Leflunomide Aurobindo (Leflunomide)

• Leflunomide is a disease‑modifying antirheumatic drug that acts on autoimmune joint disorders.
• Rheumatoid arthritis: reduces joint inflammation, pain and slows structural damage.
• Psoriatic arthritis: improves skin lesions and joint symptoms, helping maintain function.

• Leflunomide inhibits the mitochondrial enzyme dihydroorotate dehydrogenase, which blocks de novo pyrimidine synthesis. This limits the proliferation of activated T‑lymphocytes and other immune cells, thereby reducing the autoimmune response that drives joint inflammation and damage.

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

Common Side Effects

• Diarrhoea: loose stools occurring during early therapy.
• Nausea: feeling of sickness or upset stomach.
• Alopecia: thinning or loss of hair.
• Rash: skin redness or itching.
• Elevated liver enzymes: mild increase in ALT/AST.
• Hypertension: rise in blood pressure.

Serious or Rare Side Effects

• Severe liver injury: jaundice, hepatic failure.
• Stevens‑Johnson syndrome: severe skin blistering.
• Bone marrow suppression: low blood cell counts.
• Interstitial lung disease: breathing difficulty, cough.
• Severe infections: opportunistic bacterial or viral infections.
• Teratogenicity: birth defects if exposure occurs during pregnancy.

• Before initiating Leflunomide, clinicians should evaluate several safety parameters.
• Pregnancy contraindication: avoid use in women who are pregnant or may become pregnant.
• Liver function monitoring: check ALT/AST before start and periodically thereafter.
• Blood count monitoring: assess complete blood count regularly.
• Hypertension surveillance: monitor blood pressure throughout treatment.
• Infection risk: screen for active infections and avoid live vaccines.
• Store below 25°C: keep in the original pack, protect from moisture.

Leflunomide can alter the activity of several co‑administered medicines.

Major Interactions (Avoid)

• Warfarin: increased anticoagulant effect, risk of bleeding.
• Teriflunomide: additive toxicity, especially hepatic.
• Live vaccines: risk of uncontrolled infection.
• Immunosuppressants (e.g., cyclosporine): heightened immunosuppression.
• Cholesterol‑binding resins (e.g., cholestyramine): reduced Leflunomide absorption.

Moderate Interactions (Monitor Closely)

• Statins: possible increase in muscle toxicity.
• Antihypertensives: additive blood‑pressure lowering.
• Oral contraceptives: reduced efficacy, consider alternative methods.
• NSAIDs: may increase liver enzyme elevations.
• Methotrexate: combined bone‑marrow suppression risk.