Leflunomide can cause serious birth defects. If you are pregnant or are considering having a child, you should discuss this issue with your rheumatology provider before beginning the medication. For this reason, it usually is not prescribed to young women. Breastfeeding while taking leflunomide is not recommended. Use of an effective form of birth control is critical throughout the course of this treatment and for up to two years after it is stopped. This is important, because leflunomide lasts in the body a long time, even after stopping the medication, and could still cause birth defects during this time. Men taking leflunomide who wish to have a child also should talk with their rheumatology provider about how to discontinue the medication. Cholestyramine is a medication you can take to help remove leflunomide from your system.
Be sure to tell your rheumatology provider about all of the medications you are taking, including over-the-counter drugs and natural remedies, as these may reduce the effectiveness of leflunomide. The following medications are among those that may interfere with leflunomide: cholestyramine (Questran), tolbutamide (Orinase), and rifampin (Rifadin or Rimactane). Any medications that can affect the liver should be used with caution with leflunomide.
Live vaccinations should be avoided while taking this medication. Be sure to discuss any vaccines with your rheumatology provider before receiving them. It may be important to receive certain vaccines before starting this medication, such as the Pneumovax (pneumonia vaccine), hepatitis B, or the tetanus booster for some patients.
Because this medication can lower your immunity, it is important you discuss this with any provider treating you for an infection, as this may lead to a different evaluation or treatment. Also, be sure to notify your provider before any surgeries while taking this medication, as leflunomide can increase the risk of post-operative infections and/or slow the healing of your wounds.