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12D. ANTI-RHEUMATIC DRUGS (DMARDS) in 12. MUSCULOSKELETAL DISORDERS & PAIN
LEFLUNOMIDE
IMMUNE MODULATOR | ANTI-RHEUMATIC
PK: D: 0.13 L/kg (Vd) M: Hepatic E: Feces (48%), urine (43%)

Indications & Dose: PSORIATIC ARTHRITIS PO Adult Loading dose: 100mg OD 3 days, MD 20mg OD | RHEUMATOID ARTHRITIS PO Adult Loading dose: 100mg OD 3 days, MD 10-20mg OD

Contra: Hypersensitivity, immunocompromised patients, severe infect, hepatic impairment, moderate-to-severe renal impairment, severe hypoproteinemia, bone-marrow dysplasia, live vaccines, suspected pregnancy

Precautions: History of TB, history of significant hematologic abnormalities

ADR: Serious: Chest pain, HTN, pneumonia, abnormal LFTs, Others: Headache, dizziness, asthenia, alopecia, rash, dry skin, weight loss, rhinitis, pharyngitis, nausea, vomiting, diarrhea, abdominal pain, dyspepsia, gastroenteritis, mouth ulcers, UTI, hypokalemia, joint pain/disorders, bronchitis

DDI: Serious Methotrexate increases adverse effects of drug (hepatotoxicity & hematotoxicity), Warfarin increases INRs with bleeding complications, Itraconazole may cause hepatic failure, Colestyramine/Charcoal/Rifampicin reduces active metabolite of drug

Diet: With/without food

Monitor: CBC, serum phosphate, liver transaminases

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