Arava (Leflunomide)

(℞) Prescription Required

    Arava (Leflunomide) Dosage and Side Effects

    ARAVA is used to treat adult patients who have active rheumatoid arthritis.

    Proper Use of this medication

    Usual dose:

    ARAVA has been prescribed for you alone. Do not share it with anyone else, even if their symptoms are the same as yours, as it may bring more harm than good.

    ARAVA is supplied as film-coated tablets of 10, 20, and 100 mg strengths. Your doctor will usually want you to build up the amount of ARAVA in your body. For doing so, you will usually start the treatment by taking a tablet of 100 mg once daily for the first 3 days. Thereafter, your doctor will usually reduce the dose to a tablet of 20 mg to be taken once daily. For some people, their doctor will instead prescribe a tablet of 10 mg once daily.

    You should always follow your doctor’s instructions. Do not take any more or any less tablets than what your doctor says. You will normally take ARAVA over long periods of time. However, your doctor will advise you if and when you need to stop taking ARAVA.

    You can take ARAVA during meals or at any time between meals. However, it works best if you take it at the same time every day. Swallow the tablet whole with a glass of water or another fluid.

    Overdose:

    If you accidentally take more than one tablet, nothing is likely to happen. If possible, take your tablets or the box with you to show the doctor.

    Missed dose:

    If you forget to take a tablet of ARAVA take it as soon as you remember, unless it is nearly time for your next dose. Do not double-up on the next dose to make up for the one missed.

    Side Effects

    As with any medication, ARAVA can cause some side effects. It may, however, affect different people in different ways. Just because side effects have occurred in other people does not mean you will get them. In studies of patients with rheumatoid arthritis, common side effects included: diarrhea, loss of appetite, nausea (queasiness), vomiting, abdominal pain, weight loss (usually mild), headache, dizziness, weakness, abnormal skin sensations like tingling, inflammation of a tendon sheath, increased hair loss, eczema, and dry skin. Should these side effects occur and be bothersome, please consult your doctor. Your doctor may decide to decrease the dose of ARAVA or may want you to stop the medication.

    ARAVA can also increase blood pressure (usually mildly) and your blood pressure will need to be checked regularly.

    Ulceration or inflammation of the mouth and skin rash are common with ARAVA. However, tell your doctor without any delay if you develop skin rash or mucous membrane lesions (e.g. lesions in the mouth). This is because, in cases, such reactions may develop into severe, sometimes life-threatening skin reactions such as painful blister, red rash spreading and skin peeling. They may, therefore, require discontinuation of ARAVA and immediate action by your doctor.

    Also common are mild allergic reactions and itching, whereas occurrence of hives is uncommon. Severe and potentially serious allergic reactions are very rare. Symptoms of severe allergic reactions to any medications include weakness, drop in blood pressure and difficult breathing. If such symptoms do occur, do not take any more ARAVA tablets and consult your doctor immediately.

    Blood tests may often show a decrease in the number of white blood cells. However, a pronounced decrease in the number of white cells or of all blood cells may occur rarely in some patients. Tell your doctor without any delay if you have symptoms such as paleness, tiredness, if you bruise or bleed easily or if you have symptoms of infection such as fever, chills or sore throat. Such symptoms may be due to disorders of your blood cells. They may require discontinuation of ARAVA and other medications, and further action by your doctor.

    Blood tests may also show an increase in some liver function test results. In very rare cases this may indicate an abnormality, which may develop into serious conditions such as hepatitis and liver failure, which may be fatal. Therefore, if you develop symptoms such as unusual tiredness, nausea, vomiting, abdominal pain, or jaundice (yellow discoloration of the eyes or skin) inform your doctor at once.

    Like other antirheumatic medicines that to some extent reduce the immune defense, ARAVA may increase the susceptibility to infections. Tell your doctor without any delay if you have any symptoms of an infection (such as fever, sore throat, or cough). This is because some infections might become more severe and, therefore, they need to be treated early.

    Cases of lung inflammation causing difficulty breathing have occurred rarely in patients receiving ARAVA. Tell your doctor without delay if you experience new or worsening of shortness of breath and/or cough, with or without associated fever, at any time while you are taking ARAVA.

    Your doctor will assess your condition and will decide on appropriate course of action. This may require additional tests, for example, blood analysis. In some cases your doctor may recommend to stop taking ARAVA. However, simply stopping ARAVA may not be enough to prevent further progression of the side effect. You may be required to take certain medicines, which speeds up the elimination of ARAVA from you body. Additional follow-up visits to the doctor and diagnostic tests may be needed to monitor your condition.

    Please consult your doctor or pharmacist if you notice any of the side effects listed in this leaflet or any other undesired effects or unexpected changes. If sudden or severe reactions do occur, do not take any more ARAVA tablets and consult your doctor immediately.

    Warnings and Precautions

    The medication can stay in your body for a long period of time. Therefore some precautions and side effects may follow from this characteristic of the drug.

    What are the Risks of Birth Defects with ARAVA?

    For female patients:

    You may be at high risk of having a deformed baby if you do not follow the following instructions:

    If you are pregnant, or suspect that you may be, you must tell your doctor and you must not start taking ARAVA.

    If you are of childbearing age (women who might get pregnant), it must be confirmed with a pregnancy test that you are not pregnant just before beginning your treatment.

    Women must use reliable birth control methods when taking ARAVA. If you are of childbearing age, discuss methods to avoid becoming pregnant with your doctor.

