Leflunomide

Brand names

• Arava

Usage

To reduce the signs and symptoms of moderate to severe active rheumatoid arthritis. Leflunomide is prescribed for patients who have not responded adequately to one or more antirheumatic medications.

How it works

Leflunomide appears to suppress overactivity of the immune system, which is believed to cause rheumatoid arthritis. It also appears to reduce inflammation.

Side effects

Serious

Liver toxicity may occur; it can be detected by your doctor with blood tests; it may be discerned by the patient if it causes jaundice, characterized by yellowish discoloration of the skin and eyes.

Common

Diarrhea, hair loss, rash, nausea, vomiting, abdominal pain.

Less common

Allergic reaction, back pain, bronchitis, pneumonia, nasal congestion, itching.

Possible interactions

Other medicaments:

Leflunomide may decrease the effects of:

• live-virus vaccines.

Leflunomide taken concurrently with:

• activated charcoal (various) may result in decreased leflunomide benefits.
• cholestyramine (Questran, others) and other cholesterol-lowering resins may result in decreased leflunomide effectiveness.
• influenza (flu) vaccine may blunt benefits of the vaccine.
• medicines removed by CYP2C9 (such as losartan, phenytoin and S-warfarin) may lead to higher than expected blood levels and effects of those medicines.
• methotrexate (various) may lead to increased liver enzymes, although one study found increased therapeutic benefits of this combination.
• NSAIDs may lead to higher than expected blood levels of the NSAIDs.
• other medicines that blunt the immune system may result in additive effects.
• pneumococcal or smallpox vaccine may result in decreased immune response to the vaccine.
• rifampin (Rifater, others) may increase risk of leflunomide toxicity.
• tolbutamide (Orinase) may increase the active tolbutamide, resulting in a greater response from tolbutamide than expected.
• yellow fever vaccine can result in blunted response and benefit from the vaccine.

Herbal medicines or minerals:

Some patients use Echinacea to attempt to boost their immune systems. Unfortunately, use of Echinacea is not recommended in people with damaged immune systems (even if a medicine caused the damage). This herb may also actually weaken any immune system if it is used too often or for too long a time. Hay flower, mistletoe herb and white mustard seed carry German Commission E monograph indications for arthritis and may be complementary. Talk to your doctor before combining any medicines.

Marijuana smoking:

May cause additional impairment of immunity.

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