Leflunomide, sold under the brand name Arava among others, is an immunosuppressive disease-modifying antirheumatic drug, used in active moderate-to-severe rheumatoid arthritis and psoriatic arthritis. It is a pyrimidine synthesis inhibitor that works by inhibiting dihydroorotate dehydrogenase.

Arava is available as oral tablets in 10 mg, 20 mg, and 100 mg doses.A dose of 10 mg or 20 mg is usually taken once a day as a single tablet. In some cases, it may be prescribed every other day.Rheumatologists used to start Arava with three loading doses of 100 mg per day. This is not usually done any more because there is a greater risk of side effects at this dose.

Arava Takes 6 to 8 Weeks to Start Working

It usually takes 6 to 8 weeks for Arava to start working, and it can take up to 6 months to feel the maximum effect.

It is important for patients starting this medicine to keep taking it as prescribed. If the dose is changed, it can take another 6 to 8 weeks to start feeling the effects of the change.

How to Take Arava After Missing a Dose

If a patient forgets to take Arava at their usual time but remembers later on the same day, the missed dose should be taken immediately.

If yesterday’s dose is forgotten, it should be skipped, and the patient should only take their usual dose for the day.

Leflunomide works slowly, so like other medications if you start leflunomide it may be several weeks to several months before it has an effectiveness. And so again you need to be patient when you’re starting leflunomide for looking for it’s effectiveness.

Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC

Local Practitioners: Rheumatologist

Regular Blood Tests

Patients taking Arava should have their blood tested every month. It is important to make sure that this medicine isn’t harming the liver or blood counts.

Risk of Combination with Alcohol

Drinking while taking Arava can harm the liver. Patients taking this medicine are advised to stop drinking and avoid alcohol, or at the very least, significantly reduce their consumption of alcohol.

Risk of Infection

Arava can make it a bit harder for people to fight off infections. People taking this medicine should call their doctor they have a fever, think they have an infection, or have been prescribed antibiotics to treat an infection.

Patients taking Arava should coordinate with their doctor to potentially stop treatment around surgery. It can be re-started once things have healed and there’s no sign of infection.

Leflunomide works slowly, so like other medications if you start leflunomide it may be several weeks to several months before it has an effectiveness. And so again you need to be patient when you’re starting leflunomide for looking for it’s effectiveness.

Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC

Local Practitioners: Rheumatologist

The most common side effect of Arava is nausea and diarrhea.Monthly blood tests are important to ensure that Arava does not harm the liver or blood counts. Patients should stop drinking alcohol while taking Arava to reduce the chances of liver side effects.

Arava may cause birth defects and result in miscarriage. Anyone who becomes pregnant while taking this medicine should notify a doctor immediately.

Patients considering pregnancy should consider using a different medication because Arava can stay in the body for up to two years.

MORE COMMON side-effects include:

• Nausea and diarrhea
• Skin rash
• Hair thinning or loss which is reversible when the medication is stopped

RARE side-effects include:

• Blood Pressure – Arava can rarely cause an increase in blood pressure. Patients starting Arava should tell their doctor if they have high blood pressure.
• Liver – Arava may irritate the liver. This does not usually cause symptoms but may be found on blood tests. Liver side effects are rare and are usually reversible when caught early through regular monthly blood tests.
• Bone Marrow – Arava can cause a drop in the numbers of white blood cells (which help fight infection) and platelets (which help to stop bleeding). With monthly blood tests, it is unusual for this to be a serious problem.
• Infection – Any infections or fevers should be taken seriously and reviewed by a doctor.
• Tingling in the Hands and Feet – Arava can rarely cause a “pins and needles” feeling, or tingling in the hands and feet.
• Trouble Breathing – Arava can very rarely cause an allergic reaction in the lungs. Patients should call a doctor if they develop a cough that won’t go away, or develop shortness of breath.

How to minimize the side-effects of Arava:

• Patients should get regular blood tests as requested by their doctor (usually monthly) to monitor for side effects, and remember to attend their appointments
• In cases where side effects are a problem, reducing the dose or taking the medicine every other day can often help reduce them. This should only be done with guidance from a  local family doctor or physician.

Leflunomide works slowly, so like other medications if you start leflunomide it may be several weeks to several months before it has an effectiveness. And so again you need to be patient when you’re starting leflunomide for looking for it’s effectiveness.

Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC

Now Health Network Local Practitioners: Rheumatologist