dosing and side effects of leflunomide
Dosage: 10 to 20 mg daily. It is primarily metabolized by the liver. To save money, leflunomide 20 mg every other day works as well as 10 mg daily. While it is approved with a loading dose (100 mg daily × 3 days), it is rarely given because of significant GI toxicity.
- • Nausea, vomiting, diarrhea: diarrhea is the most common (17%) and may be abrogated by dose reduction.
- • Skin rash (8%): most commonly occurs during the 2nd and 5th month.
- • Cytopenias: neutropenia occurs more commonly than thrombocytopenia and usually in patients who already have a blood dyscrasia.
- • Hepatotoxicity: usually occurs when used with other hepatotoxic agents, but fatal hepatotoxicity is reported and prudent monitoring is required.
- • Cardiovascular: hypertension and hyperlipidemia both reported.
- • Weight loss: can occur in absence of any other factor.
- • Teratogenicity: pregnancy Category X.
- • Pneumonitis: seen less commonly than with MTX.
- • Neuropathy: peripheral neuropathy has been reported.