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Leflunomide Information
What are the major Leflunomide indications?
There is a number of severe diseases that have nothing to do with infections or trauma, nevertheless they turn people's lives into endless nightmare full of pain and despair. Autoimmune disorders arise from nowhere and make your own defender - your immune system - fight with your own body. Rheumatoid arthritis (RA) is an autoimmune disease destroying your connective tissue and damaging your joints. It is a very painful state ruining normal life of people; it can result in physical disabilities and death. It is vital to start systematic treatment as soon as possible to diminish pain and joint damage and give RA patients a chance of returning to normal lives.
Leflunomide is a complicated medication formulated to cope with a very complicated problem. There are a lot of speculations about Leflunomide dangers, that is why it is up to you to study the following facts carefully and decide whether you are ready to start Leflunomide therapy.
Leflunomide was the first agent for rheumatoid arthritis indicated for both symptomatic improvement and retardation of structural joint damage based on its disease modifying activity. This medications is a pyrimidine synthesis inhibitor belonging to the DMARD (disease-modifying antirheumatic drug) class of drugs. Leflunomide Arava was approved in many countries of the world (e.g., USA, Canada, Europe) in 1998.
Leflunomide demonstrated a prefect anti-inflammatory effect and a good ability to slow progression of the disease and to cause remission/relief of symptoms of rheumatoid arthritis and psoriatic arthritis (joint pain, joint tenderness, decreased joint and general mobility etc.).
Leflunomide warnings and malignancies
Leflunomide work by partially suppressing immune system, that is why the medication has the potential to promote myeloid/lymphatic malignancies or solid cancers. The absolute number of cases and the case/patient ratio is unknown.
Leflunomide numer one danger is its hepatotoxity. The total incidence of severe liver damage in patients taking Leflunomide is estimated to be as high as 0.5%, according to an internal report of the FDA. As a rule, liver damage is typically seen within the first 6 months of Leflunomide therapy.
Sometimes severe infections as development of active tuberculosis, pneumonia, PCP, and severe viral or mycotical infections, potentially leading to sepsis, death or permanent damage have been reported in patients taking Leflunomide.
Anemia or bleeding episodes in patients taking Leflunomide may also lead to serious complications.
Leflunomide contraindications
It is critically dangerous to take Leflunomide in the following cases:
- hypersensitivity to the drug or to inactive ingredients;
- pregnancy and lactation;
- preexisting pregnancy - women of childbearing potential are forbidden to become pregnant before 2 years after termination of therapy. Otherwise they are recommended to undergo a rapid elimination procedure. Men wishing become fathers should stop taking Leflunomide and undergo the same elimination procedure, too: administration of cholestyramine (8 grams 3 times daily for 11 days);
- preexisting liver or renal disease and moderate to severe diseases of the bone marrow or immune system;
- bacterial, fungal or viral infections (e.g., AIDS, latent HIV-Infection, pneumonia, active tuberculosis).
Leflunomide food and drug interactions
Make sure that you never combine Leflunomide with any other hepatotoxic medications to avoid fatal liver damage!
Never take Leflunomide with other DMARDs including chloroquine/hydroxychloroquine, live virus vaccines, tegafur, some tuberculostatics (rifampin and/or isoniazid), tolbutamide and warfarin!
Never take Leflunomide with alcohol to avoid severe allergic and hepatic reactions!
You can take Aspirin or other nonsteroidal anti-inflammatory agents (NSAR), and/or low-dose corticosteroids in the course of treatment with Leflunomide.
Administration of Leflunomide with antimalarials, intramuscular or oral gold, D-penicillamine, azathionprine or methotrexate is a risky decision.
The simultaneous therapy with methotrexate and Leflunomide may lead to severe or even fatal liver- or hepatotoxicity. Seventy-five percent of all cases of severe liver damage reported were registered under combined drug therapy Leflunomide (Arava) plus methotrexate. Nevertheless, it is necessary to inform you that some investigations have shown that the combination of methotrexate and Leflunomide in patients with RA gave far better results than either drug used alone that is why is critical situations healthcare provider can recommend you taking both of them.
Leflunomide dosage and schedules
Make sure you take Leflunomide exactly as scheduled by your doctor! Never take more or less of Leflunomide. Be prepared for a long-term therapy lasting 1 or even 2 years. Take Leflunomide at approximately the same time after a meal to get the most of your therapy.
There is an oral loading dose of Leflunomide - 100 mg taken once. This amount is followed by a once-a-day administration of 10-20 mg of Leflunomide. The good news is that beneficial effects of Leflunomide may last for some years after you complete the course of therapy.
Leflunomide side effects
Study the following list of possible Leflunomide adverse reactions and tell your doctor if you experience any of them: diarrhea (17%), respiratory infection (15%), alopecia (10%), hypertension (10%), rash and other skin problems (10%), and elevated liver enzymes (ALT and AST) (5%).
Leflunomide is known to cause severe and even lethal liver damage ranging from jaundice to hepatitis, which can be fulminant, severe liver necrosis, and liver cirrhosis. Seek immediate medical help if you understand you have any problems with your liver!
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