Manufacturer: Sanofi-Aventis, France
Pharmaceutical name: Leflunomide
Pack: 30 tabs (20mg/tab)

Arava reduces signs and symptoms of rheumatoid arthritis. It is also used to improve physical function and to prevent the development of structural damage to the joints.
Arava is a pyrimidine synthesis inhibitor. It is thought to work by blocking certain enzymes responsible for abnormal tissue development or growth.

Therapeutic actions:
Leflunomide is an immunomodulatory drug inhibiting dihydroorotate dehydrogenase (an enzyme involved in de novo pyrimidine synthesis) (abbreviation DHODH). Genuine antiproliferative activity has been proven. Additionally, several experimental models (both in vivo and in vitro) have demonstrated an anti-inflammatory effect. This double action is supposed to slow progression of the disease and to cause remission/relief of symptoms of rheumatoid arthritis and psoriatic arthritis such as joint tenderness and decreased joint and general mobility in human patients.

What is it used for?:
Leflunomide affects the immune system and reduces swelling and inflammation in the body.
Leflunomide is used to treat the symptoms of rheumatoid arthritis. Leflunomide also helps reduce joint damage and improves physical functioning.

Contraindications and cautions:
- allergy to any ingredient in Arava;
- pregnancy or planning to become pregnant.

Side effects:
Serious side effects: severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); sore throat; blisters on the inside of eyes, nose, or mouth; pale stools; chest pain; easy bruising/bleeding; feelings of numbness or tingling; fever; infection; muscle cramps, including leg cramps; easy bruising/bleeding; pale skin; blistering or peeling skin; stomach pain; unusual tiredness; vomiting; dark urine; yellowing of the eyes or skin. Less serious side effects: indigestion; back pain; diarrhea; dizziness; dry skin; hair loss; upper respiratory tract infection; headache; increased cough; joint disorder; muscle aches; nausea; runny nose; sinus infection; bronchitis; urinary tract infection; vomiting; loss of appetite; weakness; weight loss.

Interactions:
- Arava’s effectiveness may be decreased by cholestyramine;
- side effects, including liver toxicity, headache, and muscle pains may be provoken by methotrexate or rifampin;
- Arava may increase nticoagulants’s (eg, warfarin) side effects, including risk of bleeding.