Leflunomide Corticosteroids

ANTICOAGULANTS-ORAL ACITRETIN, CORTICOSTEROIDS, INTERFERON ALFA, LEFLUNOMIDE t anticoagulant effect Uncertain at present Monitor INR at least weekly until stable... 

The serum levels of the active metabolite of leflunomide are reduced by activated charcoal, and colestyramine. The manufacturers advise against the concurrent use of alcohol because of the potential for hepatotoxicity. Methotrexate may also increase leflunomide hepatotoxicity, so in general the combination is not recommended. A case of fatal fulminant hepatic failure has been reported in a patient taking leflunomide and itraconazole. A case of peripheral neuropathy has been reported in a patient taking leflunomide and tegafiir/uraciL The manufacturers predict interactions between leflunomide and phenytoin or tolbutamide, and advise caution with rifampicin as it may increase leflunomide metabolite levels. No clinically relevant interaction occurs with cime-tidine, corticosteroids or NSAIDs. 

The manufacturers say that corticosteroids may continue to be used if leflunomide is givenO ... 

Systemic corticosteroids are required for cases of anterior uveits that are refractory to eyedrops and for cases of intermediate and posterior uveitis because eyedrops cannot adequately penetrate deep into the eye. The initial corticosteroid dose is 40 mg/day of prednisone equivalent, which is adjusted according to the response to therapy. Corticosteroid-sparing alternatives are often considered for sarcoid uveitis because of the toxicity of systemic corticosteroids. Methotrexate (21), azathioprine (22), leflunomide (23), and infliximab (24) have been used for this purpose. 

In a retrospective study of rheumatoid arthrihs pahents treated with leflunomide risk factors of severe infections were identified. Among the 401 patients that started on leflxmomide therapy, 8.2% developed severe infections (pneumonia, oral candidiasis, pyelonephrihs, pulmonary tuberculosis, cellulitis, disseminated herpes zoster, tonsil-lihs and pulmonary cryptococcosis). Risk factors for severe infections were older age, presence of diabetes mellitus and (increasing) daily dosage of corticosteroids [Sl ]. 

---