Penicillamine Leflunomide

Slow-acting antirheumatic drugs Methotrexate Hydroxychloroquine, sulfasalazine Infliximab, etanercept, leflunomide, penicillamine, gold... 

D. Pharmacokinetics and Clinical Use Sulfasalazine, hydroxychloroquine, methotrexate, cyclosporine, penicillamine and leflunomide are given orally. Infliximab and etanercept are given by injection. Gold compounds are available for parenteral use (gold sodium thiomalate and au-rothioglucose) and for oral administration (auranofin). 

The synthetic DMARDs include gold salts, hydroxychloroquine, and sulfasalazine. Less common synthetic DMARDs are penicillamine and minocycline. Synthetic immunosuppressants used for the treatment of inflammatory diseases include the antimetabolites methotrexate, leflunomide, and azathioprine. 

The manufacturers say that the concurrent use of leflunomide and other DMARDs (they list azathioprine, chloroquine, hydroxychloroquine, intramuscular or oral gold and penicillamine) has not yet been studied but they say that combined use is not advisable because of the increased risk of serious adverse reactions (haemo- or hepatotoxicity). As the active metabolite of leflunomide has a long half life of 1 to 4 weeks the manufacturers say that a washout of colestyramine or activated charcoal should be given if patients are to be started on other DMARDs. See also Methotrexate, below. 

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