Arava (Leflunomide) — Patient Information (UK)

Arava is a medicine containing leflunomide. It is used to treat certain inflammatory conditions, most commonly rheumatoid arthritis and psoriatic arthritis. Arava works by reducing the activity of the immune system in a controlled way to help calm inflammation and slow joint damage over time.

This page explains how Arava works, how it is used, what to expect, and important safety information. Always follow the advice given by your healthcare professional and read the Patient Information Leaflet provided with your medicine.

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Basic product information

• Medicine name: Arava
• Active ingredient: Leflunomide
• Common dosage forms: Tablets (strengths vary by product)
• Medicine type: Disease-modifying anti-rheumatic drug (DMARD)
• Prescription status (UK): Classified as a prescription-only medicine in the UK
• How it’s taken: Usually by mouth once daily

Arava is designed for long-term use. Many people notice some improvement within weeks, but it can take longer to see the full benefit.

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How Arava works (mechanism of action)

Leflunomide helps control autoimmune inflammation by interfering with how certain immune cells make the building blocks they need to multiply.

After you take leflunomide, your body converts it into an active metabolite (a form that does the main work). The active metabolite reduces the activity of an enzyme involved in pyrimidine synthesis, a pathway required for rapid cell growth. This leads to:

• Less overactivity of immune cells
• Reduced inflammatory signalling
• A slower progression of joint damage in inflammatory arthritis

Compared with symptom-relief medicines, DMARDs like Arava aim to change the course of the disease. This is why early improvement can be gradual.

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Pharmacokinetics (how your body handles it)

Understanding pharmacokinetics can help you appreciate why Arava is sometimes described as having a “long-lasting” effect.

• Absorption: Leflunomide is taken by mouth and is absorbed into the bloodstream.
• Activation: It is converted into an active metabolite in the body.
• Distribution: The active metabolite can remain in the body for a long time.
• Half-life: The active metabolite has a long half-life, which means drug effects may persist even after stopping.
• Elimination: Clearance is usually through metabolism and elimination pathways; in some situations, a “washout” may be used to speed removal.

Because levels can remain high for weeks, healthcare professionals may suggest specific steps if Arava needs to be stopped—for example, before pregnancy or in certain safety situations.

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What Arava is used for (indications)

In the UK, leflunomide (Arava) is used to treat certain inflammatory joint diseases, including:

• Rheumatoid arthritis (RA): To reduce symptoms and slow structural joint damage.
• Psoriatic arthritis (PsA): In adults, to treat active disease in certain cases.

Arava may be chosen when ongoing control of disease activity is needed, often as part of a broader treatment plan that may include other medicines (for example, steroids or pain relief).

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When you should start noticing effects (timing)

Arava is not an immediate pain-reliever. Typical timing is:

• First changes: Some people notice improvement within a few weeks.
• More noticeable benefit: Often develops over 2–3 months.
• Full effect: May take several months depending on disease activity and response.

Your clinician may also use blood tests to monitor inflammation markers and safety markers as treatment continues.

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Dosing and how to take Arava

Dosing can vary based on your condition, other medicines, and blood test results. Always follow the dose and schedule provided to you.

Typical dosing approach

• Common schedule: Once daily by mouth.
• Initial loading strategy (sometimes used): Some treatment plans include an initial higher dose for a limited period, followed by a maintenance dose. Other plans may start with the maintenance dose directly.
• Maintenance dose: Usually lower than any initial dosing.

Practical tips for taking Arava

• Take consistently: Try to take your tablet at the same time each day.
• Swallow whole: Do not crush or chew unless your leaflet specifically allows it.
• Use a reminder: Consider an alarm or medication app to avoid missed doses.
• What if you miss a dose? Take it when you remember on the same day. If it’s nearly time for the next dose, skip the missed dose. Do not take a double dose. If you are unsure, ask your pharmacist or healthcare professional.

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Food interactions

Leflunomide can generally be taken with or without food. However, maintaining a consistent routine may help you avoid stomach upset and improve adherence. If you notice digestive symptoms, you can discuss whether taking it with food works better for you.

