Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Leflunomide is an oral, disease-modifying drug that is used in the treatment of rheumatoid arthritis. Leflunomide reduces inflammation in the joints that is responsible for both the symptoms of rheumatoid arthritis and the destruction of joints. This reduces symptoms as well as the progressive deformities of the joints caused by the arthritis. Leflunomide reduces inflammation by suppressing the activity of immune cells responsible for the inflammation. Leflunomide suppresses immune cells by inhibiting dihydroorotate dehydrogenase, an enzyme that is necessary for the production of DNA and RNA. Without DNA and RNA the immune cells (and most other types of cells) cannot multiply or function (or exist). Because of its unique and different mechanism of action, leflunomide is of value when added to other medications used for treating rheumatoid arthritis. Leflunomide was approved by the FDA in September, 1998.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: 10, 20, and 100 mg tablets
STORAGE: Leflunomide should be stored at room temperature 15-30°C (59-86°F).
PRESCRIBED FOR: Leflunomide is used for the treatment of active rheumatoid arthritis in adults. It reduces the signs, symptoms and joint damage caused by rheumatoid arthritis.
DOSING: The usual dose is 100 mg daily for the first 3 days, followed by 20 mg daily. Doctors may reduce the dose to 10 mg daily if side effects appear. It may require up to four weeks of therapy before improvement of the arthritis are seen. It is not known if ingestion of food or alcohol affects the absorption or action of leflunomide.
DRUG INTERACTIONS:Cholestyramine and charcoal decrease the concentration of the active form of leflunomide in the blood probably by preventing absorption. Rifampin increases the blood concentration of the active form of leflunomide by 40% probably by increasing the conversion of leflunomide to its active form. This may increase the side effects of leflunomide.
PREGNANCY: Leflunomide is harmful to the developing fetus and should not be used during pregnancy.
NURSING MOTHERS: It is unknown whether leflunomide accumulates in breast milk. Since leflunomide could cause harm to the infant, women taking leflunomide should probably refrain from breastfeeding.
SIDE EFFECTS: The most frequently reported side effects are diarrhea, nausea, headache, rash, itching, loss or thinning of hair and weight loss. Leflunomide also may cause high blood pressure, chest pain and abnormal heartbeats. Since leflunomide suppresses the immune system, it may increase the risk to patients of infections. The most frequently reported infections involve the respiratory tract. Leflunomide may cause abnormal liver tests in the blood, suggesting damage to the liver. The liver tests usually return to normal with continued treatment. The dose of leflunomide should be reduced if liver tests are persistently greater than twice the upper limit of normal, and leflunomide should be discontinued if the levels remain above three times the upper limit of normal despite a reduction in dose. Leflunomide should not be administered to individuals with liver problems.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Ankylosing spondylitis is a form of chronic inflammation
of the spine and the sacroiliac joints. The sacroiliac joints
are located in the low back where the sacrum (the bone directly
above the tailbone) meets the iliac bones (bones on either side
of the upper buttocks). Chronic inflammation in these areas causes
pain and stiffness in and around the spine. Over time, chronic
inflammation of the spine (spondylitis) can lead to a complete cementing
together (fusion) of the vertebrae, a process referred to as ankylosis.
Ankylosis leads to loss of mobility of the spine.
Ankylosing spondylitis is also a systemic disease, meaning it can affect other tissues throughout the body. Accordingly, it
can cause inflammation in or injury to other joints away from the spine, as
well as to other organs, such as the eyes, heart, lungs, and kidneys.
Ankylosing spondylitis shares many features with several other
arthritis
conditions, suc...
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