Leflunomide (Arava®)

Arava is used for rheumatoid arthritis and other forms of inflammatory arthritis. It works by inhibiting a certain type of white blood cell, the T cell, which plays an important role in causing joint inflammation.

The Arava dose is 10 mg or 20 mg a day. A loading dose of 100 mg a day for three days can be given.

Because the potential for significant birth defects exists, avoid pregnancy while on Arava. Any woman of childbearing age on Arava should use effective forms of contraception. Arava lasts a very long time in your body. Therefore, if pregnancy is desired, Arava must be cleared from your body. This can be accomplished by giving a resin called cholestyramine at eight grams three times a day for 11 days.

Other potential side effects include:

• fatigue
• flu-like symptoms
• upset stomach
• diarrhea
• headaches
• thinning hair
• mouth sores
• elevated liver tests
• lowering of the red cell (anemia), or white cell (infection fighting) counts
• increased risk of infections

Minimize alcohol while on Arava.

Arava can begin to take effect after four weeks, reaching maximum effect after three to five months. Not everyone responds to Arava optimally, and your doctor may discuss adding other medications, if necessary. Because it is a slow-acting medicine, stopping it for one or two weeks while you have an infection or if you require surgery does not usually result in a flare-up of symptoms. Only if the medicine is stopped for several weeks do symptoms usually start to recur.

Before starting Arava, you will need to have a baseline complete blood count (CBC) and liver test (ALT). One month after starting Arava, these labs are repeated to make sure your body is tolerating the medicine at periodic intervals determined by your rheumatologist. If multiple abnormal liver tests occur, liver biopsy might be required, but this is extremely uncommon.

If you have any infection more serious than a cold or bladder infection, it is a good idea to stop Arava for a week or two until you’re better. It is also fairly standard to stop Arava the week before and the week of significant surgery.