Leflunomide dosage

Leflunomide Arava Oral 100 mg/d for the first 3 days continue with a maintenance dosage of 20 mg/d thereafter. May decrease joint ero-sion/destruction with relatively few serious side effects effects of longterm use remains to be determined. 

Leflunomide is taken orally. In most regimens it is begun with a loading dose of 100 mg/day over 3 days followed by a maintenance dosage of 10-20 mg/day. Leflunomide 100 mg/week had similar effectiveness and less toxicity in open trials compared with daily dosing (21,93). 

Usually, overdosage and adverse events can be managed by dosage reduction, the addition of colestyramine, and symptomatic therapy (36). However, in one study in patients with rheumatoid arthritis, leflunomide 10 mg/ day compared with 20 mg/day was associated with less efficacy and more adverse events leading to treatment withdrawal (24). Colestyramine 3x8 g/day for 11 days is recommended to wash out leflunomide, if A77 1726 plasma concentrations do not fall to 0.02 mg/1 or less, additional colestyramine is advised. Without this washout procedure, it can take up to 2 years to reach A77 1726 plasma concentrations of 0.02 mg/1. Oral activated charcoal 50 g every 6 hours for 24 hours also reduced plasma A77 1726 concentrations (80). 

Leflunomide is administered orally as a single daily dose without regard to meals. Therapy may be initiated with a loading dosage given for 3 days, followed by the usual maintenance dose. It undergoes primarily enterohepatic circulation, extending its duration of action. Cholestyramine can be used to enhance its elimination in cases of toxicity. 

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 ]. 

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