Drugs used in Immune Disease - Leflunomide

Question 1

What is the Loading dose for Leflunomide?

Answer 1

Oral 100mg for 3 days
This LD can increase risk of Adverse effects can be omitted

Question 2

Leflunomide MOA

Question 3

Why does Leflunomide require a washout procedure

Answer 3

Teriflunomide has a very long half-life (1-4 weeks) and therefore a process which accelerates its elimiination may be required when;
* Incase of pregnancy or plan to conceive
* Occurence of serious S/Es

Question 4

What is the maintenance dose for Leflunomide?

Answer 4

10-20mg OD

Question 5

How long does leflunomide take to start to work?

Answer 5

Effects start 4-6 weeks and may further imporve up to 4-6 months

Question 6

What is the monitoring of leflunomide?

Answer 6

LFTs, FBCs, BP
Prior to initiation
Every 2 weeks for the first 6 months
Then every 8 weeks.

Question 7

What are the S/E of leflunomide?

Answer 7

Hepatic impairement
Bone marrow suppression
Increased BP
GI irritation
Alopecia
Skin reactions
Dizziness

Question 8

What are the contra-indications of leflunomide?

Answer 8

Hepatic impairement
Severe immunodeficiency
Severe infection
Severe hypoproteinaemia
Pregnancy / Breastfeeding

Question 9

What is the t1/2 of leflunomide?

Answer 9

1-4 weeks

Question 10

What is the wash out procedure of leflunomide?

Answer 10

Stop treatment
Give colestyramine 8g TDS or activated charcole 50g QDS
Treat for 11 days

Question 11

Why does Leflunomide have a long half-life

Answer 11

Bc it is secreted into bile from which it is recycled to the liver via the enterohepatic circulation.