Leflunomide: what it is for and how to take it

Leflunomide is an antirheumatic and selective immunosuppressant indicated for the treatment of active rheumatoid arthritis in adults, and may also be indicated in the case of psoriatic arthritis, which is arthritis that appears in people who have psoriasis.

This medicine has antiproliferative properties and works by reducing inflammation in the joints and reducing the progression of the disease, relieving symptoms and improving quality of life.

Leflunomide is offered free of charge by the SUS, as long as it has a medical indication, or it can be purchased in pharmacies under the name Arava, available in the form of 20 mg or 100 mg tablets, sold upon presentation of a medical prescription.

What is it for

Leflunomide is indicated for the treatment of:

• Active rheumatoid arthritis;
• Active psoriatic arthritis.

This medicine helps to reduce the symptoms of the disease and joint damage, helping to reduce the progression of the disease and improving quality of life.

Leflunomide should be used with the advice of a rheumatologist and regular medical monitoring to assess the effectiveness of the treatment and the emergence of side effects.

If you would like to see a rheumatologist, make an appointment in the nearest region:

How to drink

The tablets contain leflunomide 20 mg or 100 mg, and should be taken orally, with a glass of water, before or after a meal.

Leflunomide doses for adults vary according to the condition being treated and include:

1. Active rheumatoid arthritis

Treatment of active rheumatoid arthritis generally begins with a loading dose of 100 mg of leflunomide, once a day, for 3 days.

From then on, the recommended maintenance dose is 20 mg of leflunomide, once a day, depending on tolerance to the treatment, and this dose can be reduced by the doctor, if necessary.

2. Active psoriatic arthritis

Treatment of active psoriatic arthritis with leflunomide starts with a loading dose of 100 mg, once a day, for 3 days.

The recommended maintenance dose is 20 mg of leflunomide once a day.

How long for leflunomide to take effect

The effect of leflunomide usually begins after 4 weeks of treatment and may improve after up to 4 to 6 months.

Not using a loading dose may be considered by the doctor to reduce the risk of side effects.

This is especially true in people at increased risk of hematological or liver toxicity, due to the use of leflunomide with other medications, such as methotrexate or other immunosuppressants.

Care during treatment

Treatment with leflunomide is long-term and must be carried out with regular monitoring by a rheumatologist, which must include monitoring ALT levels and blood pressure.

Before starting treatment with leflunomide and during treatment, a complete blood count should also be performed.

Possible side effects

The most common side effects of leflunomide are high blood pressure, headache, stomach or back pain, nausea, diarrhea, loss of appetite, weakness, hair loss or skin irritation.

In addition, aphthous stomatitis, mouth ulcers, colitis, vertigo and tingling are also common.

Leflunomide can also reduce blood leukocytes, which are defense cells, and increase the risk of infections, with symptoms such as fever, chills, mouth sores, difficulty swallowing or swollen gums. In these cases, medical help should be sought immediately.

This medicine can also affect the liver, and you should go to the nearest emergency room if symptoms such as dark urine, light stools, yellowish skin and eyes appear. Know how to identify all the symptoms of liver problems.

Who shouldn’t use

Leflunomide should not be used in the following situations:

• Allergy to leflunomide, teriflunomide or any other component of the tablet;
• Suspected or confirmed pregnancy, or breastfeeding;
• Liver failure;
• Severe immunodeficiency, such as AIDS;
• Change in bone marrow function;
• Anemia, leukopenia, neutropenia or thrombocytopenia;
• Serious infections.

Furthermore, leflunomide is contraindicated for children under 18 years of age, as the efficacy and safety of this medication in juvenile rheumatoid arthritis have not been established.