Leflunomide (Arava)


Leflunomide (Arava) is a drug approved to treat adult moderate to severe rheumatoid arthritis along with other rheumatic diseases. It belongs to a class of medications called disease-modifying antirheumatic drugs (DMARDs), which aim to decrease inflammation and permanent damage.

Leflunomide blocks the formation of DNA, which is important for replicating cells, such as those in the immune system. It suppresses the immune system to reduce inflammation that causes pain and swelling.

How to Take It

Leflunomide usually is given as a 20 mg tablet once a day. Sometimes, patients are given 10 mg, especially if they experienced side effects with the higher dose. Leflunomide should be taken with food. Complete benefits may not be experienced until 6–12 weeks after starting the medication.

It is important that you have regular blood tests, including those for liver function, while taking this medication. You should not take leflunomide if you have a pre-existing liver disease, such as hepatitis or cirrhosis. Because alcohol may increase the risk of liver damage from leflunomide, alcohol should be avoided.

Side Effects

The most common side effect of leflunomide is diarrhea, which occurs in approximately 20% of patients. This symptom frequently improves with time or by taking a medication to prevent diarrhea. If diarrhea persists, the dose of leflunomide may need to be reduced.

Less common side effects include nausea, stomach pain, indigestion, rash, and hair loss. In fewer than 10% of patients, leflunomide can cause abnormal liver function tests or decreased blood cell or platelet counts. Rarely, this drug may cause lung problems, such as cough, shortness of breath or lung injury.

Tell Your Rheumatology Provider

Leflunomide can cause serious birth defects. If you are pregnant or are considering having a child, you should discuss this with your rheumatology provider before beginning the medication. Breastfeeding while taking leflunomide is not recommended. Use of an effective form of birth control is critical throughout the course of this treatment. Men taking leflunomide who wish to have a child also should talk with their rheumatology provider about how to discontinue the medication. Cholestyramine is a medication you can take to help remove leflunomide from your system.

Live vaccinations should be avoided while taking this medication. Be sure to discuss any vaccines with your rheumatology provider before receiving them. It may be important to receive certain vaccines before starting this medication, such as the Pneumovax (pneumonia vaccine), hepatitis B, or tetanus booster for some patients.

Because this medication can lower your immunity, it is important you inform your rheumatologist if you have any infections or are planning to undergo any surgeries.

Updated March 2023 by Bhakti Shah, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing. This information is provided for general education only.

Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

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