Leflunomide Print Page

What is Leflunomide?

  • Leflunomide is in a class of medications called Disease Modifying Anti-Rheumatic Drugs, or DMARDs. DMARDs are a slow acting but effective treatment for rheumatoid arthritis and other forms of inflammatory arthritis.
  • Leflunomide is a newer DMARD considered by some to be equivalent in effect to methotrexate for rheumatoid arthritis.
  • It can also used in the treatment of other types of inflammatory arthritis, vasculitis, myositis and others.

What is the typical dose for Leflunomide?

  • Leflunomide comes in tablet form. Most rheumatologists will start Leflunomide at 20mg daily.
  • However, 10mg daily and 20mg every second day are also reasonable & common, and depends on the individual patient.

How does Leflunomide work?

  •  While there has been extensive research into this area, it remains unclear as to the exact mechanism of action. Its primary mechanism is through an effect it has on lymphocyte function, a specific type of white blood cell.

How soon will I feel the effects of leflunomide?

  • Like all DMARDs, leflunomide takes time to work. Most patients start to feel the positive effects of leflunomide at 4-8 weeks, with maximum benefit at 3-6 months. Side effects can occur earlier.

What are the possible side effects of leflunomide?

Some of the side effects of leflunomide are similar to methotrexate. Side effects may include:

  • Leflunomide can cause stomach upset. In particular, diarrhea can be a significant problem for some patients on leflunomide.
  • In some cases, leflunomide can cause hair thinning.
  • Leflunomide can lower your blood counts and irritate your liver.
  • While not common, leflunomide can raise your blood pressure.

Is there a way to reduce the risk of side effects?

  • Tell your rheumatologist if you are having any problems. They can adjust or stop leflunomide if necessary.
  • Get your bloodwork done regularly as directed by your physician, usually monthly.
  • Limit your alcohol intake to 1-2 drinks/week.
  • Have your blood pressure monitored.
  • Do not become pregnant or nurse while on leflunomide. Discuss a plan to stop leflunomide and safely conceive with your rheumatologist. Because leflunomide stays in the body for a long time, your doctor will likely suggest you take a special medication to clear your body of leflunomide.

My doctor started me on leflunomide and methotrexate at the same time. Because they both can affect my blood counts and liver, is this safe?

  • Both you and your rheumatologist should be more cautious if you are taking both methotrexate and leflunomide at the same time as there is an increased risk of some side effects. However, this is a common combination which can be effective in treating your condition. Often, your rheumatologist will lower the dose of one of these medications to improve the safety. Of course, it is also important to ensure you continue to do your regular bloodwork as scheduled.

What should I do if I miss a dose?

  • You can safely take your dose later in the day. If you do not remember until the next day, just take your regular dose; do not take a double dose. As long as this does not happen regularly, you should not experience any ill effects.

How can I safely stop leflunomide?

  • It is safe to just stop leflunomide; you do not need to slowly reduce the dose. However, keep in mind, if you were gaining any benefit from leflunomide, it will usually take at least 6 weeks to lose it. If you are stopping because of more severe side effects, your doctor may recommend a medication regimen to clear the leflunomide out of your system, as it can otherwise remain in you for 1-2 years.

For more information about leflunomide, visit AlbertaRheumatology.com and consult your physician.