Leflunomide / Arava for Rheumatoid Arthritis – all your questions answered

Leflunomide For Rheumatoid Arthritis

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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 on 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 the modulation of the immune system and decreasing inflammation.

What is the effect of Leflunomide on Rheumatoid Arthritis?

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 help reduce side effects such as fatigue and 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 uncontrolled infections. If an infection develops, the patient should consider interrupting therapy.

Can Leflunomide affect my organs?

Leflunomide can affect the liver. Patients with severe hepatic impairment and preexisting liver disease should not avoid using leflunomide If liver enzymes increase 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 ensure you get a proper vaccine response. For patients receiving COVID-19 vaccine, holding for one or two weeks after the vaccine is given is recommended.

Is Leflunomide safe for pregnancy?

Leflunomide should NOT be used in pregnant women because it can potentially 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 before starting this therapy.

This medication information is limited. Patients should use it as a tool better to understand the medication’s role in 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 a physician’s medical advice, diagnosis, or treatment. 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. 

Disclaimer

All content shared on this site is for informational purposes only and is not a substitute for medical advice, diagnosis, or treatment. This site and its services do not constitute the practice of medicine. You should always talk to your health care provider for diagnosis and treatment regarding your specific medical needs. We don’t represent that any of the products or services offered through this site are safe, appropriate, or effective for you. We advise you to always seek the advice of a physician or other qualified health care provider regarding personal health or medical conditions. If you know or suspect you have a medical problem, contact a qualified healthcare professional immediately. If you’re experiencing a medical emergency, call 911.

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