Leflunomide: What It Is, How It Works, and What to Expect

When you see Leflunomide, an oral disease‑modifying antirheumatic drug (DMARD) used mainly for rheumatoid arthritis, Arava you might wonder how it fits into your treatment plan. Rheumatoid arthritis is an autoimmune condition that damages joints, and immunosuppressants like leflunomide help calm the overactive immune response. As a DMARD, leflunomide aims to slow disease progression rather than just relieve pain. It’s taken by mouth, usually once a day, and doctors often start with a short loading phase to reach steady levels faster. If you’re new to the drug, you’ll hear a lot about labs, liver checks, and possible side effects, but understanding the basics can make the journey a lot smoother.

How Leflunomide Works Inside Your Body

Leflunomide works by blocking an enzyme called dihydroorotate dehydrogenase. This enzyme is essential for making pyrimidines, the building blocks of DNA and RNA. By limiting pyrimidine synthesis, the drug slows down the proliferation of activated lymphocytes that drive joint inflammation. In plain terms, it puts the immune system’s “accelerator” in a lower gear, which reduces swelling and pain over time. The effect isn’t immediate; you’ll usually notice improvements after several weeks, which is why patience and consistent dosing are key.

The typical prescription starts with a 100 mg loading dose taken once daily for three days, followed by a maintenance dose of 20 mg per day. Some doctors may adjust the dose based on liver function tests or how well you tolerate the medication. Because leflunomide has a long half‑life, it stays in your system for weeks after you stop taking it, which can be useful if you need to pause therapy for surgery or a pregnancy plan.

Common side effects include mild digestive issues, such as nausea or diarrhea, and occasional headaches. More serious concerns involve liver enzyme elevations, high blood pressure, and rare blood‑cell problems. Regular blood work—typically every four to eight weeks—helps catch any issues early. If your liver enzymes rise sharply, your doctor may lower the dose or stop the drug altogether.

Leflunomide is contraindicated in pregnancy because it can harm a developing fetus. Women of child‑bearing age must use reliable contraception during treatment and for at least 12 months after stopping. The drug is also off‑limits for people with severe liver disease or existing immunodeficiency conditions, as it could worsen those problems.

Because leflunomide interacts with several other medicines, it’s important to discuss all your current prescriptions with your healthcare provider. Anticoagulants like warfarin may become less effective, and hormonal contraceptives can lose potency, so backup birth control is advised. Other immunosuppressants, such as methotrexate, can increase the risk of liver toxicity, so dose adjustments or extra monitoring may be required.

Practical tips for staying comfortable on leflunomide: take the tablet with food to lessen stomach upset, keep a simple log of any new symptoms, and never skip the scheduled lab tests. If you notice persistent fatigue, rash, or unusual bruising, call your doctor right away. Staying hydrated and maintaining a balanced diet can help your liver handle the medication better.

Below you’ll find a curated collection of articles that dive deeper into each of these topics—mechanism details, dosing strategies, side‑effect management, and real‑world patient experiences. Whether you’re just starting therapy or looking for ways to fine‑tune your regimen, the resources here will give you clear, actionable information to make the most of leflunomide.