Leflunomide dose continued at 20 mg/day and the methotrexate dose could be increased to a maximum of 20 mg/week. Monitor Closely (1)leflunomide will increase the level or effect of phenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. Monitor Closely (1)fostamatinib will increase the level or effect of leflunomide by decreasing metabolism. beclomethasone, inhaled increases toxicity of leflunomide by unspecified interaction mechanism. Leflunomide tablets, USP are available in two strengths: Tablets: 10 mg, white to off white, round, film-coated tablets debossed with "57" on one side and "11" on the other side. Use Caution/Monitor. I am taking Arava 20 mg daily since January 2020. Psoriatic Arthritis: Types, Causes, Symptoms & Treatments, Get Pain Relief With the Most Common Arthritis Medications. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid or Use Alternate Drug. Take this medication exactly as prescribed. Immunosuppressants also increase risk of infection with concomitant live vaccines. Minor/Significance Unknown. leflunomide and olaparib both increase pharmacodynamic synergism. Avoid or Use Alternate Drug. Leflunomide is used for long-term treatment. To make sure leflunomide is safe for you, tell your doctor if you have: a history of liver disease or hepatitis (leflunomide can cause severe liver problems); nerve problems, such as neuropathy caused by diabetes; a weak immune system or bone marrow disorder; or. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Immunosuppressants also increase risk of infection with concomitant live vaccines. Geriatric Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of leflunomide in the elderly. If your side effects are too bothersome, ask your provider if you can go down to 10 mg daily. activated charcoal decreases levels of leflunomide by inhibition of GI absorption. Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Disclaimer: Our goal is to provide you with the most relevant and current information. Use Caution/Monitor. You may need to show airport staff the pharmacy label for your medication. Monitor Closely (1)ponatinib increases levels of leflunomide by Other (see comment). Serious - Use Alternative (1)leflunomide and muromonab CD3 both increase immunosuppressive effects; risk of infection. Our website services, content, and products are for informational purposes only. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Use Caution/Monitor. Coadminstration of leflunomide and ocrelizumab may cause increased risk of infections, pancytopenia, agranulocytosis and thrombocytopenia. Eluxadoline may increase the systemic exposure of coadministered BCRP substrates. Your provider might tell you to stop taking leflunomide (Arava) if you develop a serious infection. CYP2C9/10 inhibition decreases tamoxifen metabolism to active metabolites. Enhanced anti angiogenesis (theoretical interaction). MISSED DOSE: If you miss a dose, take it as soon as you remember. Minor/Significance Unknown. Avoid or Use Alternate Drug. What is leflunomide (Arava)? Modify Therapy/Monitor Closely. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC. Tell your doctor immediately if you develop any signs of an infection such as fever, chills, or persistent sore throat. Avoid or Use Alternate Drug. Leflunomide (Arava) can stay in your body for years after you stop taking it. Consider dosage reduction for BCRP substrates if adverse effects are experienced when coadministered. This drug isnt recommended if you have liver disease. Modify Therapy/Monitor Closely. Maintenance: 20 mg orally once a day (If not well tolerated, the dose may be decreased to 10 mg orally once a day) Where can I get more information (Arava)? Monitor Closely (1)tafamidis will increase the level or effect of leflunomide by Other (see comment). Serious - Use Alternative (1)leflunomide, axicabtagene ciloleucel. Monitor Closely (1)leflunomide decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Immune response to vaccine may be decreased in immunocompromised individuals. Serious - Use Alternative (1)leflunomide decreases effects of influenza virus vaccine quadrivalent by pharmacodynamic antagonism. Fostemsavir inhibits BCRP transporters. Talk to your doctor if you have been exposed to an infection or for more details.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication must not be used during pregnancy. leflunomide decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Always ask your health care professional for complete information about this product and your specific health needs. