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Leflunomide For Rheumatoid Arthritis

Leflunomide / Arava for Rheumatoid Arthritis – all your questions answered

Leflunomide is a medication that is used for rheumatoid arthritis patients. The brand name is called Arava. This medication is also part of the disease modifying anti-rheumatic drugs. Before I start my patients on this therapy, we have a comprehensive discussion, where I answer all their questions. Here are the most common questions that my patients ask.

  • What is Leflunomide?
  • What is the effect of Leflunomide in Rheumatoid Arthritis Patients?
  • Is Leflunomide similar to methotrexate?
  • Is Leflunomide a pill or an injectable medication?
  • Can Leflunomide be combined with other medications such as biologics?
  • Why do I need to take folic acid with leflunomide?
  • What are the most common side effects?
  • Will I get more infections while on leflunomide?
  • Can Leflunomide affect my organs?
  • Can I drink while taking leflunomide?
  • Can I get vaccinated while taking leflunomide?
  • Is Leflunomide safe for pregnancy?

What is Leflunomide?

Leflunomide is a common medication used in patients with rheumatoid arthritis. This medication is used for modulation of the immune system and decreasing inflammation.

What is the effect of Leflunomide in Rheumatoid Arthritis Patients?

Patients with rheumatoid arthritis have high levels of inflammation. Leflunomide works to treat rheumatoid arthritis by inhibiting pyrimidine synthesis, resulting in anti-proliferative and anti-inflammatory effects.

Is Leflunomide similar to methotrexate?

Leflunomide is similar to methotrexate as they are both immunosuppressants used to treat rheumatoid arthritis. They both work through modulation of the immune system and decreasing inflammation. Leflunomide is usually used for those who haven’t responded or tolerated methotrexate.

Is Leflunomide a pill or an injectable medication?

Leflunomide is an oral therapy. Leflunomide has 10 mg and 20 mg tablets and may be taken without regard to meals.

 

When to take Leflunomide For Rheumatoid Arthritis ?

Can Leflunomide be combined with other medications such as biologics?

Leflunomide can be combined with other medications such as NSAIDs, Hydroxychloroquine, Sulfasalazine and Biologics. Discuss with your rheumatologist when you have to take additional medications in combination with leflunomide.

Why do I need to take folic acid with leflunomide?

Folic acid and biotin vitamins might be helpful in reducing side effects such as fatigue, headaches and protect liver cells.

How to monitor if Leflunomide is safe for my body?

It is recommended to obtain baseline tests (CBC, liver and renal panel, hepatitis test, tuberculosis screening). Regular laboratory blood work should be done for all patients on arava / leflunomide. That should include monthly labs for the first three months of therapy, followed by every two months and, if laboratory results are normal, continue with laboratory tests every 3 months.

What laboratory tests should be done for leflunomide?

 

What are the most common side effects?

Here listed are the most common side effects reported by patients on leflunomide:

  • Skin rash
  • Gastrointestinal issues including diarrhea, nausea, abdominal pain, gastrointestinal pain, mucosa ulcer, and vomiting
  • Nervous system symptoms including headache and dizziness
  • Hypertension
  • Alopecia
  • Pruritus, or itchy skin
  • Asthenia, or physical weakness
  • Back pain
  • Tenosynovitis
  • Bronchitis
  • Rhinitis

Will I get more infections while on leflunomide?

Leflunomide may increase susceptibility to infection. Infections include pneumonia, tuberculosis, and aspergillosis. Leflunomide is not recommended in patients with severe immunodeficiency, or severe, uncontrolled infections. If infection develops, the patient should consider interrupting therapy.

Can Leflunomide affect my organs?

Leflunomide can affect the liver. Patients with severe hepatic impairment, preexisting liver disease should not avoid using leflunomide If liver enzymes are increasing during therapy with leflunomide, the therapy should be discontinued. Hypertension can also be seen.

Can I drink while taking leflunomide?

It is recommended that you avoid drinking alcohol while taking leflunomide. If you have intermittent alcohol intake, that may be tolerated, but it is recommended to disclose this to your rheumatologist to have frequent laboratory monitoring.

Can I get vaccinated while taking leflunomide?

Yes, you may be vaccinated while taking leflunomide. However it may be best to withhold therapy with leflunomide for two weeks after the vaccines are given to make sure you get a proper vaccine response.For patients receiving COVID-19 vaccine, it is recommended to hold for one or two weeks after the vaccine is given.

Is Leflunomide safe for pregnancy?

Leflunomide should NOT be used in pregnant women due to its potential to cause fetal harm. Those who have the potential to become pregnant are advised to use two methods of contraception during leflunomide treatment. If a patient becomes pregnant, stop leflunomide and use an accelerated drug elimination procedure. It is advised to stop breastfeeding during leflunomide treatment. Discuss with your rheumatologist if you are planning on getting pregnant. Get a pregnancy test done prior to start this therapy.

 

DISCLAIMER

This medication information is limited. Patients should use it as a tool to better understand the medication role in the disease treatment. It is not supposed to be comprehensive and does NOT include all information about a diagnosis, treatment, medication, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a physician. Patients must speak with their physician for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. 

Author

Diana M. Girnita is a rheumatologist and founder and CEO, Rheumatologist OnCall. She can also be reached on FacebookInstagram, and YouTube.

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