Arava (leflunomide)
How this therapy is used at Arthritis Care of Texas in Corpus Christi, TX — what it is, how it is taken, side effects, and safety checks.
- Treats
- Rheumatoid arthritis · Psoriatic arthritis
- How given
- Pill
- How often
- Once daily
Arava is a disease-controlling treatment: it calms the immune activity driving rheumatoid arthritis, easing symptoms and helping protect joints from damage. It builds up slowly — judge it over 2–3 months — and it is not a painkiller. Because it stays in the body a long time, its effects (good and bad) change slowly too.
What it is: A DMARD that regulates an overactive immune system and modifies the underlying disease process rather than just treating symptoms. It is not a painkiller — benefits may take 6 or more weeks, with full effect up to 6 months. It is used for rheumatoid arthritis, psoriatic arthritis, and other autoimmune diseases. A consultant rheumatologist prescribes and monitors it initially.
Before starting: It is not prescribed — or is stopped — if you are pregnant, breastfeeding, or planning a baby soon; if you have severe side effects; or if you are starting an interacting treatment. A blood test and blood pressure check are done before starting, with regular blood tests and BP checks during treatment — you should not take leflunomide unless you're having regular checks.
How it's taken: A tablet once daily at the same time, swallowed whole, with or without food — usually 10 or 20 mg daily. It is a long-term treatment; keep taking it even if it is slow to work, and even when you improve.
Side effects: Most common: diarrhoea, nausea, mouth ulcers, weight loss, stomach pain, headache, dizziness, weakness, pins and needles, dry skin, rashes, and hair loss (rare or minor), plus a slight rise in blood pressure. It can reduce blood-cell counts (increasing infection risk) and affect the liver — hence the regular blood tests. Report infection signs, bruising or bleeding, rash, breathlessness, unusual tiredness, stomach pain, or jaundice promptly. Chickenpox and shingles can be severe.
Wash-out: Leflunomide can remain in the body for over a year after stopping. A "wash-out" (cholestyramine for 11 days) speeds elimination — used if pregnancy occurs, if there are severe side effects, or when switching to an interacting drug.
Interactions: Warfarin and phenytoin. Discuss all new medicines with your doctor.
Pregnancy: Both men and women are advised to use contraception. Women planning pregnancy should stop leflunomide and have a wash-out before trying (or use contraception for up to 2 years after stopping). If pregnancy occurs while on it: stop the drug and speak to your doctor about a wash-out — harm is very unlikely if both are done. Men are advised to have a wash-out before fathering a child, as a precaution. Breastfeeding is not recommended.
Why the checks: The monitoring follows the drug: liver tests and blood counts are checked regularly because Arava can affect both silently, and early changes are easy to act on; blood pressure is watched because it can creep up; and the wash-out procedure exists because the drug leaves the body slowly — if it must be cleared fast, the wash-out is how, verified with blood levels.
Used for Rheumatoid arthritis · Psoriatic arthritis
Common worries
Why blood tests every month at first?
Arava can affect the liver and lower blood counts without symptoms. Regular tests in the early months catch a change while it is small — usually a dose adjustment or a pause is all that follows.
I’ve read it stays in the body for years. Is that true?
It can linger, yes — the body recycles it. If it ever needs to be removed quickly (for pregnancy planning or side effects), a ‘wash-out’ medicine binds it and clears it in days. This is well understood and planned for.
Can I drink alcohol on it?
Best to keep alcohol minimal or avoid it: both alcohol and Arava are processed by the liver, and combining them raises the strain. Your provider will give you a clear personal guideline.
Ready to be seen? New patients are seen within 2–4 weeks.