From the FDA Drug Label
Maintenance Therapy Daily dosing of 20 mg is recommended for treatment of patients with RA. A small cohort of patients (n=104), treated with 25 mg/day, experienced a greater incidence of side effects; alopecia, weight loss, liver enzyme elevations. Doses higher than 20 mg/day are not recommended. If dosing at 20 mg/day is not well tolerated clinically, the dose may be decreased to 10 mg daily
- The lowest dose of Arava (leflunomide) to fight inflammation is 10 mg daily 1.
- This dose is recommended when the patient is not able to tolerate the daily dose of 20 mg.
From the Research
The lowest effective dose of Arava (leflunomide) for treating inflammation is typically 10 mg once daily, as supported by the most recent study 2. This dose is often preceded by a loading dose of 100 mg once daily for 3 days. Some patients may require 20 mg daily for better symptom control, but starting with the lower dose helps minimize side effects while still providing anti-inflammatory benefits. Leflunomide works by inhibiting an enzyme called dihydroorotate dehydrogenase, which reduces the production of inflammatory cells and cytokines that contribute to conditions like rheumatoid arthritis. This medication takes several weeks to reach its full effectiveness, so patience is necessary when beginning treatment. Regular blood tests are essential during therapy to monitor liver function and blood counts, as Arava can cause liver damage and reduced blood cell production in some patients. Key points to consider when prescribing leflunomide include:
- Starting with a low dose to minimize side effects
- Monitoring liver function and blood counts regularly
- Being aware of the potential for liver damage and reduced blood cell production
- Considering the use of leflunomide in combination with other medications, such as sulfasalazine, for enhanced efficacy 3. It's also important to note that leflunomide has been compared to other treatments, including methotrexate and biologic agents, in terms of efficacy and safety 4, 5, 6. However, the most recent and highest quality study 2 supports the use of leflunomide at a dose of 10 mg once daily as a effective treatment for inflammation.