Leflunomida Tillomed (Leflunomide)

Leflunomide, a disease‑modifying antirheumatic drug (DMARD), acts on inflammatory pathways in autoimmune joint diseases.

• Rheumatoid arthritis: reduces joint inflammation, pain, and swelling while slowing radiographic progression and improving physical function.
• Psoriatic arthritis: improves both skin lesions and joint symptoms, helping to control disease activity and prevent joint damage.
• Active adult disease: assists patients with moderate to severe disease in achieving clinical remission and maintaining functional ability.
• Inadequate response to methotrexate: provides an alternative therapeutic option for adults whose disease remains active despite standard therapy.

• Leflunomide is converted in vivo to its active metabolite teriflunomide, which selectively inhibits the mitochondrial enzyme dihydroorotate dehydrogenase. This blockade reduces de novo pyrimidine synthesis, limiting the proliferation of activated lymphocytes. By decreasing the pool of nucleotides required for DNA replication, the drug dampens the immune response that drives joint inflammation in rheumatoid and psoriatic arthritis.

Leflunomide may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Diarrhea: loose stools or increased frequency.
• Nausea: feeling of sickness or upset stomach.
• Alopecia: thinning or loss of hair.
• Elevated liver enzymes: mild increase in hepatic transaminases.

Serious or Rare Side Effects

• Severe liver injury: hepatitis or hepatic failure requiring monitoring.
• Bone marrow suppression: anemia, leukopenia, or thrombocytopenia.
• Pulmonary toxicity: interstitial lung disease or pneumonitis.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.

When prescribing Leflunomida Tillomed, clinicians should observe several safety precautions to minimize risk.

• Liver function monitoring: assess transaminases before treatment and periodically during therapy.
• Blood pressure assessment: monitor for hypertension, especially in patients with cardiovascular risk.
• Pregnancy avoidance: drug is contraindicated in pregnancy; ensure effective contraception for women of childbearing potential.
• Breastfeeding restriction: not recommended for nursing mothers due to potential infant exposure.
• Infection vigilance: screen for active infections and avoid live vaccines during treatment.
• Store at below 25°C: keep in the original packaging, protect from moisture and light.

Leflunomide can interact with several medicines, altering efficacy or increasing toxicity.

Major Interactions (Avoid)

• Warfarin: may increase INR and bleeding risk.
• Methotrexate: combined use can heighten hepatic toxicity.
• Live vaccines: immunosuppression raises risk of severe infection.

Moderate Interactions (Monitor Closely)

• Statins: increased risk of myopathy and elevated creatine kinase.
• Azathioprine: additive bone marrow suppression potential.
• Sulfasalazine: may further elevate liver enzymes.