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Leflunomide is a medication that requires careful consideration due to the potential risks associated with its use. The following points provide crucial safety information and warnings for patients and healthcare professionals:

• Pregnancy Risks: Leflunomide must not be taken during pregnancy as it can cause severe harm, potentially life-threatening, to an unborn child. Women of childbearing age are required to have a negative pregnancy test before starting this treatment and must use effective birth control while on the medication and until it is confirmed that leflunomide has been completely cleared from their body. If you suspect pregnancy during treatment, notify your doctor immediately.

• Liver Concerns: There is a risk of serious liver damage when taking leflunomide, particularly within the first six months. It is contraindicated in patients with existing liver conditions such as hepatitis B or C. Regular liver function tests are necessary, and symptoms like persistent nausea, dark urine, or jaundice should be reported to your healthcare provider without delay.

• Infection Risk: The medication can compromise your immune system, increasing susceptibility to serious infections. Prior to starting leflunomide, screening for infections like tuberculosis is essential. Patients with active infections or those on immunosuppressive therapy should discuss the risks with their doctor.

• Blood Cell Count Issues: Leflunomide may reduce blood cell counts, leading to potential complications such as thrombocytopenia (low platelet count) and anemia. This can also heighten the risk of infection due to a decrease in white blood cells.

• Allergic Reactions: There is a possibility of severe allergic reactions, including life-threatening conditions like anaphylaxis and DRESS syndrome. Seek immediate medical attention if you experience symptoms such as facial swelling or difficulty breathing.

• Nerve Pain: Some individuals may experience nerve pain, which could persist even after stopping the medication. Report any sensations of numbness or tingling to your healthcare provider, as they may recommend discontinuing the drug and initiating a rapid elimination procedure.

• Lung Disorders: Rare cases of interstitial lung disease have been reported, which can be serious. Symptoms such as coughing or breathing difficulties warrant prompt medical consultation.

• Blood Pressure Elevation: Regular monitoring of blood pressure is advised as leflunomide may cause an increase. Report any significant changes to your healthcare team.

• Medication Clearance: Leflunomide is slowly eliminated from the body, potentially taking up to two years. For individuals planning pregnancy or experiencing adverse effects, treatments like cholestyramine or activated charcoal may be prescribed to expedite drug removal.

Contraindications:

• Severe liver disorders
• Current pregnancy or lack of effective birth control in women of childbearing potential
• Known allergies to leflunomide or related medications
• Concurrent use of teriflunomide (Aubagio)

Always consult your healthcare provider for personalized advice and before making any changes to your treatment plan.

When taking this medication, some common side effects may include diarrhea, headache, nausea, rash, and dizziness. These are generally mild, but if they persist or worsen, consult your healthcare provider. Other frequent effects include abnormal liver lab results, hair thinning or hair loss, high blood pressure, weakness, back pain, joint pain or stiffness, upset stomach, vomiting, bronchitis, runny nose, mouth sores, and itchy skin.

It's important to monitor for more serious side effects, which, although rare, require immediate medical attention. These include severe liver problems characterized by symptoms such as stomach pain, yellowing of the skin or eyes, and clay-colored stool. Serious infections may present as fever, difficulty breathing, or burning during urination, and unusual tiredness.

Additionally, be alert for signs of severe allergic reactions, such as rash, hives, painful blisters, skin reddening or peeling, and swollen lymph nodes. If you notice any of these serious symptoms or any unexplained changes in your health, seek medical help right away. Always keep in touch with your healthcare provider regarding any side effects you experience.

Leflunomide, known as Arava, can interact with various medications and supplements. It's important to inform your healthcare provider about all the medications, vitamins, and supplements you are currently taking, whether they are prescribed, over-the-counter, or herbal.

Certain drugs should not be taken with Leflunomide. For instance, Teriflunomide, a medication used for multiple sclerosis, should be avoided as it is very similar to Leflunomide and taking them together can lead to harmful effects.

Additionally, Leflunomide may interact with other medications, potentially altering their effectiveness. This drug can slow the removal of some medications from your body, potentially affecting drugs like Ketorolac and tovorafenib. Conversely, it can also speed up the removal of other medications, impacting drugs such as vorasidenib.

There are medications that are generally not recommended to be used with Leflunomide unless necessary, in which case your doctor may adjust the dosage or frequency. These include, but are not limited to, Methotrexate, Warfarin, Cyclosporine, Tacrolimus, Atorvastatin, Simvastatin, and various live vaccines like the influenza virus vaccine and the measles virus vaccine.

Always consult with your healthcare provider to manage these interactions safely.