Drug interactions between Arava and prednisone

MONITOR CLOSELY: The use of leflunomide in combination with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Serious infections including sepsis, as well as opportunistic infections like Pneumocystis jiroveci pneumonia, pulmonary and extrapulmonary tuberculosis, and aspergillosis have been reported with the use of leflunomide, particularly in patients on concomitant immunosuppressive therapy. Agents that may be significantly myelo- or immunosuppressive include antineoplastic agents, radiation, zidovudine, linezolid, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (greater than 10 mg/day to 1 mg/kg/day, whichever is less, of prednisone or equivalent for more than 2 weeks), and long-term topical or inhaled corticosteroids. There have also been rare reports of pancytopenia, agranulocytosis, and thrombocytopenia in patients receiving leflunomide alone. However, these events occurred more frequently in patients who received concomitant treatment with methotrexate or other immunosuppressive agents, or who had recently discontinued these therapies.

MANAGEMENT: Close monitoring for the development of infection is recommended if leflunomide is used in patients who have recently received or are receiving other immunosuppressive or myelosuppressive agents. Platelet, white blood cell count, and hemoglobin or hematocrit should be evaluated at baseline and regularly during chronic concomitant therapy. If evidence of bone marrow suppression occurs, treatment with leflunomide should be stopped, and cholestyramine or charcoal administered to accelerate elimination of leflunomide's active metabolite from plasma.