Leflunomide Medication: Uses, Dosage, and Side Effects Overview

Summary of Key Points

Leflunomide is a prescription medication primarily used to treat autoimmune conditions such as rheumatoid arthritis and psoriatic arthritis. It works by reducing inflammation and slowing down the immune system’s attack on the body. Leflunomide helps alleviate symptoms like joint pain, swelling, and stiffness. However, it may cause side effects, so it’s crucial to take it exactly as prescribed and consult your healthcare provider if you encounter any issues.

Names of Medication

US Brand Name: Arava

Generic Name: Leflunomide

The generic name refers to the active ingredient in the medication, which remains consistent across different brands. In this case, Leflunomide is the generic name.

Pharmacologic Category

Antirheumatic, Disease-Modifying (DMARD)

Immunosuppressant

Leflunomide Dosage

Leflunomide is prescribed for various autoimmune conditions, and the dosage may differ depending on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. If you need to discuss your dosage or treatment plan, our telemedicine providers are available to assist.

Leflunomide for Rheumatoid Arthritis

Initial dose: 100 mg once daily for 3 days, followed by 20 mg once daily. Some patients may tolerate a lower dose of 10 mg daily if side effects occur.

Leflunomide for Psoriatic Arthritis

Initial dose: 100 mg once daily for 3 days, followed by 20 mg once daily. Treatment is typically long-term to manage symptoms.

Leflunomide for Ankylosing Spondylitis

Initial dose: 100 mg once daily for 3 days, followed by 20 mg once daily. Consult your doctor for the appropriate duration of treatment.

Leflunomide for Juvenile Idiopathic Arthritis (Off-Label Use)

Initial dose: 100 mg once daily for 3 days, followed by 10-20 mg once daily, depending on the child’s weight. Always consult a pediatric specialist for dosing recommendations.

Leflunomide for Systemic Lupus Erythematosus (Off-Label Use)

Initial dose: 100 mg once daily for 3 days, followed by 20 mg once daily. The duration of treatment depends on symptom control.

Leflunomide for Multiple Sclerosis (Off-Label Use)

Initial dose: 100 mg once daily for 3 days, followed by 20 mg once daily. Consult your healthcare provider for guidance on long-term management.

Leflunomide for Crohn’s Disease (Off-Label Use)

Initial dose: 100 mg once daily for 3 days, followed by 20 mg once daily. The length of treatment varies based on symptom severity.

Leflunomide for Ulcerative Colitis (Off-Label Use)

Initial dose: 100 mg once daily for 3 days, followed by 20 mg once daily. Consult your doctor to determine the most appropriate treatment plan.

Leflunomide for Gout (Off-Label Use)

Initial dose: 100 mg once daily for 3 days, followed by 20 mg once daily. Treatment is generally long-term to prevent flare-ups.

Leflunomide for Osteoarthritis (Off-Label Use)

Initial dose: 100 mg once daily for 3 days, followed by 20 mg once daily. Consult your healthcare provider to determine the appropriate duration of treatment.

Dosage Forms and Strengths

Tablet: 10 mg

Tablet: 20 mg

Administration Instructions for Leflunomide

Leflunomide should be taken orally, with or without food. Swallow the tablet whole with a glass of water. It’s important to take Leflunomide at the same time each day to maintain consistent levels in your body. If you miss a dose, take it as soon as you remember, but do not double up on doses. Always follow your healthcare provider’s instructions when taking this medication.

Adverse Reactions and Leflunomide Side Effects

Like all medications, Leflunomide can cause side effects. Some are common and mild, while others may be more serious. If you experience any side effects, contact your healthcare provider immediately. Our telemedicine providers are available to assist if you have concerns.

Common Side Effects (affecting more than 1 in 10 people):

1. Diarrhea: Loose or watery stools are common. Be sure to drink plenty of fluids to stay hydrated.
2. Nausea: Feeling nauseous is common, especially when starting treatment.
3. Hair thinning: Some patients may notice mild hair loss or thinning.

Less Common Side Effects (affecting 1 in 100 people):

1. Rash: Skin irritation or rash may occur. Contact your doctor if the rash worsens or persists.
2. High blood pressure: Leflunomide can raise blood pressure, so regular monitoring is recommended.

Serious Side Effects (affecting fewer than 1 in 1,000 people):

1. Liver damage: Leflunomide can affect liver function. Symptoms may include yellowing of the skin or eyes (jaundice), dark urine, or severe fatigue. Seek medical attention immediately if you notice these symptoms.
2. Severe infections: Since Leflunomide suppresses the immune system, it can increase the risk of infections. Contact your doctor if you develop a fever, cough, or other signs of infection.

Contraindications for Leflunomide

A contraindication is a specific situation or condition where a particular medication should not be used because it may cause harm. For Leflunomide, there are several contraindications to be aware of before starting treatment. These are important to discuss with your healthcare provider to ensure your safety.

Pregnancy: Leflunomide is contraindicated during pregnancy because it can cause serious birth defects. The medication can harm the developing fetus, so women of childbearing age must use effective contraception while taking Leflunomide and for a significant time after stopping it.

Liver disease: If you have severe liver disease, Leflunomide is not recommended. This is because Leflunomide is processed by the liver, and if your liver is not functioning properly, the medication can accumulate to dangerous levels, increasing the risk of liver damage.

Severe immunodeficiency: Leflunomide suppresses the immune system, so it is contraindicated in individuals with severe immunodeficiency (such as those with HIV/AIDS or those undergoing chemotherapy) because it can increase the risk of serious infections.

