Decreased plasma levels of leflunomide. Unless being used to treat leflunomide toxicity or hypersensitivity, avoid cholestyramine in patients receiving leflunomide.
May potentiate the hepatotoxicity of leflunomide. Close clinical and laboratory monitoring (LFTs, CBC with differential and platelets) is indicated during coadministration.
NSAIDs and tolbutamide
Free-fraction serum concentrations were increased by leflunomide. The clinical importance of this finding is unknown. Monitor the clinical response. If an interaction is suspected, adjust the dose of these agents as needed.
May increase leflunomide serum levels. Coadminister with caution and provide close clinical and laboratory monitoring.
Vaccination with live vaccines is not recommended. Consider the long half-life of leflunomide when contemplating giving a live vaccine after discontinuing leflunomide.
Increased INR has been reported rarely during coadministration. Closely monitor coagulation parameters when starting, stopping, or changing the dose of leflunomide and adjust the warfarin dose as needed.