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Indications

Leflunomide is a disease modifying medicine used to treat active rheumatoid arthritis in adults, and sometimes psoriatic arthritis. It helps reduce joint pain, swelling and stiffness and slows damage to the joints over time.

How It Works

Leflunomide is changed in the body into an active substance that blocks an enzyme called dihydroorotate dehydrogenase. Rapidly dividing immune cells need this enzyme to multiply. By slowing these cells, it calms the overactive immune response that causes joint inflammation. Benefit usually starts after 4 to 6 weeks and may keep improving for several months.

Dosage and Administration

Take exactly as prescribed by your specialist. Treatment sometimes starts with a short higher loading dose and then continues with a lower daily dose. Swallow the tablet whole with water, with or without food, at the same time each day. Regular blood tests are needed during treatment.

Interactions

• Methotrexate and other medicines that can harm the liver or bone marrow increase the risk of serious side effects.
• Warfarin effect may be increased, so blood clotting needs checking.
• Live vaccines should be avoided during treatment and for some time after.
• Cholestyramine and activated charcoal remove Leflunomide from the body quickly and are used on purpose for washout.
• Alcohol adds to the risk of liver damage.

Contraindications

• Allergy to Leflunomide or Teriflunomide.
• Pregnancy, or women who could become pregnant and are not using reliable contraception.
• Breastfeeding.
• Liver disease, severe kidney disease, serious infection, severe immune deficiency or low blood counts.

Side Effects

Common effects include diarrhoea, nausea, stomach pain, raised liver enzymes, hair thinning, rash, itching, raised blood pressure, headache, dizziness and weight loss.

Get urgent medical help if you notice yellow skin or eyes, dark urine, fever, sore throat or other signs of infection, unusual bruising or bleeding, a severe skin rash with blistering or peeling, new cough or breathlessness, or numbness and tingling in the hands or feet.

Pregnancy and Lactation

Leflunomide can cause serious harm to an unborn baby. Pregnancy must be excluded before starting, and reliable contraception is needed during treatment. The medicine stays in the body for up to two years, so anyone planning pregnancy, including men wishing to father a child, should talk to the doctor about a washout procedure. Do not breastfeed while taking it.

Precautions and Warnings

• Blood counts, liver tests and blood pressure are checked before and regularly during treatment.
• Tell your doctor about any infection, including past tuberculosis.
• Limit alcohol.
• Do not stop or change the dose without speaking to your doctor.

Overdose

Overdose may cause diarrhoea, stomach pain, liver problems and low blood counts. Seek medical help straight away; doctors may give Cholestyramine or charcoal to remove the drug.

Therapeutic Class

Disease modifying antirheumatic drug (DMARD), immunomodulator.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.