Indication and Usage
Leflunomide (Cara) is indicated in adults for the treatment of active rheumatoid arthritis(RA):
1.to reduce signs and symptoms
2.to inhibit structural damage as evidenced by X-ray erosions and joint space narrowing
3.to improve physical function.

Dosage and Administration
Loading dose
Due to the long half-life in patients with RA and recommended dosing interval (24hours),a loading dose is needed to provide steady-state concentrations more rapidly.It is recommended that Leflunomide(Cara) therapy be initiated with a loading dose of one 100mg tablet per day for 3days.Elimination of the loading dose regimen may decrease the risk of adverse events.This could be especially important for patients at increased risk of hematologic or hepatic toxicity such as those receiving concomitant treatment with methotrexate or other immunosuppressive agents.

Maintenance therapy
Daily dosing of 20mg is recommened for treatment of patients with RA.A small cohort of patients(n=104); treated with 25mg/day;experienced a greater incidence of side effects;alopecia,weight loss,liver enzyme elevations.Doses higher than 20mg/day are not recommended.If dosing at 20mg/day is not well tolerated clinically,the dose may be decreased to 10mg daily.Liver enzymes must be monitored and dose adjustment may be necessary.Due to the prolonged half-life of the active metabolite of Leflunomide(Cara), patients should be carefully observed after dose reduction,since it may take several  weeks for metabolite levels to decline.

Pregnancy
Not indicated in pregnancy.

ursing Mothers
Leflunomide(Cara) should not be used by nursing mothers.It is not known whether Leflunomide(Cara) is excreted in human milk.Many drugs are excreted in human milk,and there is a potential for serious adverse reations in nursing infants from Leflunomide(Cara).Therefore,a decision should be made whether to proceed with nursing or to initiate treatment with Leflunomide(Cara),taking into account the importance of the drug to the mother.

Presentation
Leflunomide(Cara) Tablets 20mg are available in blister pack of 30’s(10’s x 3 strips).

Manufactured by;
S.J & G. Fazul Ellahie (Pvt.) Ltd,Pakistan