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated. Leflunomide (Arava) can affect other blood cell counts as well, so make sure to get regular blood work. Do not receive a "live" vaccine while using leflunomide, or you could develop a serious infection. Your doctor may occasionally change your dose. ublituximab and leflunomide both increase immunosuppressive effects; risk of infection. Side effects of Arava (leflunomide) can vary, but may include diarrhea, rash, high blood pressure, and more. Immunosuppressants also increase risk of infection with concomitant live vaccines. Use Caution/Monitor. This information is not a substitute for medical advice. Serious - Use Alternative (1)azathioprine and leflunomide both increase immunosuppressive effects; risk of infection. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Applies only to oral form of both agents. Monitor Closely (1)ponesimod and leflunomide both increase immunosuppressive effects; risk of infection. Immunosuppressants also increase risk of infection with concomitant live vaccines. Dont take more than one dose at a time or extra doses. Before you start treatment with leflunomide, your doctor may perform tests to make sure you do not have tuberculosis or other infections. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Methotrexate is a drug used to treat rheumatoid arthritis, psoriasis, and other conditions. If leflunomide and methotrexate are given concomitantly, monitor liver toxicity with ALT, AST, and serum albumin testing. Contact your doctor at once if you develop signs of infection. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada). Monitor Closely (1)belatacept and leflunomide both increase immunosuppressive effects; risk of infection. Please note that only the generic name of each medication is listed below. For people with serious infection: This drug isnt recommended if you have a weak immune system or serious infections. unspecified interaction mechanism. With any medication, there are risks and benefits. These side effects may go away during treatment as your body adjusts to the medicine. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.AcyclovirAdenovirus VaccineAtorvastatinBaricitinibBosentanCefaclorCiprofloxacinDabrafenibDasabuvirDengue Tetravalent Vaccine, LiveElagolixEnzalutamideFurosemideGlyburideGrazoprevirInfluenza Virus Vaccine, LiveIrinotecanLetermovirMeasles Virus Vaccine, LiveMethotrexateMontelukastMumps Virus Vaccine, LivePaclitaxelPexidartinibPitavastatinPoliovirus Vaccine, LiveRepaglinideRevefenacinRosuvastatinRotavirus Vaccine, LiveRubella Virus Vaccine, LiveSimvastatinSmallpox VaccineSulfasalazineTenofovir AlafenamideTopotecanValacyclovirVaricella Virus Vaccine, LiveWarfarinYellow Fever VaccineZoster Vaccine, Live. Either increases effects of the other by immunosuppressive effects; risk of infection. If you become pregnant or think you may be pregnant, inform your doctor right away (see Precautions section).This drug may rarely cause serious (possibly fatal) liver disease. At steady state plasma levels accumulate about 33- to 35-fold compared with single dose. Avoid or Use Alternate Drug. Contraindicated. lomustine increases toxicity of leflunomide by immunosuppressive effects; risk of infection. What other drugs will affect leflunomide (Arava)? Use Caution/Monitor. Contraindicated. lasmiditan increases levels of leflunomide by Other (see comment). This side effect usually goes away after you stop leflunomide (Arava). Leflunomide medac is a ' generic medicine '. Leflunomide oral tablet is available as the brand-name drug Arava. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity. Contact your doctor immediately if you experience any of the following: The following side effects may get better over time as your body gets used to the medication. Otesezonale, a BCRP inhibitor, may increase the effects and risk of toxicities of BCRP substrates. commonly, these are "non-preferred" brand drugs. Immunosuppressants also increase risk of infection with concomitant live vaccines. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. These side effects may go away during treatment as your body adjusts to the medicine. Is Stills Disease Similar to Rheumatoid Arthritis? Contact the applicable plan Use Caution/Monitor. After you stop taking leflunomide, you may need to be treated with other medicines to help your body eliminate leflunomide quickly. Serious - Use Alternative (1)leflunomide, brexucabtagene autoleucel. No dosage adjustment provided by the manufacturer; use with caution, Preexisting liver disease: Not recommended, Baseline ALT >2 times ULN: Not recommended, Severe hepatic impairment: Contraindicated, Hepatotoxicity following administration: Discontinue therapy and determine cause; if lefluonamide induced, discontinue treatment and initiate accelerated drug elimination process, Drug elimination process recommended to achieve nondetectable plasma levels (ie, <0.02 mg/L) after discontinuation, Step 