If you take other medicines that affect the stomach or digestion, it’s still important to review your full medication list with your pharmacist.

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Alcohol and medicine interactions

Alcohol

Alcohol can increase the risk of liver problems when combined with medicines that may affect the liver. With Arava, this risk is a key safety consideration. In practice, many clinicians advise:

• Avoid heavy or frequent alcohol intake
• Limit alcohol and discuss your typical consumption with your healthcare professional
• Do not start new alcohol-heavy patterns after beginning treatment

Medicine interactions (examples)

Some drug interactions can increase side effects or alter safety. Always tell your clinician and pharmacist about all medicines you take, including over-the-counter products and herbal supplements.

Common interaction considerations include:

• Liver-affecting medicines: Combining with other drugs known to stress the liver may increase risk of abnormal liver function tests.
• Medicines that suppress the immune system: The combined effect may raise the risk of infection.
• Warfarin: There is a potential interaction risk; your INR may require closer monitoring if both are used.
• Teriflunomide: Leflunomide and teriflunomide are closely related; avoid duplication unless advised.
• Vaccines: Some vaccines may be less suitable during immune-modifying therapy; ask your healthcare professional about timing.

Also consider that individual interaction risk depends on your liver health, kidney function, and other medications.

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Safety profile and important warnings

Like all medicines, Arava can cause side effects. Many people tolerate it well when properly monitored, but regular blood tests are important.

Key areas of monitoring

• Liver function: Arava can affect liver enzymes. Your clinician will typically monitor liver tests.
• Blood counts: It may affect white blood cells and other blood components. Full blood counts are commonly monitored.
• Infection risk: Because it modifies the immune response, infections can occur more easily.
• Skin and allergy reactions: Rare but potentially serious reactions can occur.

Common side effects

Not everyone will get side effects. Commonly reported effects may include:

• Diarrhoea or stomach upset
• Nausea
• Headache
• Hair thinning (may occur in some people)
• Increased liver enzymes on blood tests
• Reduced appetite

Seek urgent medical advice if you get

• Symptoms of serious infection: fever, chills, severe sore throat, or breathlessness
• Signs of liver problems: yellowing of the skin/eyes, dark urine, severe fatigue, or persistent nausea/vomiting
• Severe skin reaction: widespread rash, blistering, skin peeling, or mouth sores
• Breathing symptoms: new or worsening cough, shortness of breath, or chest discomfort
• Unexplained bruising/bleeding: which may suggest blood count issues

If any of these occur, contact urgent care services or your healthcare team promptly.

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Practical use tips

1) Keep to monitoring schedules

Regular blood tests are one of the most important ways to stay safe with Arava. Tests often include:

• Liver function tests
• Full blood count
• Other tests depending on your medical history

2) Watch for infection early

Contact your healthcare team early if you suspect an infection (for example, chest infection, urinary symptoms, fever, or flu-like illness). Prompt advice can prevent complications.

3) Sun protection

Some people taking immunomodulatory medicines report increased sensitivity to sun/UV. Use practical sun protection measures such as clothing, shade, and appropriate sunscreen.

4) Pregnancy and family planning considerations

Arava can remain in the body for a prolonged period. If pregnancy is a possibility now or in the future, discuss family planning with your healthcare professional as early as possible. You may be advised on specific steps to reduce residual drug levels before conception.

5) Contraception

Reliable contraception is often recommended while taking leflunomide and for a period after stopping, because of the long-lasting metabolite. Follow the guidance provided by your clinician.

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Alternative options (if Arava is not suitable)

Many treatments can help control rheumatoid arthritis or psoriatic arthritis. The best option depends on your symptoms, previous medication responses, comorbidities, and safety considerations. Common alternatives include:

Conventional DMARDs

• Methotrexate: Often first-line for RA; monitored closely with blood tests.
• Sulfasalazine: Sometimes used alone or with other DMARDs.
• Hydroxychloroquine: Useful for some people, particularly in mild disease.

Other disease-controlling treatments

• Biologic therapies: Target specific immune pathways (require specialist review and monitoring).
• Targeted synthetic DMARDs (tsDMARDs): e.g., Janus kinase (JAK) inhibitors in appropriate patients; requires careful risk assessment.

