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Leflunomide

    DEA Class; Rx

    Common Brand Names; Arava

    • DMARDs, Other; 
    • Immunosuppressants

    Disease-modifying antirheumatic drug (DMARD); isoxazol derivative; has a fast onset of action (4 weeks) relative to other DMARDs; decreases symptoms and retards structural joint damage in RA; under investigation as an immunosuppressive agent for organ transplants and for SLE.

    Indicated for Rheumatoid Arthritis

    Pregnancy

    Hypersensitivity

    Severe hapatic impairment

    Current treatment with teriflunomide

    Diarrhea (17%)

    Respiratory infections (15%)

    Alopecia (10%)

    Hypertension (10%)

    Rash (10%)

    Nausea (9%)

    Bronchitis (7%)

    Headache (7%)

    Abdominal pain (5%)

    Abnormal LFT’s (5%)

    Accidental injury (5%)

    Back pain (5%)

    Dyspepsia (5%)

    UTI (5%)

    Dizziness (4%)

    Infection (4%)

    Joint disorder (4%)

    Pruritus (4%)

    Weight loss (4%)

    Anorexia (3%)

    Cough (3%)

    Gastroenteritis (3%)

    Pharyngitis (3%)

    Stomatitis (3%)

    Tenosynovitis (3%)

    Vomiting (3%)

    Weakness (3%)

    Allergic reaction (2%)

    Chest pain (2%)

    Dry skin (2%)

    Eczema (2%)

    Pain (2%)

    Hepatotoxicity reported

    Vaccination with live vaccines not recommended

    Potential increase risk for malignancy

    Increase in blood pressure reported with therapy; check blood pressure before initiating therapy and periodically thereafter

    Rare cases of drug reaction with eosinophilia and systemic symptoms (DRESS) reported; discontinue therapy; a drug elimination procedure recommended

    Co-administration of teriflunomide with leflunomide not recommended, as leflunomide is parent compound of teriflunomide

    Peripheral neuropathy reported; most recover after discontinuing drug; risk factors include age >60 years, concomitant neurotoxic drugs, and diabetes; if patient develops peripheral neuropathy, consider discontinuing and performing accelerated elimination procedure

    Interstitial lung disease (ILD) reported and has been associated with fatal outcomes; risk increased with prior history of ILD; if pulmonary symptoms worsen in patients with pre-exixting ILD, consider discontinuing therapy and performing accelerated drug elimination procedure

    A pregnancy exposure registry monitors pregnancy outcomes in women exposed to therapy during pregnancy

    Clinical lactation studies not conducted to assess presence of drug in human milk, effects on breastfed child, or on milk production

    Adults

    20 mg/day PO for maintenance dose.

    Elderly

    20 mg/day PO for maintenance dose.

    Adolescents

    Safety and efficacy have not been established.

    Children

    Safety and efficacy have not been established.

    leflunomide

    tablet

    • 10mg
    • 20mg
    • 100mg