Leflunomide Why are you taking this drug?
This drug is given to patients suffering from rheumatoid arthritis. Leflunomide works by reducing disease activity, so that there is less inflammation in the joints, this may help to reduce joint damage. There is no direct pain relieving effect so you will need to continue other arthritis tablets, at least for some time. It ma take from 6 to 12 weeks to get the full effect from leflunomide. If it is effective you can stay on treatment for several years if necessary.
How and when is it taken?
Leflunomide is usually taken as a tablet once a day. It can be taken at any time of the day. It is sensible to take it with food. Tablets should be swallowed whole. Most patients usually take one 100mg tablet a day for the first 3 days and after this one 20mg tablet per day. The dose can be reduced if you feel unwell, (eg diarrhoea). If this happens, have a word with your doctor. If you forget to take the tablet one day don’t worry, take the usual dose of 20mg the next day.
Can you take other medicines with Leflunomide?
As with all medicines, when your consultant first prescribes Leflunomide you should tell him/her what other drugs you are taking so that we can be sure that these are not likely to react. When any other doctor is prescribing a new drug for you it is important to remind them that you are taking Leflunomide. There is no definite evidence that Leflunomide does react with any of the commonly used drugs but we are always careful. Most patients who take Leflunomide also have to take other tablets for their arthritis.
Are there any side effects and what are they?
All medications can cause side effects. it is a question of balancing the risk of side effects against the benefits of treatment. Possible side effects include:
- Diarrhoea: this often settles as you get used to the tablets, sometimes we reduce the dose.
- Nausea and sickness: again this often settles as you get used to the tablets or the dose can be reduced.
- Mouth ulcers or unusually sore mouth.
- Skin rashes and increased hair loss
- Changes in blood tests, which is why you need regular blood tests. Blood tests may show an increase in some liver test results, which in very rare cases may develop into serious conditions such as hepatitis and liver failure which may be fatal. Therefore, if you develop symptoms such as unusual tiredness, abdominal pain or jaundice (yellow discolouration of the eyes or skin), inform your doctor at once. If you have any side effects that concern you contact your family doctor, the rheumatology nurse or your consultant. If you are not able to contact somebody straight away stop leflunomide until you have received advice.
Vaccination with live vaccines is not recommended while on treatment with Leflunomide. Alcohol may increase the risk of side effects and is best kept to a minimum.
Pregnancy and breast feeding
Leflunomide has not been given to pregnant women. It is recommended that you do not become pregnant whilst taking Leflunomide or within 2 years of stopping, as it may be harmful to your baby. Please consult your doctor. We may be able to reduce this time with further treatment. You should use reliable contraception. You should not breast feed whilst taking Leflunomide. There is no evidence of any effect on men’s fertility but if you are considering increasing your family please discuss this with your family doctor, the rheumatology nurse or your consultant. It is recommended that you take a course of tablets to remove Leflunomide from your system more quickly.
Why is careful monitoring so important?
Monitoring the effects of your new treatment is important and we need to check your blood regularly. This will usually be done in your family doctor’s surgery. By doing this we hope to pick up any side effects early, before you are aware of them or they cause any harm. Blood tests are usually fortnightly for 6 months and then every 2 months. We check your blood pressure about once a month for 6 months and then every 2 months. If you are unable to attend please ring for another appointment.
If you have any questions, queries or worries about your treatment please contact the rheumatology clinic or your family doctor.