Bone marrow suppression: If you have a history of bone marrow suppression or blood disorders, Leflunomide may worsen these conditions, leading to dangerously low blood cell counts.

Active infections: Leflunomide weakens the immune system, making it harder for your body to fight infections. If you have an active infection, taking Leflunomide could worsen it or make it more difficult to treat.

Drug to Drug Interactions

Leflunomide can interact with other medications, potentially increasing the risk of side effects or reducing the effectiveness of either drug. It is crucial to inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements. Some common Leflunomide interactions include:

1. Warfarin (Coumadin): Leflunomide can amplify the effects of warfarin, a blood thinner, which may increase the risk of bleeding.
2. Rifampin (Rifadin): This antibiotic can raise Leflunomide levels in your bloodstream, potentially leading to toxicity.
3. Cholestyramine (Questran): Cholestyramine can decrease Leflunomide’s effectiveness by speeding up its removal from the body.
4. NSAIDs (e.g., ibuprofen, naproxen): While NSAIDs are commonly used for pain and inflammation, combining them with Leflunomide may heighten the risk of liver damage.
5. Live vaccines: Since Leflunomide suppresses the immune system, receiving live vaccines while on this medication can increase the risk of contracting the infection the vaccine is meant to prevent.

Leflunomide in Pregnancy

Is it Safe to Take Leflunomide During Pregnancy?

No, Leflunomide is not safe during pregnancy. Classified as a Category X drug by the FDA, it can cause serious harm to an unborn baby, including birth defects. Women who are pregnant or planning to become pregnant should avoid Leflunomide. If you are of childbearing age and taking Leflunomide, it is essential to use effective birth control. If you become pregnant while on Leflunomide, contact your healthcare provider immediately. A specific “drug elimination protocol” can help remove Leflunomide from your system more quickly.

Leflunomide While Breastfeeding

Is it Safe to Take Leflunomide While Breastfeeding?

No, Leflunomide is not recommended while breastfeeding. The medication can pass into breast milk and may harm a nursing infant. If you are breastfeeding or planning to breastfeed, consult your healthcare provider about safer alternatives.

Estimated Cost of Leflunomide Medication

The cost of Leflunomide can vary depending on the pharmacy and your insurance coverage. Without insurance, a 30-day supply of Leflunomide (typically 20 mg tablets) costs around $50 to $100 with a GoodRx coupon. Prices may differ, so it’s a good idea to check with your local pharmacy or use a prescription discount service like GoodRx to find the best price.

Possible Alternatives to Leflunomide

If Leflunomide is not suitable for you, several alternative treatments and lifestyle changes may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss your options.

1. Rheumatoid arthritis: Alternatives include methotrexate, sulfasalazine, or biologics like adalimumab (Humira). Lifestyle changes such as regular exercise, a balanced diet, and stress management can also help reduce symptoms.
2. Psoriatic arthritis: Medications like methotrexate, cyclosporine, or biologics such as etanercept (Enbrel) may be used. Maintaining a healthy weight and avoiding smoking can improve outcomes.
3. Ankylosing spondylitis: NSAIDs like ibuprofen or biologics like infliximab (Remicade) are common alternatives. Physical therapy and regular exercise can also help manage symptoms.
4. Juvenile idiopathic arthritis: Treatment options include methotrexate, NSAIDs, and biologics like tocilizumab (Actemra). Regular physical activity and a balanced diet are essential for managing symptoms.
5. Systemic lupus erythematosus: Hydroxychloroquine (Plaquenil) and corticosteroids are common alternatives. Avoiding sun exposure and managing stress can help reduce flare-ups.
6. Multiple sclerosis: Disease-modifying therapies such as interferon beta or glatiramer acetate (Copaxone) may be used. Regular exercise and a healthy diet can support overall health.
7. Crohn’s disease: Alternatives include biologics like infliximab (Remicade) or corticosteroids. Dietary changes, such as avoiding trigger foods, can help manage symptoms.
8. Ulcerative colitis: Medications like mesalamine (Asacol) or biologics like vedolizumab (Entyvio) may be used. A low-fiber diet during flare-ups can help reduce symptoms.
9. Gout: Alternatives include allopurinol (Zyloprim) or febuxostat (Uloric). Lifestyle changes such as reducing alcohol intake and avoiding purine-rich foods can help prevent flare-ups.
10. Osteoarthritis: NSAIDs, acetaminophen (Tylenol), and physical therapy are common alternatives. Weight management and regular low-impact exercise can help reduce symptoms.

Recent Updates on Leflunomide Research

Recent studies continue to explore Leflunomide’s effectiveness in treating autoimmune conditions. One area of ongoing research is its potential use in combination with other disease-modifying antirheumatic drugs (DMARDs) to improve outcomes in patients with rheumatoid arthritis and psoriatic arthritis. Researchers are also investigating whether Leflunomide could benefit other autoimmune conditions, such as multiple sclerosis and lupus, though more studies are needed to confirm its safety and effectiveness in these areas.

Another research focus is minimizing Leflunomide’s side effects, particularly its impact on liver function. New formulations and dosing strategies are being studied to reduce the risk of liver damage while maintaining the drug’s effectiveness. If you’re interested in learning more about ongoing research or participating in a clinical trial, talk to your healthcare provider or schedule a telemedicine appointment with one of our providers today.

James Kingsley

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