DrugindexOnline^{2nd edition}

Generic name: Leflunomide
Brand names: Arava

Why is Leflunomide prescribed?

Arava is used in the treatment of rheumatoid arthritis. It reduces the pain, stiffness, inflammation, and swelling associated with this disease, improves physical function, and staves off the joint damage that ultimately results.

Most important fact about Leflunomide

You MUST NOT take Arava if you are pregnant; it can harm the developing baby. If you are still in your childbearing years, your doctor will want to see negative results from a pregnancy test before starting you on Arava. You'll also need to use reliable contraceptive measures as long as you take the drug.

If you become pregnant while taking Arava, your doctor will stop the drug immediately and prescribe a regimen of cholestyramine (Questran) in 8-gram doses 3 times a day for 11 days. Questran helps to clear Arava from the bloodstream, possibly preventing harm to the unborn child.

How should you take Leflunomide?

Your dosage of Arava will be decreased after the first 3 days. Never take more than your doctor prescribes.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at the same time.

--Storage instructions...

Store at room temperature away from light.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Arava.

• More common side effects may include:
  Abdominal pain, back pain, bronchitis, cough, diarrhea, dizziness, hair loss, headache, high blood pressure, indigestion, itching, joint disorders, loss of appetite, mouth ulcers, nausea, rash, respiratory infection, sore throat, stomach inflammation, tendon inflammation, urinary tract infection, vomiting, weakness, weight loss

Why should Leflunomide not be prescribed?

Remember that you must not take Arava if you are pregnant or plan to become pregnant. You'll also need to avoid Leflunomide if it gives you an allergic reaction.

Special warnings about Leflunomide

Arava is potentially damaging to the liver. Your doctor will test your liver function before starting Arava therapy. If you have significant liver disease, including hepatitis, you'll be unable to take Arava. If you develop liver problems while taking the drug, your dose will have to be reduced or eliminated.

Theoretically, Arava may interfere with your body's ability to fight off infection. The drug is therefore not recommended for people with cancer, bone marrow problems, severe infections, AIDS, or any other immune system problems. You should also avoid immunization with live vaccines while taking Arava.

Since there is a possibility that Arava could damage your liver or cause blood problems (such as a loss of white blood cells used to fight infection or a loss of cells that help your blood clot), it is essential that your doctor conducts a monthly blood test for the first 6 months of therapy, then every 6 to 8 weeks thereafter. If you are taking Arava and the cancer drug methotrexate together you may be even more susceptible to these problems. Your doctor will need to test your blood every month. Notify your doctor promptly if any signs of a blood problem appear. Warnings include easy bruising, frequent infections, unusual fatigue, and paleness.

Arava has been known to cause rare but serious skin reactions. If you develop a skin rash or eruption, stop taking Arava and contact your doctor. Arava can also reduce your blood cell count.

Your doctor will prescribe the drug cautiously if you have kidney problems, since poor kidney function can increase the amount of Arava in your system.

Arava does not appear to cause fetal harm when taken by the father prior to conception. Nevertheless, if you plan to father a child, your doctor will instruct you to stop taking Arava and will prescribe a regimen of cholestyramine to clear Arava from your system.

Possible food and drug interactions when taking Leflunomide

If Arava is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Arava with the following:

Cholestyramine (Prevalite, Questran)
Methotrexate (Rheumatrex)
Nonsteroidal anti-inflammatory drugs such as Advil, Aleve, Motrin, and Naprosyn
Rifampin (Rifadin, Rifamate, Rifater)
Tolbutamide (Orinase)

Special information if you are pregnant or breastfeeding

Do not take Arava while pregnant or breastfeeding. Taken during pregnancy, the drug can cause birth defects. And although it is not known whether Arava appears in breast milk, there is good reason to suspect that it will cause serious side effects in nursing infants.

Recommended dosage

ADULTS

The recommended starting dose is one 100-milligram tablet daily for the first 3 days. If you have an increased risk for blood disorders or liver problems, your doctor may choose to eliminate the 100-milligram starting dose to reduce the risk of serious side effects.

After the first 3 days, the doctor will reduce the dose to 20 milligrams a day. If side effects appear, the dose may be further decreased to 10 milligrams a day.

CHILDREN

Arava is not recommended for children less than 18 years old.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose of Arava, seek medical treatment immediately.

• Symptoms of Arava overdose may include:
  Abdominal pain, anemia, blood disorders, diarrhea, liver problems