1: Administer cholestyramine 8 g PO TID 11 days; the 11 days do not need to be consecutive unless there is a need to lower the plasma level rapidly, Step 2: Verify plasma levels <0.02 mg/L by 2 separate tests at least 14 days apart; if plasma levels >0.02 mg/L, consider additional cholestyramine treatment, Without the drug elimination procedure, it may take up to 2 years to reach plasma M1 metabolite levels <0.02 mg/L due to individual variation in drug clearance, diphtheria & tetanus toxoids/ acellular pertussis vaccine, diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine, human papillomavirus vaccine, quadrivalent, influenza virus vaccine quadrivalent, adjuvanted, influenza virus vaccine quadrivalent, cell-cultured, influenza virus vaccine quadrivalent, intranasal, influenza virus vaccine trivalent, adjuvanted, measles, mumps, rubella and varicella vaccine, live, meningococcal A C Y and W-135 polysaccharide vaccine combined, travelers diarrhea and cholera vaccine inactivated, influenza virus vaccine quadrivalent, recombinant, influenza virus vaccine trivalent, recombinant, 49 cases of severe liver injury identified, including 14 cases of fatal liver failure, Do not use with pre-existing liver disease, Do not use if elevated liver enzymes (ALT >2 X ULN), Coadministration with other drugs that cause liver injury increases risk, Recommend ALT monitoring monthly for 6 months after initiating, and q6-8weeks thereafter, If ALT rises to >3X ULN, interrupt therapy while investigating probable cause; if likely leflunomide-induced, initiate cholestyramine washout to speed elimination and conduct follow-up LFTs at least weekly until ALT value within normal range; if not leflunomide-induced ALT elevation, may consider resuming leflunomide, The active metabolite of leflunomide, teriflunomide, is eliminated slowly from plasma; use of accelerated drug elimination procedure will rapidly reduce plasma concentrations of leflunomide and active metabolite, teriflunomide, Without use of accelerated drug elimination procedure, may take up to 2 years to reach plasma teriflunomide concentrations of less than 0.02 mg/L, the plasma concentration not associated with embryo-fetal toxicity in animals, Consider accelerated elimination procedure at any time after discontinuation of therapy, and in particular, when patient has experienced a severe adverse reaction (eg, hepatotoxicity, serious infection, bone marrow suppression, Steven Johnson Syndrome, toxic epidermal necrolysis, peripheral neuropathy, interstitial lung disease), suspected hypersensitivity, or has become pregnant, All women of childbearing potential recommended to undergo accelerated elimination procedure after stopping treatment, In animal reproduction studies, oral administration of leflunomide during organogenesis at a dose of 1/10 of and equivalent to maximum recommended human dose (MRHD) based on AUC, respectively in rats and rabbits, caused teratogenicity (rats and rabbits) and embryo-lethality (rats). Minor/Significance Unknown. Avoid or Use Alternate Drug. In the clinical studies, people who took leflunomide (Arava) were more likely to have high blood pressure. Dont cut, crush, or break apart this tablet. A: Generally acceptable. leflunomide decreases effects of typhoid vaccine live by pharmacodynamic antagonism. A black box warning alerts doctors and patients about drug effects that may be dangerous. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Monitor Closely (1)leflunomide and mercaptopurine both increase immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Comment: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. It is not intended as medical advice for individual conditions or treatment. It's usually worse during the first few months. Immunosuppressants also increase risk of infection with concomitant live vaccines. Otherwise, it can take up to two years to have undetectable blood levels after stopping the drug. Do not use leflunomide in larger or smaller amounts or for longer than recommended. Liver function (blood) tests must be performed periodically while taking leflunomide. Contraindicated. This risk may be even higher for certain groups. Uses Warnings Before taking Side effects Dosage Interactions FAQ What is leflunomide? Leflunomide (Arava) may interact with certain medications or supplements. Using this drug with other potentially hepatotoxic drugs should be done cautiously. Oral Medications Used to Treat Psoriatic Arthritis. Metabolite inhibits pyrimidine nucleotide synthesis; antiproliferative for T-cells, Metabolites: A77 1726 (active)-undergoes hepatic recirculation, Renal elimination predominant during first 96 hr, thereafter fecal elimination predominates. 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