Leflunomide (Arava)


Leflunomide (Arava) is a drug approved to treat adults with moderate to severe. It belongs to a class of medications called disease-modifying antirheumatic drugs (DMARDs), which aim to decrease inflammation and 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, thereby reducing 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, if they experienced side effects with the higher dose. Leflunomide should be taken with food. Complete benefits may not be experienced until 6 to12 weeks after starting the medication.

It is important that you have regular blood tests, including those for liver function and blood counts, while taking this medication. You should not take leflunomide if you have a pre-existing liver disease, such as hepatitis or cirrhosis. Alcohol use should be avoided when taking lefunomide as this may increase the risk of liver damage. This medication should also be avoided in pregnancy and contraception is highly recommended in female patients taking lefunomide.

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

If you are pregnant or are considering having a child, you should discuss this with your rheumatology provider before beginning leflunomide as this medication can cause serious birth defects. 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 possible risks. 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 is important you inform your rheumatologist if you have any infections or are planning to undergo any surgeries as leflunomide can interfere with recovery.

Updated February 2024 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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