week 3- leflunomide

Question 1

what are the indications for leflunomide?

Answer 1

arthritis, rheumatoid arthritis

Question 2

what is the dose of leflunomide for RA?

Answer 2

100 mg OD for 3 days (loading dose)
• Then, DECREASE to 10-20 mg OD
• LD can increase the risk of adverse events – can be omitted

Question 3

what is the time for effect for leflunomide like OTHER DMARDS?

Answer 3

The effect starts after 4-6 weeks and may further improve up to 4-6 months

Question 4

what are some monitoring for leflunomide and when ?

Answer 4

liver function tests (LFT), full blood count (FBC) and BP
• Prior to initiation
• Every 2 weeks for the first six months
• Then, every 8 weeks

Question 5

what are some side effects for leflunomide?

Answer 5

• Hepatic impairment (when used with other hepatic drugs)=LFT
• Bone marrow suppression –
leucopenia, anaemia,
thrombocytopenia, pancytopenia (low levels could lead to infection)=FBC
• Increased BP (Common)=BP

Question 6

what are some common side effects?

Answer 6

• GI
• Alopecia
• Skin reaction
-dizziness

Question 7

what are some contraindications for leflunomide?

Answer 7

• Hepatic impairment – accumulation
• Severe immunodeficiency
• Severe infection
• Severe hypoproteinaemia
• Moderate to severe renal
impairment – no data
• Pregnancy
• Breastfeeding

Question 8

what are some cautions for leflunomide?

Answer 8

• Administration with haematotoxic or
hepatotoxic drugs
• History of TB
• Bone marrow suppression –
anaemia, leucopenia,
thrombocytopenia

Question 9

how long is the half life for leflunomide?

Answer 9

1-4wks

Question 10

what needs to occur if the drug is discontinued?

Answer 10

• Monitoring after discontinuation is required
• Washout procedure –
• Stop treatment
• Give colestyramine 8 g TDS or activated charcoal 50g QDS
• Treat for 11 days

Question 11

what are some other additional advice to patients?

Answer 11

• Avoid live vaccines
• Avoid alcohol (increase risk of hepatic impairment)
• Can be taken with or without food