood thinner Xarelto's sales gained about 19 percent, reaching $710 million, surpassing analysts' expectations of $669.5 million. In the quarter, J&J submitted applications to the FDA for two vascular new indications.

Last summer, J&J completed its $30 billion acquisition of Actelion. The deal contributed 4.2 percent of J&J's full-year pharma segment's operational sales growth of 8.3 percent. The unit posted $36.3 billion in revenue for the quarter.

J&J's consumer segment was roughly flat, posting 0.4 percent operational growth to reach $3.5 billion in sales. The company's medical device unit grew 6.5 percent operationally to generate $7 billion in revenue.