    The risk of giving birth to a deformed baby can best be estimated by the amount of ARAVA remaining in your body when you become pregnant. If you plan to become pregnant after stopping ARAVA, it is important to inform your doctor beforehand. Once you stop taking ARAVA, you must wait a period of 2 years before trying to get pregnant. However, this waiting period may be shortened to a few weeks by taking a certain medicine that will speed up the elimination of ARAVA from your body. If this option is chosen, inform your doctor if you are taking an oral contraceptive pill. The medicine that speeds up the elimination of ARAVA may lower the effect of your contraceptive pill and you may need another contraceptive method during this period. In either case it should be confirmed by two blood tests two weeks apart that ARAVA has been sufficiently eliminated from your body before you try to become pregnant. Your doctor can give you more information about the options available to reach low blood levels of ARAVA. For information regarding blood levels measurements, please also contact your doctor.

    If you are currently taking ARAVA, or if you have taken it within the last 2 years and you believe that you may be pregnant, it is VERY IMPORTANT that you contact your doctor immediately. You must have a pregnancy test at the first delay of your period, and if the test confirms that you are pregnant, discuss with your doctor the risk of the treatment to your baby. Your doctor may propose at the first delay of your period to rapidly start the treatment which speeds up elimination of ARAVA from the body, as this may decrease the risk to your baby.

    For male patients:

    You may be at high risk of fathering a deformed baby if you do not follow the following instructions:

    Once you start taking ARAVA, you should take every precaution to avoid getting your partner pregnant. You should use a reliable birth control as recommended by your doctor, during ARAVA therapy. If you have any questions about reliable birth control methods, consult your doctor.

    If you wish to father a child after having stopped ARAVA, it is important to inform your doctor beforehand. Once you stop taking ARAVA, you must wait a period of 2 years before trying to father a child. However, this waiting period may be shortened to a few weeks by taking a certain medicine that will speed up the elimination of ARAVA from your body. In either case it should be confirmed by two blood tests that ARAVA has been sufficiently eliminated from your body and you should then wait for another 3 months before you try to get your partner pregnant. Your doctor can give you more information about the options available to reach low blood levels of ARAVA. For information regarding blood level measurements, please also contact your doctor.

    If you are currently taking ARAVA, or if you have taken it within the last 2 years and your partner suspects that she may be pregnant you must both immediately contact your doctors. Your partner must have a pregnancy test at the first delay of her period, and if the test confirms that she is pregnant, you should discuss with your doctors the risk of the treatment to the baby.

    What are Other Precautions with ARAVA?

    All patients:

    Before you start to take ARAVA, and also while you are taking ARAVA, your doctor will carry out blood tests to monitor your blood cells and your liver at regular intervals. Similarly, your blood pressure will need to be checked regularly. It is important to keep your medical appointments.

    Tell your doctor if you have ever suffered from tuberculosis. If you have ever had tuberculosis, your doctor will carefully monitor you, in order to be able to treat you without delay in case it becomes active again.

    Tell your doctor if you have, or if you have had heart disease or lung disorders.

    Tell your doctor if you have unexplained chronic diarrhea or weight loss.

    In certain circumstances (serious side effects, changing antirheumatic treatment or in case of a desired pregnancy) your doctor will decide that you should take a certain medicine which speeds up the elimination of ARAVA from your body.

    Tell your doctor if you experience symptoms that can cause numbness, tingling or burning in the hands and feet, muscle weakness or other altered sensations while taking ARAVA. Your doctor will give you a medication which can speed up the elimination of ARAVA from your body.

    Interactions with this medication

    Drinking alcohol with ARAVA:

    It is not recommended to drink alcohol during treatment with ARAVA. Drinking alcohol while taking ARAVA may result in harm to your liver more than you would usually expect.

    Taking other medicines together with ARAVA:

    Medication to relieve pain and inflammation such as nonsteroidal anti-inflammatory drugs (NSAIDs) or cortisone can be taken together with ARAVA. However, your doctor will give you specific instructions about these medicines.

    You must not receive any type of live vaccinations while treated with ARAVA or within 6 months after stopping ARAVA. Check ahead with the clinic if you have to be vaccinated.

    Before you start taking ARAVA, be sure to tell your doctor about all medicines you are taking or have taken recently including any that you bought without a prescription or any natural products. This is because the effects of ARAVA or the other medicines may be changed or you might get side effects. Furthermore, do not start any new medicine, whether prescription, non-prescription or natural products without first checking with your doctor.

    Examples of drugs that may interact with ARAVA are:

    • activated charcoal

    • azathioprine

    • cholestyramine

    • cimetidine (stomach acid medicine)

    • D penicillamine

    • duloxetine (anti-depressant)

    • gold

    • methotrexate

    • phenytoin

    • teriflunomide

    • theophylline (asthma medicine)

    • tizanidine (muscle relaxant medicine)

    • warfarin

    • medicines used to treat diabetes, such as: repaglinide, pioglitazone, rosiglitazone, nateglinide or tolbutamide

    • oral contraceptives

    • some medicines used to treat infections such as: antimalarial drugs, cefaclor, ciprofloxacin, penicillin G, rifampin, rifampicin, zidovudine

    • medicines used to lower blood cholesterol, such as: rosuvastatin, atorvastatin, simvastatin, pravastatin

    • anti-inflammatory drugs, such as: indomethacin, ketoprofen, sulfasalazine

    • diuretics (water losing pills), such as: furosemide

    • some medicines to treat cancer such as: paclitaxel, methotrexate, topotecan, daunorubicin, doxorubicin

    ARAVA can stay in your body for a long period of time after you stop taking it. Therefore, when ARAVA is stopped and another drug (for example methotrexate) is started to treat your rheumatoid arthritis, there is a possibility of increased risks of adverse events. Your doctor may give you a certain medicine that will speed up the elimination of ARAVA from your body before starting the other drug.

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    The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.