Arava: Targeted Symptom Control for Rheumatoid Arthritis
Arava
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| Product dosage: 20mg | |||
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Synonyms | |||
Arava (leflunomide) is a disease-modifying antirheumatic drug (DMARD) specifically engineered to manage the symptoms and progression of rheumatoid arthritis. By selectively inhibiting pyrimidine synthesis in activated lymphocytes, it reduces inflammation, minimizes joint damage, and helps preserve physical function. This oral treatment offers a convenient therapeutic option for adults with moderate to severe active rheumatoid arthritis, providing sustained relief and improving quality of life. Clinical studies demonstrate its efficacy in reducing tender and swollen joint counts and slowing radiographic progression.
Features
- Active ingredient: Leflunomide
- Available in 10 mg and 20 mg tablets
- Oral administration, once-daily dosing
- Selective inhibition of dihydroorotate dehydrogenase (DHODH)
- Modulates autoimmune response without broad immunosuppression
- Long half-life (approximately 2 weeks) allowing consistent therapeutic levels
Benefits
- Reduces pain, swelling, and morning stiffness associated with rheumatoid arthritis
- Slows the progression of joint damage and erosions visible on X-ray
- Helps maintain physical function and daily activity levels
- Provides long-term disease control with once-daily oral dosing
- May reduce or delay the need for corticosteroid use
- Can be used as monotherapy or in combination with other DMARDs like methotrexate
Common use
Arava is indicated for the treatment of adults with active rheumatoid arthritis. It is particularly suitable for patients who have had an inadequate response to one or more DMARDs or who require an alternative to methotrexate. The medication is commonly prescribed for moderate to severe cases where disease activity is affecting quality of life and functional capacity. It may be used as initial therapy or added to existing treatment regimens when additional disease control is needed.
Dosage and direction
The recommended dosing regimen for Arava includes a loading dose followed by maintenance therapy. The loading dose is 100 mg once daily for 3 days, then reduced to the maintenance dose of 20 mg once daily. For patients who cannot tolerate the 20 mg dose, the maintenance dose may be decreased to 10 mg daily. Tablets should be taken with water, with or without food, at approximately the same time each day. Dose adjustments may be necessary based on clinical response and tolerability. Treatment response is typically evaluated after 4-8 weeks of therapy.
Precautions
Patients should have baseline liver function tests (ALT) and complete blood count before starting treatment and monitored regularly thereafter. Use with caution in patients with pre-existing liver disease or elevated liver enzymes. Bone marrow suppression may occur; monitor blood counts periodically. Consider vaccination status before initiation, as live vaccines should be avoided during treatment. Patients should be advised that it may take several weeks to notice clinical improvement. Use effective contraception during treatment and for specified time after discontinuation due to teratogenic potential.
Contraindications
Arava is contraindicated in patients with known hypersensitivity to leflunomide or any component of the formulation. It should not be used in patients with severe hepatic impairment. Contraindicated in patients with severe immunodeficiency, bone marrow dysplasia, or severe uncontrolled infections. Pregnancy and breastfeeding are absolute contraindications due to teratogenic effects. Not recommended for patients with significant renal impairment (CrCl <30 mL/min). Should not be administered concomitantly with teriflunomide.
Possible side effects
Common side effects (>10% of patients) include diarrhea, nausea, headache, elevated liver enzymes, alopecia, and rash. Less frequent adverse reactions (1-10%) may include hypertension, abdominal pain, respiratory infections, weight loss, and oral ulcers. Rare but serious side effects (<1%) include severe liver injury, pancytopenia, serious skin reactions, peripheral neuropathy, and interstitial lung disease. Most side effects are dose-dependent and may improve with dose reduction. Patients should report any signs of infection, unusual bruising, or persistent gastrointestinal symptoms.
Drug interaction
Arava may interact with other hepatotoxic drugs including methotrexate, increasing risk of liver toxicity. Concurrent use with other immunosuppressive agents may increase risk of infections. Rifampin may increase leflunomide levels. Cholestyramine and activated charcoal accelerate elimination of leflunomide. Warfarin monitoring is recommended as leflunomide may enhance its anticoagulant effect. Live vaccines should be avoided. NSAIDs and other RA medications may be used concomitantly with appropriate monitoring.
Missed dose
If a dose is missed, take it as soon as remembered on the same day. If missed entirely for a day, resume the regular dosing schedule the next day at the usual time. Do not double the dose to make up for a missed dose. For patients on the loading dose phase, maintain the scheduled regimen without additional compensation for missed doses. Consistent daily administration is important for maintaining therapeutic levels.
Overdose
Symptoms of overdose may include increased incidence and severity of adverse reactions, particularly gastrointestinal effects and elevated liver enzymes. In case of suspected overdose, discontinue Arava immediately and initiate an accelerated elimination procedure using cholestyramine or activated charcoal. Monitor hepatic function and hematological parameters closely. Supportive care should be provided based on symptoms. There is no specific antidote for leflunomide overdose.
Storage
Store at room temperature (20-25°C or 68-77°F) in the original container. Protect from light and moisture. Keep tightly closed and out of reach of children. Do not store in bathroom or other humid areas. Do not use after expiration date printed on packaging. Properly dispose of any unused medication through take-back programs or according to local regulations.
Disclaimer
This information is for educational purposes only and does not replace professional medical advice. Always consult with a qualified healthcare provider before starting or changing any treatment regimen. Individual responses to medication may vary. The prescribing physician should consider the complete medical history and current condition of the patient. Full prescribing information including boxed warnings should be reviewed before administration.
Reviews
Clinical trials demonstrate that approximately 60-65% of patients achieve ACR20 response with Arava treatment. Many rheumatologists report satisfactory disease control and improved patient outcomes with long-term use. Patients frequently report significant improvement in joint pain and stiffness, though some note gastrointestinal side effects during initial treatment phases. The convenience of once-daily dosing is frequently cited as a positive aspect of therapy. Real-world evidence supports its effectiveness in maintaining remission and slowing radiographic progression in appropriate patient populations.