Leflunomide

Leflunomide is a disease-modifying anti-rheumatic drug (DMARD) that helps to slow down joint damage, reduce inflammation and disability caused by rheumatoid arthritis.

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What is this medication used for

Leflunomide is a disease-modifying anti-rheumatic drug (DMARD) that helps to slow down joint damage, reduce inflammation and disability caused by rheumatoid arthritis. 

Dosage and How to Use

Leflunomide dose ranges from 10mg to 20mg daily. Alternate day dosing may also be used for some patients. The dose may vary depending on your disease activity and response to medication. 

Take Leflunomide with or without food. It should be swallowed whole without chewing and works best when taken at the same time every day. 

Leflunomide does not work immediately. It may take up to 12 weeks before the full benefits of this drug are seen. Thus it is important to take your medicine regularly, otherwise you may not benefit at all.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dose. Do not double the dosage to make up for the missed dose.

Side Effects, Precautions, Contraindication

Can leflunomide  be taken with other medications?

Leflunomide may be prescribed along with other medicines used for treating rheumatoid arthritis (e.g. corticosteroids). Some medications (e.g. Warfarin, Cholestyramine, activated charcoal) can interact with Leflunomide. Hence, you should discuss with your doctor before starting any new medication.

Influenza (flu) and pneumococcal vaccinations are safe and recommended when you are on Leflunomide. Discuss with your doctor if you intend to get other vaccinations such as live vaccines for yellow fever and shingles as they are not recommended.

Avoid alcohol consumption while taking Leflunomide as alcohol can increase the risk of liver toxicity.

Please inform your doctor, pharmacist or rheumatology nurse clinician if you are taking other medications including over-the-counter medicines, supplements and traditional/herbal remedies as they may interact with Leflunomide. 


What are the important side effects of leflunomide?

There are some side effects of Leflunomide which you may or may not experience. Always discuss with your doctor if you experience any side effects.

SIDE EFFECT  MANAGEMENT
Nausea, vomiting, diarrhoea, abdominal pain, loss of appetite or weight loss
Take medication after food to minimise the side effects. Sucking hard, sugar-free candy may reduce nausea and vomiting. Inform your doctor if symptoms are severe or if you experience loss of appetite.

Headache, dizziness, weakness

Usually improves as you get used to the medication.
Loss of hairIt is reversible when the medicine is discontinued.
Increased blood pressure Check your blood pressure regularly. Consult your doctor if high blood pressure persists.
Lung infection / lung disease (rare side effect)
Symptoms: Cough with or without fever, shortness of breath or difficulty breathing
Consult your doctor immediately if these symptoms occur.
Blood disorder (rare side effect)
(Warning signs: May be asymptomatic; unusual bleeding or bruising, lip or mouth ulcers with “flu-like” symptoms may occur)
Consult your doctor immediately. It is important to monitor the effects of your new treatment, particularly during the first three months of treatment. For your safety, you need to do regular blood tests for monitoring.

If you develop rashes, facial swelling or shortness of breath after taking the medication, you could be allergic to the medication. Please seek medical attention immediately.

Are there any special precautions that I need to take?

Avoid crowded places and consumption of raw or undercooked food while on Leflunomide. 
  
Inform your doctor if you intend to conceive or breastfeed while taking this medication as Leflunomide can cause serious birth defects to an unborn baby. 

Reliable contraceptive measures must be used to avoid unplanned pregnancy if any one partner, regardless of male or female, is on Leflunomide. 

Women who wish to become pregnant while on Leflunomide or after stopping Leflunomide will need to take another drug, Cholestyramine to help remove Leflunomide from their body. Without this, pregnancy should be strictly avoided for up to 2 years after stopping Leflunomide. If you suspect that you are pregnant while on Leflunomide, inform your doctor immediately. As Leflunomide is excreted into the breast milk, women are advised not to breastfeed.

Men are also advised not to father a child for at least 3 months after stopping Leflunomide. If you intend to, inform the doctor as you will have to discontinue Leflunomide as well as undergo a drug elimination procedure. 

After taking Cholestyramine, it is recommended for women to avoid becoming pregnant and men to avoid fathering a child for at least 3 months.

If you develop a fever, sore throat or other infections, see a doctor immediately because Leflunomide may reduce your immune response and cause some infections to become more severe. Inform the doctor whom you consult that you are taking Leflunomide. During this period, you may temporarily stop taking Leflunomide for 1-2 weeks until you recover.

Inform your doctor before any surgeries as Leflunomide may increase the risk of post-operative infection and/or slows down the wound healing.


What monitoring do I require while I am taking leflunomide?

You will need to have your blood pressure measured before and while on this medication. Regular blood tests will also be done to monitor effects of the medicine on your blood count and liver.

Handling and Storage

Store your medication in a cool, dry place away from heat, moisture and direct sunlight.

If you have any problem with your treatment, please contact your doctor, pharmacist or rheumatology nurse clinician.  

Please keep all medications out of reach of children.


© Tan Tock Seng Hospital, Singapore 2017. All rights reserved. All information correct as of August 2017. No part of this document may be reproduced, copied, reverse compiled, adapted, distributed, commercially exploited, displayed or stored in a database, retrieval system or transmitted in any form without prior permission of Tan Tock Seng Hospital. All information and material found in this document are for purposes of information only and are not meant to substitute any advice provided by your own physician or other medical professionals.

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