Leflunomide adverse effects

Leflunomide (Arava) is an isoxazole derivative approved for the treatment of rheumatoid arthritis in 1998. Limited data suggest that it is comparable in efficacy to sulfasalazine and produces fewer adverse effects. It has a faster onset of action (4 weeks) than other DMARDs. 

Adverse effects The most common of these are headache, diarrhea, and nausea. Other untoward effects are weight loss, allergic reactions including a flu-like syndrome, skin rash, alopecia, and hypokalemia. Leflunomide is teratogenic in experimental animals, and is therefore contraindicated in pregnancy, and in women of childbearing potential. It should be used with caution in patients with liver disease, because it is cleared by both biliary and renal excretion. Cholestyramine increases the clearance of leflunomide. 

The safety profile of leflunomide has been said to be excellent, with no myelosuppressive or nephrotoxic adverse effects (40,41). Its major adverse effects are gastrointestinal... 

However, the rate of adverse effects associated with leflunomide was significantly lower than with methotrexate and other disease-modifying antirheumatic drugs (DMARDs) in an analysis of 40 594 patients with rheumatoid arthritis (8,51). The incidences of adverse events per 1000 patient-years were as follows ... 

Rheumatoid arthritis Single-center experience 3 months Leflunomide 100 mg/day for 3 days, then 20 mg/day plus infliximab 3 mg/ kg at 0,6, and every 8 weeks (n = 17) 20 adverse effects in 13 patients 8 discontinued (20)... 

However, clinical trials and subsequent observational studies outside Japan have not suggested that leflunomide causes an excess of pulmonary adverse effects (61). 

Adverse effects of leflunomide on the skin in patients with rheumatoid arthritis include alopecia (9-17%), rash (11-12%), pruritus (5-6%), dry skin (3%), and eczema (1-3%) (9,10,12). Single cases of an erythema multiforme-like drug eruption (82), exfoliative dermatitis (83), a lichenoid drug reaction (84), and skin ulceration (85) have been reported. 

B-lymphocytes. It is currently approved for use in rheumatoid arthritis. Bioavailability is 80% after oral administration. Leflunomide is metabolized in the liver to the active metabolite A77,1726. Biliary recirculation of A77,1726 contributes to the long half-life of 15 to 18 days. Adverse effects noted with leflunomide in solid-organ transplantation studies include skin rash, anemia, and elevated liver enzymes. 

Chan V, Tett SE. How is leflunomide prescribed and used in Australia Analysis of prescribing and adverse effect repotting. Pharmacoepidemiol Drug Saf 2006 15 485 93. 

Adverse Side Effects. Leflunomide s primary side effects include gastrointestinal distress, allergic reactions (skin rashes), and hair loss.57 This drug can also affect the liver liver function may need to be monitored periodically.19,70... 

LEFLUNOMIDE ANTIDIABETIC DRUGS -TOLBUTAMIDE Possible T effect of tolbutamide Uncertain Monitor blood sugar closely. Watch for and warn patients about symptoms of hypoglycaemia - For signs and symptoms of hypoglycaemia, see Clinical Features of Some Adverse Drug Interactions, Hypoglycaemia... 

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