Teratogenicity leflunomide

The drug may cause liver toxicity and is contraindicated in patients with preexisting liver disease. The ALT should be monitored monthly initially and periodically thereafter. Leflunomide may cause bone marrow toxicity a complete blood cell count with platelets is recommended monthly for 6 months and then every 6 to 8 weeks thereafter. It is teratogenic and should be avoided during pregnancy. 

Toxicities include elevation of liver enzymes with some risk of liver damage, renal impairment, and teratogenic effects. A low frequency of cardiovascular effects (angina, tachycardia) was reported in clinical trials of leflunomide. 

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. 

In oral embryocytotoxicity and teratogenicity studies in rats and rabbits, leflunomide was embryocytotoxic (growth retardation, embryolethality) and teratogenic (malformations of the head, rump, vertebral column, ribs, and limbs) (87). Not only is leflunomide teratogenic and fetotoxic in animals, but its active metabolite is detectable in plasma up to 2 years after withdrawal. 

Leflunomide Teratogen, hepatotoxidty, gastrointestinal disturbance, skin reactions... 

No clinically relevant interactions have been seen between leflunomide, mycophenoiate or siroiimus and combined oral contraceptives, but the manufacturer of siroiimus suggests some caution. Mycophenoiate has been shown to be teratogenic in ani-mals and so the manufacturer suggests contraceptive precautions in addition to the use of hormonai contraceptives. Tacrolimus may increase the piasma ieveis of hormonai contraceptives. 

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