Medication Review: Leflunomide Medication Review

In this educational session, Jessica Farrell, PharmD, from Albany Medical Center and Albany College of Pharmacy and Health Sciences, provides key clinical pearls on Leflunomide, a lesser-discussed DMARD (disease-modifying antirheumatic drug) used in rheumatology. While not frequently prescribed for new patients, many individuals remain on Leflunomide long-term, making it essential to understand its pharmacokinetics, potential toxicities, and considerations for special populations.A unique aspect of Leflunomide is its enterohepatic recycling, which allows its active metabolite to persist in the body for an extended period—even years after discontinuation. In cases of toxicity (such as liver enzyme elevations or alopecia) or if a pregnancy is planned, a cholestyramine wash can be used to effectively eliminate the drug from the system. While Leflunomide is generally well tolerated, clinicians should be mindful of its impact as patients age, since declining kidney and liver function may necessitate dose adjustments or discontinuation.For more expert insights and digital resources, visit the RhAPP website and RhAPP ACE App for the latest in rheumatology education.