If you’re considering switching, do not stop Arava suddenly without discussing with your healthcare professional. The long persistence of its active metabolite can affect the timing of any changes.

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UK market and legal context

In the United Kingdom, Arava (leflunomide) is a regulated medicine. It is:

• Authorised for use in the UK under applicable medicines regulations
• Supplied through appropriate channels with safety oversight
• Subject to standard pharmacy and prescribing frameworks for prescription medicines

For the latest regulatory updates, references, or safety notices, healthcare professionals and patients can consult the UK medicines regulatory information sources and official patient information leaflets included with the product.

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Recent guidance and monitoring emphasis (UK)

Guidance for DMARD use commonly emphasises:

• Regular blood tests to monitor liver function and blood counts
• Infection risk awareness and early review when symptoms occur
• Medication review for interactions and liver-risk factors (including alcohol)
• Family planning planning due to the long-lasting nature of leflunomide’s active metabolite

Your clinic may follow national rheumatology recommendations and local protocols on the choice of DMARD, dose adjustments, and monitoring frequency.

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Delivery and availability in the UK

Arava tablets may be available through UK pharmacies depending on supplier stock and the specific strength required. Availability can change due to supply timelines and manufacturing schedules.

• Typical delivery: Available for home delivery where allowed by the pharmacy’s service model.
• Order processing: Dispatch times may vary; you will receive tracking and updates when available.
• Packaging: Medicines are delivered in appropriate, secure packaging to protect tablets during transit.

If you need a specific strength or formulation, it’s helpful to confirm stock availability before ordering.

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FAQ

1. How long does Arava take to work?

Some improvement may begin within weeks, but the full effect often takes 2–3 months or longer. Consistent long-term use is usually necessary to see benefits.

2. Can I drink alcohol while taking Arava?

Alcohol should be limited because of possible liver effects. Avoid heavy drinking and discuss your typical intake with your healthcare professional.

3. Do I need blood tests?

Yes. Blood monitoring commonly includes liver function and full blood counts to help detect side effects early and guide ongoing safe use.

4. What if I miss a dose?

Take it as soon as you remember on the same day. If it’s close to the next scheduled dose, skip the missed dose. Do not take a double dose. If unsure, seek advice from your pharmacist.

5. Are there foods I should avoid?

Arava can usually be taken with or without food. However, if you experience stomach upset, taking it with food may help. Keep your diet consistent and discuss any major changes with your healthcare team.

6. Can Arava be taken with other medicines?

Some combinations require extra caution, especially medicines that affect the liver or blood, or those that influence immune function. Tell your pharmacist and healthcare professional about everything you take—including over-the-counter and herbal products.

7. What are the signs of serious side effects?

Seek urgent advice for symptoms such as severe infection (fever, chills), signs of liver problems (yellow skin/eyes, dark urine), severe skin reactions, or breathing problems (new/worsening cough or shortness of breath).

8. Can I stop Arava when I feel better?

It’s usually not recommended to stop without medical advice. DMARDs help control disease activity over time, and stopping may lead to flare-ups. Also, leflunomide can persist in the body for a long time.

9. Are there alternatives to Arava?

Yes. Options may include other conventional DMARDs (such as methotrexate), biologic therapies, or targeted synthetic DMARDs depending on your diagnosis and circumstances. Your clinician can help choose the safest effective option.

10. Is Arava suitable for everyone?

Not necessarily. Your suitability depends on factors such as liver health, infection risk, current medications, and pregnancy/family planning plans. Your healthcare professional can assess risks and monitoring needs.

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Summary

Arava (leflunomide) is a DMARD used to treat active rheumatoid arthritis and psoriatic arthritis. It reduces immune-driven inflammation and can slow disease progression. Because leflunomide can affect the liver and blood counts, regular monitoring is essential. With careful follow-up, many patients achieve meaningful improvements in symptoms and long-term joint health.

If you have questions about your treatment or how to take your tablets safely, speak to your healthcare professional or pharmacist.