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Jun 6, 2024


Leflunomide Use For Rheumatoid Arthritis

Rheumatoid arthritis

Rheumatoid arthritis, often abbreviated as RA, is an autoimmune disorder characterized by chronic inflammation of your joints. Your immune system mistakenly attacks healthy cells in your body, specifically the lining of the membranes that surround your joints.

Symptoms include joint pain, swelling, and stiffness, and, over time, can result in damage to the affected joints. Rheumatoid arthritis commonly affects the small joints in your hands and feet and can cause systemic symptoms such as fatigue and fever.

Rheumatoid arthritis is believed to impact around 1.3 million adults in the United States. It is more common in women than in men and typically occurs between the ages of 30 and 60. While rheumatoid arthritis is a chronic and progressive condition, early diagnosis and appropriate medical management can help control symptoms and prevent joint damage.

How Leflunomide Works

Leflunomide is commonly prescribed for rheumatoid arthritis especially in those who cannot tolerate methotrexate, another RA medication.

Leflunomide is a type of medication known as a disease-modifying antirheumatic drug (DMARD). It works by targeting an enzyme called dihydroorotate dehydrogenase (DHODH). This enzyme plays an important role in producing DNA and RNA, which are crucial for cell growth and function. By blocking DHODH, Leflunomide slows down the production of DNA and RNA. This is especially important in immune cells, like T cells.

T cells are a type of white blood cell that play a significant role in the immune response. In conditions like rheumatoid arthritis, an overactive immune response leads to inflammation and damage to body tissues, notably the joints. By reducing the proliferation of these T cells, Leflunomide decreases the overall immune activity, leading to reduced inflammation and less joint damage.

Leflunomide also has anti-inflammatory properties that further help in reducing the swelling, pain, and stiffness. This dual mechanism helps manage the symptoms and slows the progression of the disease.

Dosage and Administration

Leflunomide is available in tablet form and comes in dosages of 10 mg and 20 mg. It can be taken orally, with or without food.

It typically takes about 4 to 6 weeks to begin noticing the effects of the medication, and achieving full effectiveness may take up to 4 to 6 months.

If you miss a dose, take it as soon as you remember. However, if it's nearly time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not double dose.

Do not discontinue Leflunomide without consulting your doctor. Due to the drug's long-lasting presence in your body, stopping it suddenly might not lead to immediate symptoms. However, abruptly discontinuing the medication could cause your rheumatoid arthritis symptoms to return. In some cases, medications like Cholestyramine might be prescribed to help remove the drug more quickly from your system.

Side Effects

Common Side Effects
  • Abdominal pain or upset stomach
  • Nausea
  • Diarrhea
  • Headache
  • Dizziness
  • Back pain
  • Weakness or fatigue
  • Hair thinning or loss
  • High blood pressure
  • Rash or itchy skin

If you experience any of these symptoms, it's important to discuss them with your healthcare provider. They can help determine if a dose adjustment or a switch to another medication is needed.

Seirous Side Effects

Leflunomide can also cause more serious side effects, and it's crucial for those on this medication to be closely monitored by healthcare professionals.

  • Liver Problems: nausea, upper stomach pain, itching, fatigue, loss of appetite, dark urine, clay-colored stools, or jaundice
  • Severe Skin Reactions: fever, sore throat, swelling in your face or tongue, burning in your eyes, and a red or purple skin rash that spreads and causes blistering and peeling. Stevens-Johnson syndrome is a rare but severe reaction that requires immediate medical attention.
  • Lung Injury: new or worsening cough, or shortness of breath
  • Signs of Infection: weakness, fever, chills, red or swollen gums, or difficulty swallowing
  • Neurological Symptoms: numbness, tingling, or burning pain in your hands or feet
  • Allergic Reactions: difficulty breathing, swelling, or severe dizziness, which require urgent medical attention

If you experience any of these serious side effects, contact your doctor immediately and stop taking the medication.


Leflunomide can interact with various medications and substances, which may affect its effectiveness or increase the risk of side effects. Inform your doctor and pharmacist about all medications and supplements you are currently taking, including prescribed and over-the-counter drugs, vitamins, and dietary or herbal supplements.

Medications that can interact with Leflunomide invlude:

  • Teriflunomide
  • Methotrexate
  • Warfarin

You should also avoid live vaccines while taking Leflunomide, and for six months after stopping it, as the vaccine's effectiveness can be reduced due to a weakened immune system. If you're unsure about any vaccine you are scheduled to receive, consult your doctor or pharmacist for advice.

Leflunomide and Pregnancy

Leflunomide is not safe during pregnancy as it is known to be teratogenic, meaning it can harm the developing fetus. Women who are pregnant, planning to become pregnant, or not using reliable contraception should not take Leflunomide.

If you are on Leflunomide and planning to conceive, or if you miss a period during treatment, contact your doctor immediately. Before starting Leflunomide, during treatment, and for two years after stopping, you must use effective birth control. If you plan to conceive within two years after stopping Leflunomide, a washout procedure using cholestyramine or activated charcoal might be necessary to remove the drug from your body.

Speak With Your Doctor

If you've been considering Leflunomide for rheumatoid arthritis, or if it has been prescribed, talking with your doctor is crucial. Discuss your medical history, current medications, and any concerns you might have to ensure Leflunomide is suitable for you. Your doctor can address your questions, monitor your health, and optimize the safety and effectiveness of your treatment.

You can also explore cost-saving options for your prescription through services like Marley Drug, which offers competitive prices and free home delivery.

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