Leflunomide
Generic name
Leflunomide
Brand name
ATC Code
L04AA13
- Dosages
- Side effects in children
- Warnings & precautions in children
- Contra-indications in children
-
Interactions - PK
- Renal impairment
- References
Pharmacokinetics in children
The pharmacokinetics of leflunomide appear to be similar in children and adults. Adamson et al. (2004) found a slightly lower clearance (0.19 L / m2 / day) compared to adults (0.26 L / m2 / day), but no definitive conclusions can be drawn due to large inter-individual variability .
dose recommendation of formulary compared to licensed use (on-label versus off-label)
No information is present at this moment.
Available formulations
No information is present at this moment.
Dosages
| Juvenile idiopathic arthritis (JIA) |
|---|
|
Renal impaiment in children > 3 months
GFR ≥10 ml/min/1.73m2: Dose adjustment not required.
GFR <10 ml/min/1.73m2: A general recommendation on dose adjustment cannot be provided.
The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here
Side effects in children
Silverman et al. (2005) found the following adverse reactions occurring in ≥10% of patients (6-17 years), requiring treatment and that were possibly related to leflunomide: headache, alopecia, abdominal pain, respiratory tract infection, nausea, diarrhea, dizziness , cough, rhinitis, rash, mouth ulcers, dyspepsia, flu-like symptoms, gastrointestinal upset, pharyngitis, anemia, arthralgia, malaise, pain, abnormal liver function tests and ecchymosis.
The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here
Contra-indications
No information available on specific contra indications in children.
The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here
Warnings & precautions in children
The active metabolite of leflunomide is likely to cause serious birth defects when used during pregnancy and has a very long half-life. Attention should be paid to adequate contraception. If there is a desire to have children, consult the SmPC for detailed instructions about waiting time, a wash-out procedure and monitoring of bloodlevels.
Interactions
The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here
IMMUNOSUPPRESSANTS
This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.
| Selective immunosuppressants | ||
|---|---|---|
| L04AA24 | ||
| L04AA32 | ||
| L04AA02 | ||
| L04AA06 | ||
| L04AA31 | ||
| L04AA04 | ||
| L04AA44 | ||
| Other immunosuppressants | ||
|---|---|---|
| L04AX01 | ||
| L04AX03 | ||
| Tumor necrosis factor alpha (TNF-alpha) inhibitors | ||
|---|---|---|
| L04AB04 | ||
| L04AB01 | ||
| L04AB06 | ||
| L04AB02 | ||
| Interleukin inhibitors | ||
|---|---|---|
| L04AC03 | ||
| L04AC02 | ||
| L04AC08 | ||
| L04AC13 | ||
| L04AC19 | ||
| L04AC10 | ||
| L04AC22 | ||
| L04AC07 | ||
| L04AC05 | ||
| Calcineurin inhibitors | ||
|---|---|---|
| L04AD01 | ||
| L04AD02 | ||
| Sphingosine-1-phosphate (S1P) receptor modulators | ||
|---|---|---|
| L04AE01 | ||
| Janus-associated kinase (JAK) inhibitors | ||
|---|---|---|
| L04AF02 | ||
| L04AF02 | ||
| L04AF08 | ||
| L04AF01 | ||
| Monoclonal antibodies | ||
|---|---|---|
| L04AG04 | ||
| Mammalian target of rapamycin (mTOR) kinase inhibitors | ||
|---|---|---|
| L04AH02 | ||
| L04AH01 | ||
| Complement inhibitors | ||
|---|---|---|
| L04AJ01 | ||
| L04AJ02 | ||
| Dihydroorotate dehydrogenase (DHODH) inhibitors | ||
|---|---|---|
| L04AK02 | ||
References
- Chickermane PR, et al., Evaluation of the benefits of sequential addition of leflunomide in patients with polyarticular course juvenile idiopathic arthritis failing standard dose methotrexate, Clin Exp Rheumatol, 2015, 33(2), 287-92
- Ayaz NA, et al, Leflunomide treatment in juvenile idiopathic arthritis, Rheumatol Int, 2019, 39(9), 1615-19
- Alcântara AC, et al., A longterm prospective real-life experience with leflunomide in juvenile idiopathic arthriti, J Rheumatol, 2014, 41(2), 338-44
- Foeldvari I, et al., Effectiveness of leflunomide in patients with juvenile idiopathic arthritis in clinical practice, J Rheumatol, 2010, 37(8), 1763-7
- Silverman E, et al,, Long-term open-label preliminary study of the safety and efficacy of leflunomide in patients with polyarticular-course juvenile rheumatoid arthritis, Arthritis Rheum, 2005, 52(2), 554-62
- Silverman E, et al., Leflunomide or methotrexate for juvenile rheumatoid arthritis, N Engl J Med, 2005, 352 (16), 1655-66
- Nederlandse Vereniging voor Kindergeneeskunde, Richtlijn Juveniele idiopathische artritis, medicamenteuze behandeling van kinderen met, www.nv.nl, 27 december 2017
- Shi J, et al., Population pharmacokinetics of the active metabolite of leflunomide in pediatric subjects with polyarticular course juvenile rheumatoid arthritis, J Pharmacokinet Pharmacodyn, 2007, 32(3-4), 419-39
- Adamson, P. C., et al., Pediatric phase I trial and pharmacokinetic study of the platelet-derived growth factor (PDGF) receptor pathway inhibitor SU101, Cancer Chemother Pharmacol, 2004, 53(6), 482-8
Changes
Therapeutic Drug Monitoring
Overdose
